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Electric Installation Verification
1 (We) -1
(Electrical Contractor Name or Homeowner's Name)
(Address) (City) (State) (Zip Code)
accept the responsibility to perform the electric work as stated below, at the following address:
vg ti.Sr , -
(Address where work will be performed)
The nature of the work consists of: (Check One or Describe the Nature of Work)
tl. Reconnection or new circuit for replacement Heating Plant and/or A/C Condenser.
Reconnection or new circuit for replacement Electric Water Heater or power vented
water her.
R,oconnectidn 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 permit.
Reconnection or new circuit for the replacement of other permanently wired
appliances / fixtures.
New circuit for the addition of Ale to an individual dwelling unit, including
required. service electrical outlets. Note: Homeowners ca z only do their own
electric on a single, family owner occupied home. Work on a condominium,
duplex, rental, or multi-use building would require a licensed Electrical
Contractor.
Other
The value of this work is $ /3 , 0
1 hereby verify this work will be performed in compliance with the License requirements of
Section 11-22 of the Oshkosh Municipal code and further verify the reconnection / installation
will be done in compliance with manufacturer and Electric code requirements.
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(Si of C oma r or Homoowncr) (Prier[ Nunn) (Date)
07/07