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ELECTRICAL SUB-CONTRACTOR AFFIDAVIT Site Address: This is to certify that I am responsible for the Electrical installation and compliance with all applicable codes. I understand that Dawson County requires Temporary Power Connection to Service Utilities before final inspection. I relieve Dawson County and its Inspectors from any liability for damages or loss of property or improper installation. Company Name State License # Licensed Electrical Contractor Signature Notary Public Signature and Stamp Date Do you have a restricted license? Yes No If no, please sign and date below. if yes, Is the scope of this work within the license restriction, if applicable.(Residential, Single Phase, maximum 200 amps)? Yes No Licensed Electrical Contractor Signature Date