HomeMy WebLinkAbout0119329-Building (siding)
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05/01/06 17:20 FAX 920 766 0883
LUECKS
VAN ERT ELECTRIC
PAGE 04
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O£hkcsh In$pectìans
920-236-5084
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Electric instalJatlon Verification
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VtJ'^ Pri- F.Jn.~¡c.
(Elec1rical CoJ\tractDI"Nam~)
¿oeD ~~!"I!!.!!o.s vJo...y k:'a... bu."',,"
(Address) (City)
5'/ /30
(Zip Code)
at the fo]jowing adð¡-ess:
/Jj:L
(Srate)
have been contracted to perfurm eleotrie instal1ation work for /.........\:..$
(Name ofpa.n:y contracted to)
!2o,S Ue,",¡~", ~',\ -¡;:, Ca.1...~
(Addres~ wbere work will be performed)
The nature of the work oonsists of: (Check One or Describe the Nann-e of Work)
-+L
:Reco~ection or new cirowt for replacement Heating Plant and/or AlC Condenser.
Reconnection O,!' lIew circuit for replacement Electric Wa~ Heate!:' or po~ vented
waterhea:tc:r.
R~onnection o£the S~ce Entrance Cable, Meter Box. alterations to rec:eptaeJes
and@¡g.tin!Z fixam.OJtue to sidì:ng / soffit instaIlIJ.tirm. Note: New Service
Enttance Cables will require a separate permit.
Reconnection or new "cmui! for the replacement of othi!:l' p=a:nf:D!Jy wired
applìaru:es / J;Îxtures.
New circJ1Ït for the addition of AlC to an individual dwelling =it (hou¡;~ or tile
individual systems in a duplex or condonrlmU!!1), including required sl!!IV'Ìco
electric a! outlets.
Other
The value of this work is $ 11 fft'J - (f) "
! hereby verity this work will be perform.,.j by an employe" of this company and" further verify
the r""ooncedeD / installation wil1 be done in COIl1þliance with manufactUrer and Electric code
teq uirements.
:;¡;;: ~ R.,¡J ~~,...
(.Sig;na¡ure of Company Officer)
4,-;. ily
(Print Name 0 Officer)
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, (Date)
5mJ
01/),8/0. T!IE la, 52
[TXIR1; NO 919S)