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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I hd.by rmrn undd l,.nah, ol Frjury Ihd I m .rmfl nlm rh. Cont.cio6 Lico$ Law for lh. lollo*m! r*,n is< 701 I 5
<br />B8in6s .nd Prof6ion Codc): Any Cily or Counly *nich Equn6 a p6nil lo .o[{ .r, "!16,
<br />inpnn., .Lmliih or r.p.tr mt
<br />tu.ruc. Fir ro tu isum., ab. r.qnic ih. applicer for sn h Fnir to fik r s'gi.d ]lrlmol lh.l lE or . n licsa.d punuarn
<br />to th. FornioN oa$. Contrrois Lk.nsd Law (Cn pr6 9. Comndcins wirh S..1o. 7000 ol DivBion ) of rh. Irusin6r .nd
<br />l,mtdi,ns Co&) or thar h. or sh. ir .r6pt lhF.froo dd 0E balis for th. !ll.s.d cr@prFn. Aiy !6Lrion ol S.<rion 701 I 5 hy .nt
<br />orpliconl Ior ! pcnil slbjals lhc applicsl lo a civil p@hy oI ml mor. rhe fivc hu.&.d d.llds (1t00)
<br />l. s 0"6 ofih. FtrFnr. c ny mplolE snh w+B c in t sk ompsurio.. wiu do 0t *tlt dr, dE lMr i mt
<br />i'{oilaloror6.dforsk(S{7Ol4,Aoi6adftlfstrBCo<t:Th.C6lr,!.r'rLk.Mt*d,6ftl.,Plylotorn6of
<br />rh. FDp-iy who hoil& o. ir.ors IIEEE id who dc uh *!rt hirelf or h6rllor thrcush hi. or hs o*n nplo! c.
<br />provd.d rhir .uch inFnrlG$ a. Dl iddn d orotu tbr 5l. ll th**q, rh. tr'ldi,B M inp..6E i! sU *'ihs oF )w
<br />orcotrpkia EOsE Aor&riu hw rlE hrrLrof Fovi,B [!r lEqd!.dil d hild d iL.ot t plotEr, n'.llEFrFxof
<br />l. 6 olrG otrh. Fipcry, m dchliv.ly .od,arin3 \irh li.d!.d .offim lo coEIrud E Fojd ISft 7Or4. luil6
<br />!,rj PBE nn Corh: Tnc Conlr*lor't LkG LlF &6 ml .rply lo e ou6 of propgl y *h. b(ild! or impm!6 'lEFr..nd sho 6drrl! fo.$(h F4dr Bnfi r codr&ro(3) !ad!.d pu.d to rh. coddn r l-koe Ll*)
<br />I u .i@pr u.dd Sdii)
<br />r!r[E8l(a!If[lsalt0!
<br />DECIAAAIION
<br />, h6cqL alfirn und6 pcnalt' dl Fjur) dm.lih. f.llo{ii! d<L'ar'06:
<br />I h.v..d vill dinl.in. cdtiftdc of coer ro s.lf-l6e fi, *616-@rqd.irtr s Fo\ii.d for 6] sa-lii t7(rJ of lhc
<br />L.t r Code tor llE Fforuc or ll! u!* tn *tth llE Fnil i e.d.
<br />ft*,".nd *ill ner.'n *!rld .omFldsn illrll,u.. 6 ,cqui.d bt sdan lr0o orrh. L.bor Cod., fo, rhc FfoIrre. of
<br />Frmh a i$El M) *o.t6' omFdion iMe. cmir ad polk) nomb.r e
<br />S tlt'TI
<br />I (dit d in rh. pdfortm. of rlE $ort ad qhth rnir Fnn is NU.( I Crllmr slplo, &) F&n in e, nmE
<br />$ a
<br />'o
<br />tE$ft iuber ro trt *n*6 snpfrrbn h*! orc,iifbni& ei rsE thi if I rhould b6oE sbi.<llo llE
<br />rolt6 onFBdbn FoyiroB of sdio. r7m olilE t bd Coda I tdL ldhlnh oEd' f,nh ro* ForirhN
<br />wAINltiG tn&.ro Kq.\ t6 cotrpqEcFn o!(nsc 6 unhqtuL ed rh.ll iubJdr e ophF ro 6imin l Frli!.nd
<br />cnil fin6 up ro oE hund.d rfioue,n &[61t1m.000), in lddnDn to lh. cosl of .otrpG{ion. &nt8d a F.ridGl fo. 't'.
<br />D.r.: 0
<br />o& rrqd dd dlonEr'3 feq
<br />I hdl6, lrrm unda Frny o f p6jo,y th, I m lia3.d ur& Fo\ tior of Chl9ls I (mffiiDs trnh S6tni 7lrco) ol D( sFn :r
<br />.f rhc Bll.t'B Ed Pofcri-{ode rd mt lk6E 6 n tull lor rn .lTdt--z-I_)v?-n-(lrY
<br />CABSIAICIIqUIEdDIISICIIII
<br />I ffi) .mm un& F6h'of pcjury lhd th6. ir ! oErruclbn ls'dns lsdy tor lh. Ff(,rrjle of rh. mrl tur $l*h rhs Fni i!
<br />su.d {s6 !097. civ c)
<br />ATIUCANIDECJ.AaAIIA!
<br />I h.dy dEn unds pcn.lly of Fjury orc oa th. follovir8 &.lsd ions
<br />l)cmhion PmitlArb6lG Nolificdio. F.ddl RcguldioE (TnE40. Pan6)
<br />R€qurcJ L!'6 of rk{ilicdion
<br />I .di,iy rhd rh. f.rloil Elub'ioN Elrdin! 6b.ros rdoul e. nor rpt licabl. ro lhis prj.d
<br />I c6lify thar I hov. Ead this applic.lion ad narc lllll lh. aborc infonnslion is coB.t1 I alrE lo corDly trIh.rl (\tr.nd (_u'nr)
<br />ordin.nc6 ed Srat.l,rs Eldiru ro bu
<br />6bov! nmtiotr.d pmp.ny lor iBFdtun
<br />.frh^r \ anJ (ntrnr\ r,0rd trrirrth.
<br />tu,licr l r
<br />^!ul
<br />\irNnrr(-
<br />l',.rnfit(trinx.rDrinrr:
<br />^A
<br />"/,/t
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light 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 />Bonding / Grounding / 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 />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rough
<br />Service Meter
<br />FINAL Z 'l{l t-//<.//(4 I 71/
<br />Notes, Remarks, Etc
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