Electrical Self-Certification Tags

Web Electrical Self-Certification Tag Order Form

To order electrical self-certification tags, please complete the order form below.

Section 1: Contractor/Corporation/Individual Name and License Number


Company Name			License #

Section 2: Applicant/Agent Name


First Name	MI	Last Name

Section 3: Address
Please enter the address where you want the tags to be mailed.

		Street number and name

City	State	Zip

Section 4: Self-Certification Tag Details

Each tag costs $15.00, please enter the number of tags you want to order:
If tags are to be returned by certified mail, please check here:
(Additional $6.00 fee for certified mail)

To associate a Client ID with this search, enter it here:

Remember if tags are sent by regular U.S. mail, there is the risk of slower delivery or lost tags. The Division of Permits can not replace delayed or lost tags.

By clicking on the submit button below, you are certifying that the information contained on this form is complete and accurate. Each order form submitted via the internet will be assessed a $3.00 enhanced access fee.

To contact the Division of Compliance, please send email to ele@civicnet.net