CID Revised 5/20/2014.2 ELECTRICAL INSPECTION REPORT AND CERTIFICATION FORM (Excluding the Grounding Electrode System, Swimming Pools and Hazardous Locations) PROJECT INFORMATION Permit No.: Floor: Suite: Project Name: Tax Map ID: Project Owner: Street Address: City: , VA ZIP: CERTIFICATION INFORMATION Company Name: Address: Suite: City: State: ZIP: Telephone: INSPECTION INFORMATION Concealment Inspection for the following (Choose One): Ditch/Trench Pole Bases Inspection Complete Job identification properly posted Approved construction documents on site Construction documents revision required Work conforms to permit Work conforms to code Yes No Deck/Slab Concrete/Masonry Wall Ufer Ground Other: Inspection Complete Equipment listed and approved Equipment grounding conductors installed Equipment is protected from the elements Depth of cover is approved Yes No NA CERTIFICATION I hereby certify that I am the person which holds the Virginia Master Electrician Tradesman Certification for the Electrical Contracting Firm that holds the permit for the project..
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