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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNER BUILDER DET,C NATTON
<br />t hscb) aIft r undd poalry of pdjn.l lhar I an cr.mrr from lhc Cofta.roB Licoe lrlv aorrhe follorvins redn (Se70ll5
<br />Rniinds and Prol6sion Codc): /\., Cny o! Counly \hich r.qlns . pnnil to cansltucl. ah6 improvo dmolish or rcroir ev
<br />srtucturc, rior lo ils usudc.. al$ r.qut6 rhc applica lor su.h pennit lo file a sisn.d slaldnal lha hc or sn is licc6.d I'6!Ml
<br />rolh.rnlir.sollh.Conlra.roasLic.nscdl-awlchapl€r9,Conm.ncinswnhSsrion7000olDivisionIoath'Busi'ardd
<br />PmlssbnsCod€)orrhalh.orsh.t.rcq'rlhscftonddrhebGisf.rlheallegederdnplion.AnvriolalionolS.clionT0ll5branv
<br />applicanrtuapdrnnsubj(rslhelppli.ahlloa.ivilp€nallyofnotnorcrnmfivchundrcddoll&s(5500)
<br />l. s o$,n6 of lhc ptuptdr. or nry.'nplo)6 rvnh s ags 6 rh.ir $lc conp@lion. sill do lh. sor* md lh srrudG i nor
<br />inlod.rl or ofiEe,l aoi ;k (sc 7crt4. B6ins md P:-ofsions cod. Th. cof,lra.toas l-i..e ks do6 .ol tppl, to d o\rr ot
<br />rlrpsldy who tlilds or inp,ove lh6ar d who &E such \rclt nnns.ll or hdsll or throuEh his or hd own cdplor'6.
<br />providcd rhar such i,nprcrodrs enot intdded oroffdal ror ek ll hos'66. $. hrildinB or imlr.r'one is eld wilhin orc ra
<br />;lompleiion, rh. o{re. Buildq will h.vt rh. budfl of provins lhd h! or slE did not build o, istrcv. th. Foporv lor $€ pupoP of
<br />l. c own€r of th€ p.opcny. dh cxclusilcly co.'ldclinA {irh li.med .onl4.lo6 ro coNlrud lfic roj.al lsc. 7044 B6ind
<br />and fiolbson Codc 'I'h. ConlEcloas l.iccne kw dod not apply ro an o\rns o I prop.nv $ho builds or impro!6 rhdNn.
<br />eid wno conlftls lor such pojdB wnh a Conhlclo(o li.4qed ptuu lo thc Codt..tors Licemc Lrw)
<br />I e .r.'npl unds Strion
<br />Drte o*nct
<br />WORI(f,RS' COMPENSATION
<br />DECI,Af,ATAN
<br />I io.b, arm urdcr poally of pdjury onc oflh€ followins d*lraiions
<br />Ihav. dwillmai.inaCdi,icarcofcormlloS.lflnsucaortortdconr.rualiorsProvidcdlorbvSclion1700oflhe
<br />L.bor Codc, for lh. pdaotrMcc of lh. lort lor whicn fic Ff,il i3 su.d
<br />I hav. and will iainlaan wortd co,np.osarion i.suroc., s rcqutcd by Sdion l?00 of lhc tlbor cod.. aor lh. ,sforl6c' of
<br />thc ryork for ehich $i3 pcmir is icau.d. My rvortc compds.lion idurmc. .mi6 dd poli.v ,!ob.r e:
<br />,"",., . AttjA,l=-r' \ [ h
<br />,r"r"."*, WL5 0 ZuvtU'aO\Z ',,^, \\ lr lzoNU
<br />I.difyrh0l inlhcplrfonnanc.ofrh.trolk lor r hich rhi p$mir is i$ued.lslrallnor mrPlovanvpd.n i.a.vndier
<br />so s ro b.cofrc subj.d b rn \orl6J comPosation lass ot ( alllomia. and .8rce ihal if I should h..omc srrbjd ro rhc
<br />wo*6' co pcnsar iqn povisions of S<ton r?00 ofrh. kbot Codc. I shall, fodn$iln codplv Nirh rios Pr ovisions
<br />WARNNC r{ibrc lo su. {o,kdl conDNlion <n.dae is unld\rlul. and ehall subjd an onplovd to dininal psthi6 ad
<br />,tril fin.s up ro on. hund'.,i thousd doll6 (tr100.0ot'1.
<br />serion 10?6 oflhc titor Code inld6l and allooe." ! ls
<br />in addition lo thc co ofcomp.Nlion
<br />I hddy aflin. ondd p€.ally of p.rjury rhtr I an licaE d undq prov6io. ofchlpl6I (.omdci.8 with Sdlio.7000) 'rDivision 11
<br />of lh€ Duin* dd PmasioN Codq 6nd ny lic.N is itr tuU lorcc dd .lld
<br />L)p
<br />2-O
<br />Li.d€NurnbG 21?an<1,"rlzl .-"."., V\V ln:l -<o\aP.:
<br />CONSTRUCTION LCNDIN(i AGENCY
<br />I nd.by.mrin nndq pqalry oln6jurr rhar lhsc is 6 cod(tuctbn lmdins arocy tu rhc prlomnce ollh. wo.k lor \rti.h rhis permn is
<br />issuqr (Sc.3097, Civ C.).
<br />Lcndq s Nanc:
<br />L.trd6 s Addt6:
<br />APPLICAN DECLARA ION
<br />I hdrtr ailnn uadq Dorhyoapdjuo onc ollh. followi.B ddlmrions:
<br />Donoliion Pdnlirs-Asb6ros Norificflion l'.ddal Rcsul ions ('rill.4(1, Pd6)
<br />R.qut.d r.lld of Notificadoi
<br />I cdiry lfial lhc ftd6l i.SnlorioB Esadrs 6h.sro! rmolal arc nol lpplicabl. b lfiis prci61.
<br />./ I cd,fr rhar I harc rad th6 tpDl'.arion ed narcthat lhc ab.v. infomalio! G cordr' l.8clo conplvwilhdl Cilvand Counlv
<br />6rdimc6 d SEl. Lls dn ins io bulldms cotrrrudn., tnd hRby oulhori4 rerrBatslivd oflhis Civ ed Counlv lo ola upon ih'
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rough
<br />Ceilinqs (T-Bar Rouqh)
<br />Meter Release tl tb l1r,Dtfi('oL# 97
<br />I
<br />Rouqh t lt t, l'Ld D*nttt -t-+rz
<br />Service Meter I
<br />FINAL t llulzo Dtklt4<n_ lf *2
<br />Notes, Remarks, Etc.rr
<br />ID/SIG.
<br />,h\e md '.n.J Dr.M! lor rukron Brs6 .2, ? , O
<br />noorr."r"rn*rrrr.rr"r" -L- / LP?
<br />Pem,trn.trrc(prin,,:
<br />"4
<br />614 H)y+v\^, tL?)29
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