|
ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Translormers
<br />Torqueino
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />lr/eter Release
<br />Rough /Dq//n" .1s'tY//wU-
<br />Service lt/eter I 'at A /l,Ltu--rara,
<br />FINAL 2llll2D Dlr^/hL+&/-14Pi/4I
<br />Notes, Remarks, Etc.ltI
<br />otrNt:R StilLDEk t)ut_(-AtATxrN
<br />I hcrchy atlirm undc, pcnalry t{ !.riury rhd I d cr.nnr irom rlE Coikrcios' Li&n{ L,* ror rh. r,nlowi4 rca$n 1$c.?0:ll 5.
<br />Blsircss afti Pnntsi{rn Crxl.): Any Ciry or Counry whih rcquncl , Fmil to con{rucr. altcr, flprorc, dcmolth or Npair ,
<br />nodft. I'dn' ns tsrrnc.. nlso rqui(r rh. rprhmr nrskh lxmir b hlca rlncJ (.l.nEnl rhalhcor ilE is liccnyJ puNMr
<br />lo lhc pnivhi()ns oi Ihe Conrrlcxr's l-iu.n*'l Llw ((:h,prcr 0- Commcncin! wirh Scctoi 7000 or Divrsidr I oflhc Bunncss antl
<br />Pnrfc\\ nrCodc)orrhar h.orih. scr.mFr lh.rcion.nd rh. basn iJrllrnllcEcd c\cnrprior AnyvidarnrnofS(lion?0.ll.5btrny
<br />lnolMnl lor . lcmnl subFls rhc {pli.ant t, a .ivrl pcnalry ol n r erc rhrn iivc nrndft,l dollds (S500).
<br />_1, !s owmr or rh. ttutf,lly, or my cnDl.y.cs w h waScs Ns rhcn alc .urFnsli,trr. wiu do llr work a.d rlt ntut'm is nut
<br />n d Ln or oflircd lnr slc {Sd ?044, Busincss ud Pdtsnrns CGlc: ftc CbnrFcktr s Liccn* L,w dds not ,!tly h m owf,r of
<br />rhc pn,txdy who hikls or ihtruEs rh.en. and who Jdr skh h* h,hr.lf nr h.r*lf.r thmu8h his or hc. own cDployc.s,
<br />IrcviJ.Jthrr\uuhimpovlrunkm,imcftloloronircnforsrLllho*cE,rhct{ildiryorinpruv.mnri.s)ltw{hroeyra
<br />oi urnDbri,n. rlE Ortur 8triltd will harc rh. bunl$ ol provin! rhnr h. or rhc Jrl mr hrll] Dr rprovc rhc ,rotsly for thc puqr{ ol
<br />_1, r\.wnooi rlr F)p.dy. rncklunvcly.onrrerirg eirh l,..nscd conrri.loN lo consrrurrh. on+cr (Sc( 7044, Bu\incs
<br />arrr Edilsi'n Co!c: 'l hc Conlraulq r Liccnsc lj*,ioc\ Br rpply b in o*ncrorta't.ny whr builds or inprovcs lhcrcon.
<br />anJ who comacB ror ruch prj.cB wnh r Conrnchrl, liccnRl ponlanl1,, thc Conln.lm s L'.cns liw)
<br />I rmc\coipr und.r SGr A & P.C Lrlhsr!n'n
<br />!II8{E&S:.EO!ICE!SAr!ON
<br />DECIAXAIION
<br />I h.r.hyal,ir undcr |j.nalr, ol lqjury onc of thc tulLws8 dccldatrns:
<br />I h.vc !!d w l minrain a Ccn ilicatc ol Cotrsnr l,' Scllltrs{c lix RnkcF omFn\arn n, ar ttuliddl lor by Scdnn 1700 ot lhc
<br />tjtrtr C-odc. for rh. lcrfomtu ol lh. Md( fix whi.h th. pcmil is (sued.
<br />lhnvc an'l willnEinrain workcr\' cohpcn\rrn,n n,\trrrnrc. a\ rcqri'tJ hys.rlDn 1700.1lhc LlhorGic. t)! lhc,Lalimun.c or
<br />rhc work fltrrhi.hrhk p.rnnr,\ nsu.n My work.s' cohp.n\rron trNurrncc (mcr iil FnLytrunrhcr &:
<br />l.,htrlv rt^utTa-Q
<br />lsltn5'3
<br />I c.dlli rlrnr rhc!.rf rnrNcollhc w.rk fo, whi(hrris pcrnrir is ns'cd.l shrll nor co[n,y dny Fiion ,n inymrnncr
<br />!) !s b hcd'B !'hjcd ro rhc worlc dJnpcn\tuon laws oi (dil.n,ir, xiJ .!rcc rhir rt l drnrld hcom suhjcd i' rhc
<br />work.$'.oml.nsarn,npri,vr!,ns.fS.crbh:lT0OofrhcljhtrGxlc,lrhrll.l"nh*(h.omolr!(hth)sIl()!is6ns
<br />WARNINC: Failuic ro s.uE eo c^ coryr.,eliotr .ovcmsc n unhwhl. o'i shall iubi*r e .q'loy.r h dimiml lEmllas .4
<br />civrl lincs up b oft hundrcd thousrd dolltrs ($lur,{Do), in ailJrrion lo rhc cod da u,6l.nsart,n, Jxmg.s 6 ProvidcJ tb. rh.
<br />\er'u. ru"6,.lrh. tib.rC,{c. mrcrc.r rJdnonry s Gc,
<br />tuVtJ-u-j
<br />IICENIED-CONIIACIAA
<br />PECIASAI(A
<br />I hcFhy ailtm un,ler pcnalryolFrjtry lhd I {m li&nsd uryler I't)vhdn oi Chrflcr 9 (commftins virh Sculion 7000).tDivision l
<br />of thc susircss aRl Ptulcsions Codc, {n my [ccns is in tull n&r a,nj cilNr.
<br />tl Hh+ B GSq rbs
<br />0
<br />CqNEIBIJCUqN.LIIPINGAAEIST
<br />I heEby .Irrn utulcr lrnllr, ol pcrj!ry trl rhrc is ! onslruction lcnlin! ascncy ror rh. lErrorlMa .r thc vtrk for vhi.h rhis Irmil is
<br />issucJ (S.c..!09?, Civ. C.)
<br />AITLICANLPECLABAIIO!
<br />I h.r.6y afm undcr Fnrlly ofrcrjury orc oflhc tollowing dccllnrnrns:
<br />Dcn,liii{rn PerditeAsh.(os Noritiu.rion F.d.ral Rc8uhtnnr (TirL 40, Pin6)
<br />_R.quircd lrtrcr of Norifdrion
<br />I ccflililh.r lhc lerlcralrceulari,)ns rcsadi,r8 r\hcnosrcB)val c norilJ|rl'c$1.h rhisrtEcr
<br />_Ic{d'ryrharlluvcr.rdrhisrmlicl,.n tlsi cth lhc rbvc id;rm{ti,xr isconcll I r!'r h s,nllly wirh dl Cn, Md C.trnty
<br />onlinrtucs rnd Strlc Laws rclrint b huilditrE conrhrclnn. ann turcbylurlntruc rcrcscnrari!.1ofrht Ciry Md C.unryh, cnlct DFrn lhe
<br />rh)!c mntron.J tn,Pcny lnr inrPc.t
<br />?ii"Ll^^,\ppliciinr 0r A[rnt Sirnrturt
<br />tnnnovan /
<br />I
<br />DATE
<br />Sub-Panels
<br />*,,, tollllll
<br />*,", rcltlln
<br />I
<br />--------T------
<br />=
|