electrical certification deficiencies report · 2020. 5. 29. · ep_005_f . any deficiencies found...
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Page 1 of 1 Electrical Certification Deficiencies ReportEP_005_F
Any deficiencies found are noted in the report and have been reported to the Facility Owner/Manager for corrective action. The Electrical Certification Deficiency Form (Insert form number) shall be submitted to the Department of Licenses and Inspections to report any deficiencies requiring correction.
Signature of Inspector :_____________________________________________ Date:____________________
Signature of Facility Owner:__________________________________________ Date:____________________
Deficiency Item Location and Description
Property Information
1 Address: ______________________________________________________________________________________________
2
Name License Number
Email Phone
Address
3
Electrical Certification Deficiencies Report
Electrical Inspection Agency (if applicable) License Number
Electrical Inspector
Deficiency Information
Declaration & Signature
Provide a report of any serious or minor deficiencies that cannot be corrected within 90 days
Provide the address of the facility and name.
Enter name of electrical inspector licensed by the City of Philadelphia and employed by a licensed inspection agency
Facility Name: _______________________________________________________________________
Insert deficiencies that require correction.
OR Full-time licensed electrician by Owner of the facility
Enter the name of the electrical contractor or inspector licensed by the City of Philadelphia who is employed on a full-time basis by the owner of the facility
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