QTY
FEE
SERVICE
LIGHT FIXTURE(S)
LIGHT OUTLET(S)
SWITCH OUTLET(S)
RECEPTACLE OUTLET(S)
ELECTRICAL INSPECTION RECORD
DATE:______________________
CITY OF SEMMES
REC. NO.:__________________
VICINITY_________________________________________________________________
B O H:_____________________
ADDRESS________________________________________________________________
RES.
COM.
OWNER-APPLICANT_____________________________________________________________________________________
ELEC. CONTRACTOR_______________________________
GEN. CONTRACTOR_______________________________
TEMP. SERVICE
INSP. DATE:
_______________
INSP.
_______________
DISP.
___________
SLAB/CONDUCT
INSP. DATE:
_______________
INSP.
_______________
DISP.
___________
ROUGH-IN
INSP. DATE:
_______________
INSP.
_______________
DISP.
___________
SERVICE RELEASE
INSP. DATE:
_______________
INSP.
_______________
DISP.
___________
FINAL
INSP. DATE:
_______________
INSP.
_______________
DISP.
___________
MOBILE HOME
INSP. DATE:
_______________
INSP.
_______________
DISP.
___________
INVESTIGATION
INSP. DATE:
_______________
INSP.
_______________
DISP.
___________
OTHER
INSP. DATE:
_______________
INSP.
_______________
DISP.
___________
CAUTION: READ CAREFULLY
I, the undersigned, attest that I/the company I represent will be performing the work necessary to complete
the electrical installation herein permitted. Said work will comply with the National Electrical Code and all
other applicable provisions.
SIGNATURE: ________________________________________________________ PHONE: __________________________
AIR. COND.
BATH FANS
CEILING FANS
DRYER(S)
RANGE(S)
MOTOR(S)
POOL BONDING
SPCL. SYS.
H W HTR
HEAT KW
TEMP. POLE
OTHER
SUBPANEL
SERVICE RELEASE
GENERATOR/K.W. SIZE __________________
QTY
FEE
SERVICE
LIGHT FIXTURE(S)
LIGHT OUTLET(S)
SWITCH OUTLET(S)
RECEPTACLE OUTLET(S)
AIR. COND.
BATH FANS
CEILING FANS
DRYER(S)
RANGE(S)
MOTOR(S)
POOL BONDING
SPCL. SYS.
H W HTR
HEAT KW
TEMP. POLE
OTHER
SUBPANEL
SERVICE RELEASE
GENERATOR/K.W. SIZE __________________
DRAW DIRECTIONAL MAP
DRAW DIRECTIONAL MAP