HomeMy WebLinkAbout0112709-Building (siding/windows)
FEB-13-2005 05:29 PM
P.01
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C;I)'Oro",,",.h
P¡mio..fI""""lionSe""'"
21! Ch"",h Ave'"
PO Box 113'
O""",,h WI $""-111'
0'"" 920-236-$'50
Fox 91O.;!"",06'
Electric Installation Verification
I (We)
fle-tTtelC
(Electrical Contractor Name)
~qo & f<o F{. PIC-t<e-Tí WI,
(Address) (City) (State) (Zip Code)
have been contracted to perform electric installation work for IN+titl a¡t/~1fIJ Uf--
(Name of party contracted to)
Drt-(;"xU;«-
st/qt-I..f
at the following address'
/& Jf (}~IÁ! s rtÜe,2. .
(Address where work will be performed)
The nature ofthc work consists of: (Check One or Describe the Nature of Work)
- Reconnection or ncw circuit for replacement Heating Plant and/or AlC 'Condenser.
Reconnection or new circuit for replacement Electric Water Heater or power vented
wat~ heater.
Reconnection ofthc Service Entrance Cable, Meter Box, alterations' to receptacles
¡md lighting fixtures due to siding / soffit installation- Note: New Service
Entrance Cables will require a separate permit.
- Reconneetion or neW circuit for the replacement of other permanently wired
appliances / fixtures.
- New circuit for the addition of AlC to an individual dwelling unit (house or the
individual syst~ms in a duplex or condominium), including required service
electrical outlets.
- Other
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The value of this work is $ 1"0.-
I hereby verify this work will be performed by an employee of this company and further verify
the reconnection / installation will be done in compliance with manufacturer ¡md Electric code
requirements.
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r:2/LL/P D, DteGVLGt:.
(Print Name of Officer)
)~ /t~ f)5
(Date)
[Company Officer)
5/02