Application

Tri-State Inspection Agency
Celebrating Over 30 years Experience

Application

Electrical Inspection Application

Please fill out this form to the best of your knowledge:

Applicant Information(Location of work)
First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code:	(5 digits)
State:
Phone:
E-Mail:
Contractor Information
Company Name:
License #:
Address Street:
City, State & Zip:
Phone:
Fax:
Email:
Date Inspection Needed:
Job Number:

Please choose what best fits the description of your residence:
Amp Service:
Dwelling:
Hot Tub/Pool:
The following is for Contractor's Only
Switches:
Lighting:
Recep:
Fixtures:
	Water Heater
	Fractional H.P Vent Fans
	Burner
	Pump
	Range
	Dryer
	Dishwasher
	AC
	Oven
Other Information
Other Equipment:
General Information:	Enter comments here!
Payment:
	I understand payment must be made either on or before the date of inspection.