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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE lD/slG.COMMENTS OWNEX BUN-DEI DEL(]^RATION
<br />I h.Err, .lrm udc. FBlr . r..rury .hr I m .e.Yi tism rh. Cor,xrd' L*re l.s lq rlE folL,w6e E (h lS( ?lr.! l 5
<br />B!nn.s! .ni PhL(bn CcL): An, C , or Counry whf,h RtuE. t ltmr h $.{od, rlrd, rmltot. dtul8h or r!.r uv
<br />nu@. Fil ro 'ri ni!tu. .l$ ErllB llr +Plral for rBh Fmr ft' nL . .(Ej rl.rcdr rhi rr or th. ii litn<l puta.J
<br />(, r,. FrvnbN .l E Co.ir-rd r l.r.r*J ll* (ChrF6 e, Co.lmD! *'rh Ser.. 7000 ,'a DN!.n I 6l ih. Busml r.J
<br />Pnrr.$ionr CoJc) or rhrl L or rlE !r .i.npr th.Elrom .,rl trE tEns nn rlt tlkS.tt .x.ntl[n Any vDlrtion .r Sei$n ?0:r L5 nv rnv
<br />r!e!{r lor t Fh'r obFk rlr .pirl.er ro..'y FMllolhr t,rrhrr'w hudErj ilolldr ($m).
<br />-1.
<br />!i oerr ol rh. FrtEnr, or my.mploytct *nh wrs.. .t lh.n e,k Ll,qEnvxon. w Jo lrE wolt.,n Erltut&td,
<br />d.nla, dofi.E{ fr et (5a ?0a4. aurirn.nd P^,LriFB Orj.: Tlt Co r diLrfiEbwLri!drrPlvouo*x.o,
<br />rh. F+.ry wt$ llll.tt d lrFrE rlrEe rd *lr, d- uh $it hm(lf or llGlf or illslh h! .r h.. oM .iihv(i
<br />nn,viJ.J rhrr !n.h mlIlrmd! c d hl.d.d or ofi.B,i for u!. lt lpkE,llE t! ltr3 or itrqn,Ern ! bU wrhh oE y.s
<br />d.rxrtlLln rll. ()rd Burlkr qI h.E UE ttrtLn ol Fnvua rhd lE d nE Jn Dn lllll q llp !h E FDlEry f( rh. |rrFr.l
<br />-1.
<br />8 owEr or rll FoFny. o.(bnwl, .o..rdrl! wlh lrttrsJ ..dr.rm h Ls<tu ilE F)iir (Sa. 7(X4. Bu.tr$
<br />.,rl h!6sm Cnt: Tn Ct'fttr'. L..nE trr &s ml .pply ro x 016 or FsFny *ho b(*lr or npmE! IE @..
<br />&d wl!, d tui! ld rEh pmj.Lrr wirh r Cinrdonr l..nkd p{ruul k' rhc qdrrdu i retr€ b*)
<br />Lm.kmd unLrsaran A &PC
<br />lr.t.:- Or
<br />DECI.AEAIIA!
<br />I rErch!.mrhunlcr Fulyol Frjury om or lh. folhuo! &.nniiir:
<br />-lh,E.rlwrll
<br />rdu . C.df{dc or Con bS.l .ruE [r *'rt6' loqErsrin. .t F[vrLd fo h, S&t,n 17Oo ol rlr
<br />Iibor Cdl.. for llE pcrfot]rl8. oI th. slt , *hich rM Fm n L$Fl
<br />I h2E :n l *rll hrd.r w"rt.u ..mp.n!.[,n rrur.fte. r R]ui.\t h, Ser t,n .1700 ol rlF lrh{ Orrc, ftn rh. Frl(,lmtu. .f
<br />rh. worl !{,*hihrhr Fm't ! r$u! My *ork$ rohtcrslrx'n inruEet.ffir.d Fnty.u.'6.t m:
<br />Pinxt Nlnftr:-
<br />-Ieniryrh.l
<br />h rlE JEtturEmc .r rh. work li)r *hrh ths t rm i\ itrkd,I rnrll ml.mPloyrny Fen D rny mrncr
<br />i s ri' lE$r ol'jEr ro rlr *rrt6'@"rFn.dDn L*r of Crl'fomi., &l +r lh.r 'Il rtE!! 6*.ft $hFr lo rlE
<br />xr 6 .onp.Nrri,npnrvli6orsftt.nJ,lborllrL.rryCirj..Ilhrllfonh*fi@n9l,arhrt.FovFn.t
<br />f,fl.rffir;x
<br />(!d fi..! up lo rE huulrd rhour.nt.ttrllrti (slflr,iDo). m rin[lin n, rh. $n tf NnrF.er
<br />Sernn 110?6 of ih. llhr Cld.. d.r{ .il .tiimy r ler
<br />DpcL6larlat
<br />I tiGb! rfirm unJ.r Fely of FrIry rhd I rn l,tncl mi.i Inr6hn of Ch,trd 9 (6trmNb! snt S.rr Dn ,00()) .r Drvnx,n ]
<br />01 rlr Buri8. lrr PmL($.! cl*L, r,n 6y Lrn< r in ftll roN !n.fiei
<br />l-f,.nr. Ch<
<br />-
<br />_Lxcns NuntE ,
<br />D.r.:- (-o .rrc-
<br />t9lirEl,lcualtl.EuuNa.f,alll(:r
<br />I hcEbr,rfunrtuld Fn.lrydrn rj"ry rhsr rh.,c 5 a ('nnruLrnn knlil3.8cEy lrtr rh. Fdtlmhc ol rh. work ntr
<br />",lltrh
<br />lhN F.rmr tr
<br />!!rEl (se. 1097, civ c )
<br />API'LIL:ANT DTCLAIAAION
<br />I H', .trm unj., FmIy dr Friury or .l llE foll'*u! &(Lntr.nt:
<br />D.mlli,. PcmrlArb.trot frdfir.rnn F.J.nl RquLlbnl lr k,(,, P,n6,
<br />R.qu!.d lrn.rotNrri!
<br />I (td'ri rh:! rrF r.d.fllrc8uLlnns E8[!h! 3rh.{r\rd'vrld. nn !,lplf,rhk rd rhR Pnt].d
<br />I$n yrhd lhrvc rcr!rhn rfi,|f,$r'n lrl dd.rhi rh. fi'vc rnn mron Lroid I r8c lo Nir,ly wih dl CI, .nJ Cotrnry
<br />,rlrrM!.tu1St.lc U$ ELrh3 i,, hx 'l],ry .ondtur k,n, ! her.t'y dr,rrE qr.€nlll ivct ol rhr ( ir y tnJ Countv l,' cnlcr drm rll
<br />rt!,w mdirFJ0n)Fnytu
<br />ADpliunl rAq.nlSiltrfllun c rLt /-/*
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Lioht Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Satety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Grounding i UFER
<br />Torquerno
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />Rough
<br />Service Meter
<br />tL'.t y i4 /b L///.7
<br />Notes, Remarks, Etc
<br />l)rr.:_
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<br />Translormers I
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<br />Meter Release I
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<br />FINAL
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