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11/,J8/2005 10: 20
19204251890
5TEINBRUNER HEATING:
PAGE 02
Cilyoro.hko'"
Dl,o,o. oil....,,;.. 5<..""
21'Ch"",hA"...
POBo. IJ)O
O.....h WI 5490'.11J0
Oll'~. '2o.,36-50!O
Fox 920.236-'084
~
omza
a I)!J
I (We)
S4'ì~G.
(Zip Code)
have been c ntracted to perform electric installation work for S
(N
at the follow ng address:
!/JÒ ~
The nature 0 the work consists of:
--X-: Reconnection or new circuit for replacement Heating P ant and/or NC Condenser,
- Reconnection or new circuit for replacement Electric ater Heater or power vented
water heater.
- Reconnectionofthe Service Entrance Cable, Meter Bo , alterations to receptacles
I and lighting fixtures due to siding / soffit installatio , Note: New Service
Entrance Cables wilt require a separate permit.
Reconnection or new circuit for the replacement of oth r permanently wired
appliances I fixtures.
- New circuit for the addition of NC to an ifldividual dw fling unit (house or the
individual systems in a duplex or condominium), in luding required service
electrical oullets,
Other
The value of this work is $
-;
I hereby veri y this work will be performed by an employee of this c mpanyand further verify
the reconnec ion I instaJlation wì\l be done in compliance with manu acturer and Electric code
requirements
cl..
f Company Officer)
11- tt"t;S-
(Date)
E: Ale
(Print Name of Officer)
6