Wiring Affidavit and Electrical Inspection Certificate
This file contains the wiring affidavit and certificate of electrical inspection required for new or existing service connections. It is essential for both residential and commercial properties. Completing and submitting this form ensures compliance with the Wisconsin State Electrical Code.
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How do I fill this out?
To begin filling out the form, start by entering your member information at the top. Next, provide the details of the electrician who performed the wiring. Finally, ensure that the appropriate signatures are added before submission.

How to fill out the Wiring Affidavit and Electrical Inspection Certificate?
1
Enter member information at the top of the form.
2
Complete electrician's details in the designated section.
3
Certify the compliance of the wiring with a signature.
4
Fill in inspector's information if applicable.
5
Mail the completed form to Jackson Electric Cooperative.
Who needs the Wiring Affidavit and Electrical Inspection Certificate?
1
Homeowners requiring new electrical service for their residence.
2
Business owners looking to establish electrical service at their premises.
3
Electricians who need to certify their wiring work for compliance.
4
Contractors managing renovations that require electrical inspection.
5
Real estate agents assisting clients with new property transactions requiring service setup.
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What are the instructions for submitting this form?
To submit this form, ensure all fields are filled accurately and sign where necessary. Mail the completed form to Jackson Electric Cooperative at N6868 County Road F, Black River Falls, WI 54615. Alternatively, you may contact them at 715.284.5385 or 800.370.4607 for further instructions.
What are the important dates for this form in 2024 and 2025?
Important dates for form submissions typically fall at the start of each construction season or when new service installations are mandated. Keep an eye on local regulations for updated timelines. Compliance with submission deadlines ensures uninterrupted electrical service.

What is the purpose of this form?
The purpose of this form is to ensure that all electrical wiring complies with the standards set by the state of Wisconsin. By filling out this affidavit and inspection certificate, electricians can certify their work and ensure that it meets legal requirements. This protects not only the consumers but also ensures safety in residential and commercial electrical installations.

Tell me about this form and its components and fields line-by-line.

- 1. Member Information: Includes sections for name, address, and phone number.
- 2. Service Type: Indicates the type of service such as residential, commercial, or temporary.
- 3. Electrician Information: Details the electrician's name, contact, and license number.
- 4. Inspector Information: Includes sections for the inspector's details and certification.
- 5. Signatures: Space for required signatures from the electrician and inspector.
What happens if I fail to submit this form?
Failing to submit this form can lead to delays in receiving electrical service. Additionally, it may result in non-compliance with state regulations, which could incur penalties. It is crucial to ensure that all required details are completed accurately before submission.
- Delays in Service: Not submitting the form may cause delays in your electrical setup.
- Non-compliance Penalties: You risk penalties for not adhering to state electrical codes.
- Inspection Obstacles: Lack of submission can prevent necessary inspections from occurring.
How do I know when to use this form?

- 1. New Service Installations: Required for all new electrical service setups.
- 2. Rewiring Projects: Necessary when existing wiring is being replaced or updated.
- 3. Temporary Power Services: Needed for short-term service setups during construction.
Frequently Asked Questions
Who needs to fill out this form?
Anyone requiring new electrical service, including homeowners and business owners, should fill out this form.
How can I edit this PDF?
You can edit the PDF by clicking on the fields you wish to modify and making the necessary changes directly.
Do I need to sign this document?
Yes, both the electrician and the inspector must provide their signatures for the document to be valid.
Where can I submit this form?
Submit the completed form via mail to Jackson Electric Cooperative at their provided address.
What happens if I forget to fill out a section?
Missing sections may result in delays, so ensure all information is complete before submission.
Is there a deadline for submitting this form?
While specific deadlines may vary by project, it's best to submit this form as soon as the wiring is complete.
Can I save my edits on PrintFriendly?
You can download your edited document, allowing for easy access to your changes.
How do I contact Jackson Electric Cooperative for help?
You can reach them at their phone number listed on the form for any inquiries.
Is there a fee associated with this service?
There may be fees associated with inspections, which are handled separately by the cooperative.
Will I receive confirmation of my submission?
Typically, confirmations are provided upon processing your submitted paperwork.