Wiring Affidavit - Adams-Columbia Electric Cooperative

Member Name*

First Last

Service Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

County*

ACEC Service Order Number

ACEC Location Number

Electrical Contractor or Wireman*

Company or Firm (if applicable)

License Number*

Daytime Phone Number of Electrician or Wireman

Street Address of Electrical Contractor or Wireman*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Residential or Commercial Service*

Type of Service*

Entrance Size (amps)*

Service Entrance Conductor Size*

Overhead or Underground Service*

Single Phase or Three Phase Service?*

Desired Voltage*

I agree to submit this form electronically and hereby authorize ACEC to verify the information in this form. By agreeing, it indicates I am the electrical contractor or wireman who did the wiring for electricity on the above premises and that all of said described electric wiring at the location above was done to comply and does comply with the Wisconsin Electrical Code, and that this written statement is made pursuant to and in compliance with the provisions of Sec. 101.865 of Wisconsin Statutes. Energizing the described wiring will in no way create a hazard.

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