North Dakota State Electrical Board
Non-GFCI Protected Equipment Notification
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Installing Company’s Name:
To date, what has the contractor done to resolve the issue: (Attach a separate sheet if necessary)
Type of Equipment Installed (Mini Split, Heat Pump, AC or etc.):
Panelboard/ Breaker Information
Panelboard Manufacturer’s Name:
Breaker Manufacturer’s Name:
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
Please consider attaching a picture of the nameplate!
* Please complete form and email to email@example.com