Electrical inspection form


Required field=•

Municipality:•
City Town Village
Municipality name:•
Site inspection address:•

Permit number:•

Inspector:•

Inspector phone:•
000-000-0000
Inspector cell:•
000-000-0000
Inspector e-mail:•

Customer name:•

Customer phone:•
000-000-0000
Electrical contractor:•

Electrical contractor phone:•
000-000-0000
Inspection date:•
Inspection certification#:•
Service type:
Residential Commercial
Duration:
Permanent Temporary
Subdivision:
Yes No
Overhead
Underground
Size:
amps           volts
Phase:
One Three
Number of meters:
Service type:
Residential Commercial
Duration:
Permanent Temporary
Customer power:
On Off        Reconnect at: Pole House
Overhead to underground
Overhead to overhead
Underground to underground
Size:
amps           volts
Phase:
One Three
Number of meters:

Details (check all that apply):
Permanent connections made.
Permanent connections required.
Service drop relocations / replacement required.
Additional / new meter install required.


Cogeneration
Solar Geothermal     Wind


Notes/Remarks: