POWDER WATTS  Installation and Service Permission form 
 

Date: 

  Installer:   
Proposed Install 

Date: 

  Contact              Number:   
Customer Information 
Name:    Landlord Name:  
Property Address:    Line 2:   
City:    State:    Zip 

Code: 

 
Primary Tele#:            Alt. Tele#:   
Account Number:    Landlord’s #:   

 

CUSTOMER OWNS PROPERTY:  CUSTOMER warrants that he/she/it owns the aforementioned property at which the installation or service work is to be performed and will allow the Installer and its subcontractors to make whatever alterations they consider appropriate for the work to be performed, which may include, without limitation, installing a non-penetrating roof mount camera and/or a wall mount apparatus for use with Powder Watts camera or switch installation(s) and to connect these to my heat cable(s). CUSTOMER agrees to indemnify and hold Installer and Powder Watts, LLC and their respective affiliates, and its and their subcontractors harmless from and against any damage, loss or expense of any nature whatsoever caused or claimed to be caused by the installation of equipment, service work performed hereunder, or as a result of CUSTOMER’s failure to obtain proper consent of the owner of the premises. 

 

______ I/we understand that roof access must be provided on the date and time of the installation. 

 

 

______ I/we agree that the signed and completed Permission Form must be provided to the Installer or technician on or before the day of installation in order for services to be performed. If the letter is not provided, it is understood that the installation will be rescheduled until such time that the document is made available. 

 

______ I/we understand that there will be no drilling into the roof of the aforementioned property under any circumstances. 

 

As the owner of the above-mentioned property, I/we represent that I/we have the authority to initial and sign this Permission Form and hereby do authorize installation of a Powder Watts camera, switch and system by Installer or its subcontractor. 

 

______________________ 

Printed Name of Customer Signature of Customer/Authorized Representative Date 

 

CUSTOMER IS TENANT:  LANDLORD/PROPERTY MANAGER warrants that he/she/it owns/manages the aforementioned property at which the installation or service work is being performed and will allow Installer and its subcontractors to make whatever alterations they consider appropriate for the work to be performed, which may include, without limitation, installing a non-penetrating roof mount camera and/or a wall mount apparatus for use with Powder Watts camera or switch installation(s) and to connect these to my heat cable(s). LANDLORD/PROPERTY MANAGER agrees to indemnify and hold Installer and Powder Watts, LLC and their respective affiliates, and its and their subcontractors harmless from and against any damage, loss or expense of any nature whatsoever caused or claimed to be caused by the installation of equipment, service work performed hereunder, or as a result of LANDLORD/PROPERTY MANAGER’S failure to obtain proper consent of the owner of the premises. 

 

______ I/we understand that roof access must be provided on the date and time of the installation. 

 

 

______ I/we agree that the signed and completed Permission Form must be provided to the Installer or technician on or before the day of installation in order for services to be performed. If the letter is not provided, it is understood that the installation will be rescheduled until such time that the document is made available. 

 

______ I/we understand that there will be no drilling into the roof of the aforementioned property under any circumstances. 

 

As the owner of the above-mentioned property, I/we represent that I/we have the authority to initial and sign this Permission Form and hereby do authorize installation of a Powder Watts camera, switch and system by Installer or its subcontractor. 

 

______________________ 

Printed Name of Landlord/Property Manager Signature of Landlord/Property Manager Date