GOVERNMENT OF GOA, DAMAN AND DIU ELECTRICITY DEPARTMENT To, Wiring Contractor's Completion and Test Report The Assistant Engineer (Electrical)/ The Junior Engineer (Electrical)/ The Supervisor (Electrical) Electricity Department. Government of Goa, Daman and Diu, ----------------------------(Local Office) I/We wish to inform you that the installment at-----------------------------------------------------------------------------------... .......................................occupied Completed by me/us in all respects and is now ready for test. I/We enclose herewith in duplicate the detailed wiring diagram for this installation, along with description ofthe Wiring*: The details of the installation and test obtained are as follows: Nature of demand Insulation Resistance Remarks-re: No. Of distribution Boards, Starters, Iron Clad Switches, etc. To Earth Between Poles LIGHTING Linghts a) Drops b) Braclets c) Watertights d) Othe Fititngs Fans Wall Plugs DOMESTIC APPLIANCES Cookers Refrigerators Water Heaters Other Purposes Wall Plugs MOTERS Industrial Nos. B.H.P. each Total B.H,P. Pumps Other Purposes MOTERS Industrial Nos. B.H.P. each Total B.H.P. Pumps Other Purposes *Size of wire stranding Single or multi-core type of insulation ,open teak wood casing and capping /conduit wiring size of conduit etc, adopted should be given under description. The wiring diagram and description of the wiring should be signed by the wiring contractor The installation was tested by me /us on__________200 ______in accordance with I.E.Rules, 1956(as amended up to date) Customer's Signature Address--------------------------- Supervisor's Signature Certificate No......... Wiring Contractor's Signature ------------------------------------------------- Address. License No........... Address.... THIS SIDE FOR USE OF ELECTRICITY DEPARTMENT ONLY Application No. .......Tariff Applicable........ Place .... Load Sanction ....... Security Deposit Rs... ReceiptNo..Date.... No. of outlets ......... Service charges Rs... Receipt No.. Date... Type of premises....... Total No. of points/motors.. Installation No............... Total connected load...... Date of Connection... Load connected on phase (watts) .. Service/Tapping ............ . Telephone crossing ........... A....... B.......C.... From pole No............ Service distance.............. Distribution Transformer KVA---- Location.................. Peak hour load (Amps) R...... y.......B..... 1. Conductor ........................... 2. Cable............................ Meter: Owner: Department/Consumer 3. ................................ Type and Make............... 4 ................................. Capacity ............ 5. ................................ Initial reading.............. 6.................................. St. No. of Mater.............. 7. ................................. St. No. of Meter seal (MRT).......... TO BE ATTESTED BY DEPARTMENT AND BY CONSUMER General: Test: Meter cover sealed on.....Seal No ... Between Phased M.............. Meter Box Sealed on....Seal No.. Phase to Earth ............... Does installation comply with wiring Rules...Neutral to Earth............,....... Are any defects noticed? .......... Rotation of Meter checked O. K...... Certified that the installation was tested and found in order: Meter Inspector/Jr. Eng. 0 & M.......- In charge Consumer's Signature State whether Residence Shop, Office, Restaurant, Cinema, Theatre Hospital, Religious Educational,Factory (described) Agricultural Pumping, Other Pumping (described), cottage industry (describe). WARNING NO CONNECTION CAN BE RELEASED WITHOUT FILLING THIS PROFORMA Expd sanction No. & date.......................Bradma NO .. Tech Sanction No. & date............................. Consumer's personal Ledger prepared on.............. Signature (Clerk) ............Signature (Clerk) Book No...... Page No........ Dated.... Billing incharge Checkd & Passed for Releasing connection Junior Engineer ASSISTANT ENGINEER
