Craig
Bitzer Company Inc.
HOMEOWNER’S AFFIDAVIT
FOR ELECTRICAL INSPECTIONS
(Please Print)
I
__________________ being the owner of land and buildings located at
__________________
(Street) ______________________________________, do hear by swear that I
have completed all
(City, State, Zip)
electrical work with my hands. I also swear that in the event of a single
family dwelling that this is, or will be, my primary residence. I also
acknowledge that by signing this affidavit that all liabilities and
responsibilities are mine alone. In the event that I do receive help that
person, or persons, will be licensed by the state of Kentucky and
appropriate license numbers will be provided to the electrical inspector.
In such a case it is understood that if proper information is not provided,
the work will not be inspected and connection to the utility company will
not be allowed until a licensed electrical contractor with proper
documentation will accept responsibility for such work.
__________________________________
Homeowner signature / Date
Following Section is
authorized for a Notary Only
Subscribe and sworn to before me by __________________________________,
applicant on this ___________ day of ______________________,
20___________.
_____________________________________
__________________________
Notary Public, State at Large
Commission Expires
Electrical Inspector
Building Inspector
Phone
#
502-829-0054 Phone
# 502-633-0692
Fax #
502-829-0054
Fax # 502-633-7623
MWF
6:30 –
8:00am
M-F 8:30am – 4:30pm
566 Elmburg Road
419 Washington
Street
Shelbyville, KY
40065 Shelbyville,
KY 40065