HomeMy WebLinkAbout0015845-Electric (garage) �
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;��'FIDAVIT �LATING TO SECTION 13.12 {c ) OF A GENEAA,L ORDINANCE
OF THE CITY OF OSHKOSH F3ELATING TO THE LICENSING OF ELECTFiICIANS
AND PAOVIDING PENALTIES
STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY ) �
1"��'f:.��:�. t�;��"�-�--e_ «1.�� �J � '�v e.�.,,-ac�. � t'�..5-e..
f
Name Address
first being duly sworn on oath, deposes and says that he is not
a �laensed electrician in the City of Oshkosh and that he has
applied for an electrical permit to do electrical work in a
residenae and/or auxiliary buildings (intended solely for pur-
poses associated with a residence) which is owned and occupied
by him, or is being constructed in his name, as his personal
home and that said residence or auxiliary buildings being so
wired are not �o be used or erecLed f or rental purposes or for
resale to present or prospective purchasers.
Affiant understands that the eTectrical work authorized by
the permit applied for 3n connection with this affidavit , must
be done only by this affiant and that he cannot employ others to
assist with the electrical work but members of his immediate
faoily.
Dated this .J; '�h day of -- - � ,t.,�J��_�. i , 19 '�-' �.
�-.�Y.��.�--a�.-4. �.
Subscribed and sworn to before
thi s �, `�` �' � .
day of „
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��wy-�"_.''_�'1�n; �\ 1�� �'A �F`i l.y'V � .
Natary Public, Winnebago County, Wisconsin
- My Commissian Expires: _ ��//.: C -,,
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PFRMIT NO.� � ��� APPL. DATE � � �G'
ELEC. CONTR. ��
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OWNER ,`,�'//G� _��G_:.r����
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ADDRESS v�, � / � �i����'
NATURE OF WORK
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' ELEC. SERV. NEW CHANGE TEMP. �
D�SC. TYPE VOLTS AMPS >
- FIX ' S �-_ Sj^1��y� �2ECEPT' S � T CIRC' S�
AI'PLIANCES
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SIGNS
IiJSF. ROUGHI SERVICE rINAI.�P-,3�
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EST. COST;��-,��---��� � PERMIT FE �.�°�'' �ATE PD.h'j��
kEMARKS
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