MINISTRY OF PUBLIC WORKS

GOVERNMENT ELECTRICAL INSPECTORTATE DIVISION

NOTIFICATION OF ELECTRICAL INSPECTION FOR INSTALLATION
I hereby give notice that I intent to have the following electrical installation work done.

………………………………………………………………………………………………………………………………………………………………………………………………………
Address (Lot#/Postal code, Street, City/Village, Region)

Description: Domestic /Residential Business Special Occupancy Industrial Other

Government Building
Designer: Address, Telephone No.:

……………………………………………………….. ………………………………………………………………………………………………………
Contractor: Address, Telephone No.:

………………………………………………………… ……………………………………………………………………………………………………..

DETAILS OF WORK

NEW INSTALLATION TEMPORARY METER CIRCUIT ADDING INCREASE LOAD

REWIRING REINSPECTION OVERHAULING SHIFTING METER CIRCUIT

On this work I have the honour of requesting that the same be inspected on completion.

……………………………………………………………………. …………………………………………………………….
Owner, Consumer of Tenant Date

Name & Address of

Owner: ……………………………………………………………………………………………………………………………………………………………………………………..

Name & Address of

Tenant: ……………………………………………………………………………………………………………………………………………………………………………………..

DESCRIPTION OF INSTALLATION

Supply/Type of
service …………………………………………………………………………………………………………………………………………………………
(Voltage, phase and frequency)

Size of Main Fuse/Circuit breaker……………………… Amps, Size of Service

Entrance Conductor (“Pig-tail”) ……………………………

Size of earth cable ……………………Size of Ground Lead …………………………Type of grounding……………………………

Type of wiring: Surface Conduit (Concealed in concrete) Trunking Romex Cable Other………………………

Type of fitting and appliances, etc.

………………………………………………………………………………………………………………………………………………

Number of Circuits: …………………………………. Number of points: Number of lamps:

120V……….. 240V…………. 3phase…………. …………………………………..

FOR OFFICIAL USE ONLY

CHECKED: The fees for inspection will be $ ...................... RECEIPT NUMBER: ………………………………………………………………

Signature/Date: ……………………………………… / …………………………. SIGNATURE: …………………………………………………………………………

Test: Date ( installation was tested ):

Inspected by: ……………………………………………… …………………………………………………….

Comments: …………………………………………………………………………………………………………………………………………………………………………………….

The above job is completed and ready for inspection.

………………………………………………………. …………………………………………………………….
Contractor Signature Licence Number

FORM #__________________ JOB#_________________ CERTIFICATE #_______________________

N.B. All forms must have contact number of Contractor.

 ELECTRICAL FEES FEE # Items TOTAL

MOTORS, GENERATORS, RECTIFIERS, WELDERS, ARC LAMPS

Per KVA $500

WIRING
TYPE OF INSTALLATION
LIGHTS
120 V
120-127 V
85-277 V
240 V

POWER OUTLET
Simplex 120 V 20A
/15A
Simplex 240 V 20A/15A
Duplex 120 V 15 A
Duplex 120 V 20A
Duplex 240 V 15A
Duplex 240 V 20A
SASO 120 V 15 A
Double SASO 120 V 15
A
Double SASO 240 V 15
A
SASO 240 V 13A
Double SASO 240 V 13
A
AC outlet with unit
AC outlet only

N.B. All forms must have contact number of Contractor.