SAFEbuilt Electric Service Release SafetyCulture

• Jobsite Address

• Conducted on

  Date

• Permit No.

• County

• City, Town, or Village

  City

  Town

  Village

• Municipality

• Inspector

Additional Information

• Customer Name

• Customer Phone Number

• Electrical Contractor

• Electrical Contractor Phone Number

• This is to certify that I have examined the electrical entrance equipment (meter socket, switch box, ground) installed by the above and it is compliance with the statutes, ordinances and all rules and regulations prescribed by the State Electric Code.

New/Rewired Service

• New Service

• Overhead

• Underground

• Rewired Service

• Overhead to Underground

• Overhead to Overhead

• Underground to Underground

Permanent/Temporary

• Permanent Service

  1 Phase

  3 Phase

• Size (amps)

• Voltage

• Temporary Service

  1 Phase

  3 Phase

• Size (amps)

• Voltage

Residential/Commercial

• Residential/Farm

• Commercial

Meter Information

• Meter Install Only

• Number of Meters