HomeMy WebLinkAbout0118628-HVAC (boiler)
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Ooh",,11 WI "."3-11311
Ollke 020-236-'0'0
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Electric Installation Verification
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(Electrical Contractor Name)
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(Address)
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(City)
have becn contracted to perform clcctric installation work for
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(State) (Zip Code)
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(Name of party contracted to)
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(Address where work will be performed) ~; ¿ - () 7) 7
at the folJowing address:
The nature of the work consists of: (Chcck One or Dcscribe the Nature of Work)
- ~econnection 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 instaHation. Note: New Service
Entrance Cables will require a separate permit.
-- Reconncction 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 systems in a duplex or condominium), including required service
electrical outlets-
- Other
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The value Oflhis work is $--
I hereby verify this work will he performed by an employee ofthis company and further verify
th~ recolln~ction / instalJation wi!l be done in compliance with manufacturer and Electric code
rcquire!11cntö-
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(Signalurc ol"Col11pany Officer) {Print Name of Officer)
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(Date)
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