HomeMy WebLinkAbout0116618-HVAC (furnace & a/c)
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CÜyofO,hko,h
Divi,ion ofInsp,,'ion S""ices
2!; Chnreh Av,"u'
PO Bodt30
O,hko,h WI 54903-l!30
om" 920-236-5050
F" 920-236-5084
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Electric Installation Verification
I(VVe)~~
eZÆ'L-IRA G CO IN C-
(Electrical Contractor Name)
81zD CO~I{Jl?:Y
(Address)
fLJ,)fv\jh-eJ(:. )::.oM>. (J)J tJ¡Jt(() rJNe;
(City) (State)
WI 5if1Q;l;,
(Zip Code)
have been contracted to perform electric installation work for fkùL- ~ß) Iù&DiÙ
(Name of party contracted to)
at the following address: I elf b C~.e- 6T.
(Address where work will be performed)
The nature ofthe work consists of: (Check One or Describe the Nature ofVVork)
X Reconnection or new circuit for replacement Heating Plant and/or AlC Condenser.
- Reconnection or new circuit for replacement Electric VV ater Heater or power vented
water heater.
- Reconnection of the Service Entrance Cable, Meter Box, alterations to receptacles
and lighting fixtures due to siding I soffit installation. Note: New Service
Entrance Cables will require a separate permit.
- Reconnection or new circuit for the replacement of other permanently wired
appliances I fixtures.
- New circuit for the addition of AlC to an individual dwelling unit (house or the
individual systems in a duplex or condominium), including required service
electrical outlets.
Other
The value of this work is $ 100.0-0
I hereby verify this work will be performed by an employee of this company and further verify
the reconnection I installation will be done in compliance with manufacturer and Electric code
requirements-
)¡A1J<:; ~. S~
(Print Name of Officer)
-s.ef-r: z 7: ZóO5
(Date)
5/02