Electrical Inspection Agency Form

Electrical Inspection Agency Form

Customer Information

Date

Owner Name

Work Site Address

Contractor Name

Inspection Agency Information

Inspection Agency Name

Inspector Name

Inspector Number

Please check the box below to confirm

I agree to take responsibility for the inspection.

Service Information

UGI Work Request Number

Grid

Meter Number

Please select service size

100A 200A 400A 600A 800A Other

If other, please provide here:

Please select the correct voltage/wire under the correct phase type:

Single Phase

120V - 2 Wire 120/240V - 3 Wire 120/208V - 3 Wire

Three Phase

120/240V - 4 Wire 120/208V - 4 Wire 240V - 3 Wire 480V - 3 Wire 277/480V - 4 Wire Other

If other, please provide here:

Please upload photo of inspection card

Additional Comments

Electric Safety

Rebates for Your Home

Rebates for Your Business

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UGI Utilities, Inc. is a natural gas and electric utility headquartered in Denver, Pennsylvania. The company is a wholly-owned subsidiary of UGI Corporation, based in Valley Forge.
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