HomeMy WebLinkAbout0116517-Building (siding)
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CityofOshk"h
Di""ion ofInspootion Sm'"s
215 Chme¡' Avenue
PO Box 1130
Oshkosh W1 54903-1130
om" 920-236-5050
P.x 920-236-5084
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Electric Installation Verification
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(print homeowner(s) name)
the homeowner(s) of
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(address where work is to be performed)
accept the responsibility for performing the electrical work as stated below for the property listed
above.
The nature of the work consists of: (Check One or Describe the Nature of Work)
Reconnection or new circuit for replacement Heating Plant and/or AlC Condenser.
Reconnection or new circuit for replacement Electric Water Heater or power vented
water heater.
Reconnection of the Service Entrance Cable, Meter Box, alterations to receptacles
~ and lighting fixtures due to siding / soffit installation. Note: New Service
Entrance Cables will require a separate permit.
- Reconnection or new circuit for the replacement of other permanently wired
appliances / fixtures.
New circuit for the addition of AlC to an individual dwelling unit, including
required service electrical outlets. Note: Homeowners can only do their own
electric on a single family owner occupied home. Work on a condominium,
duplex, rental, or multi-use building would require a licensed master
electrician.
Other
The value of this work is $
5è).ro
I hereby verifY this work will be performed by me and further verify the reconnection /
installation will be done in compliance with manufacturer and Electric code requirements.
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, Homeowner(s) Signature
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(Date)
5/02