Inspection Requests

Inspection Site
 
  Street Address:  
  City, Town, or Township:  
  County:  
  State:  
  Phone:  
  Owner:  
  Occupant:  
  Occupied As:  
  Pole #:  
  Permit #:  
  Building: New   Old  
  Section:  
  Block:  
  Lot:  
  Date:  
  Work Area in Building (Floor #, etc)  
Applicant Information
 
  Applicant Name:  
  Address:  
  City:  
  State:  
  Zip:  
  Applicant Phone # * Required  
  License #  
  Utility Job Request #  
  Electrician:  
  Electrician Phone #  
 
Utility Provider
 
  Company Name:  
  Office Location:  
Equipment Information
 
  App for: Wiring   Service
or:
 
  Ready for Inspection:  
 
Number of Rough Wiring Outlets
 
  Switches:  
  Lighting  
  Receptacles  
  Number of Fixtures  
 
Electric Heat
 
 
   
500
750
1000
1250
1500
1750
2000
2250
2500
2600
2750
3000
   
 
  Amp. Service  
  Surface Unit  
  Dishwasher  
  Range  
  Water Heater  
  Air Conditioner  
  Dryer  
  Pump  
  Oven  
  Garbage Disposal  
  Wiring and Controls for Burner  
  Amp. Receptacles  
  Fractional H.P. Vent Fans  
  Smoke/CO Detectors  
  Subpanels  
  Other Equipment  
 
Motors H.P.
Mark Number of Each Size
 
 
1/20
1/12
1/10
1/8
1/6
1/4
1/3
1/2
3/4
1
1 1/2
2
3
5
7 1/2
10
15
20
25
30
40
50
75
100
 
 
Additional Information: