HomeMy WebLinkAbout2006-HVAC (furnace/A-C
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Cityora,hko,h
Divi,io" of 1""",,;°" SoNi",
2t5Chu"hAv,"",
PO Box J]30
O,hko,h WI 54903-1130
om" 920-236-5050
Fox 920-236-5084
Electric Installation Verification
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" ' (Electrical Contra tor Name)
~({ n':'-, ("ry><'-PV1\J.-e¡!L,'1 ~J-
(Address)
D>'h t<csl "-
(City)
WI
(State)
~4qO¿f
(Zip Code)
have been contracted to perfonn electric installation work for J4-t-+ ~ /r, n^> t' tft
(Name of party contracted to)
at the following address:
IÐ"?! 4dA¡r-,~~. Ciçf.-¡<ú,~
(Address where work will be perfonned)
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 AJC 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 pennit.
Reconnection or new circuit for the replacement of other pennanently wired
appliances / fixtures.
New circuit for the addition of NC to an individual dwelling unit (house or the
individual systems in a duplex or condominium), including required service
electrical outlets.
Other
II!
Th.e value of this work is $ l{---71 ().OO f~ ~'1-L
. I hereby verify this work will be perfonned by an employee of this company and further verify
the reconnection ( installation will be done in compliance with manufacturer and Electric code
requirements.
~A ~ ~ ß Jl~;;)
( ignature of ompany Officer)
~I^tèy) ~b j¡ 01~
(Print Name of Of Icer)
B-do, 0 l,ø
(Date)
5/02