Download Housing Authority of the City of Raleigh, North Carolina

Housing Authority of the City of
Raleigh, North Carolina
Leased Housing
900 Haynes Street
Raleigh, NC 27604
Priscilla B. Batts
Director of
Leased Housing
Applications
(919)831-6387
Section 8
HAPP
(919)831-6620
ELECTRICAL CERTIFICATION LETTER
NAME OF ELECTRICIAN _______________________________________
COMPANY NAME _____________________________________________
COMPANY ADDRESS _________________________________________
CITY/ST/ZIP _________________________________________________
TENANT NAME ______________________________________________
TENANT ADDRESS __________________________________________
OWNER NAME ______________________________________________
DATE PROPERTY INSPECTED _________________________________
AN INSPECTION OF THE ELECTRICAL WIRING IN QUESTION AT THE ABOVE ADDRESS WAS COMPLETED
ON __________________.
This certifies that I am a certified licensed electrician within the state of North Carolina and that the electrical
wiring in question has been inspected and cleared for safety at the above address.
___________________________________
SIGNATURE
___________________________________
NC LICENSE NUMBER
___________________________________
TELEPHONE NUMBER
WARNING: SECTION 1001 OF THE Title 18 of the United States Code (Criminal Code and Criminal Procedures, 72 stat.
967) applies to this certification. 18 U.S.C. 1001, among other things, provides that whoever knowingly and willfully makes
or uses a document or writing knowing the same to contain any false, fictitious or fraudulent statement or entry, in any
matter within jurisdiction of any department or agency of the United States, shall be fined no more than $10,000 or
imprisoned for not more than five years, or both.
PLEASE MAIL OR BRING THIS FORM TO:
RALEIGH HOUSING AUTHORITY
ATTN: INSPECTIONS DIVISION
900 HAYNES STREET
RALEIGH NC 27604
or send by email to
[email protected]
FAX (919) 508-1193 • TDD (919) 831-6734 • 900 Haynes Street • Raleigh, NC 27604