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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 />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rough)
<br />lvleter Release
<br />Rough
<br />Service lvleter
<br />FINAL qlttltY'n a4\
<br />Notes Remarks Etc.
<br />OWNER BUILDTR DELCARATION
<br />I ncrchy affirn undcr pcnrlry.f pcrjury rtur I o cxcnpl l'mm rhc Contacron Lk.n\c tie r.r rh. follow.S rcown (Sa.?Olt 5
<br />Busincss aJd Pore$ion CLal.) Any Cily or C.nry whi.h r.quircs r Fmn io construd. rllcr. inDrcvc. dcmlhh.r El8n any
<br />shEIurc. priorro ts nsuarcc, aho rcqunesrhc atplicanr for such pcnri lo nle a sisrd srtrrcftnr rhd! h.d sh. is li..nsd punu{nr
<br />ro rhc thvitioni orlhc conha.t t Liccnscd tiw lch0prd 9. co nrncin8 Nith Scclion 70lx) of Divhion I oflhc Bosin.$ and
<br />ProtcssiotrsCodc)orlhatncorshciscxcmprthcrctiomandlhcMshlorrh.allegcdcxcmprion.Anrvi{nlin,n.rSc.rk,n70ll5byany
<br />uppljcdnliitr o pciitril subjccc I hc lllplican o !civilpcn!hyoiror rmrcrhai lilc hutuldl d.rlrs (S50o).
<br />l. N owmr or rhc ,yolf,ny. ornryc'ntn'yccs wilhwa8csr\ lh.ir slccnmpcns ion. will do ric wolli lid rhe itrrm G nor
<br />inlcndcd ororcrcd lo, slc lsa ?Ol-,1. Businc$.nd Prcfc$ions ('odc: ThcCofirctr'r l-icc.sc rjs docs nor apply to o*nc!tf
<br />rhc t,n)tcdy rho build\ or imphv.\ rh.]sn. ud qho des$ch kd( hnnsclfo. hcrsltor lhrcugh his o, hcr own cmlloF.r.
<br />Irovidcd rhar such impmsnd\m n inre l..i oroflcrcd nr rk li. h)wcld. rhr haiklin8 or nqnovcrmnl iseldNirhinom ycu
<br />ofcon{'lctkr. rhc Osrcr Buiklcr will hau lhc hurd€n olpDvins rtor he.r shc d'd nn hikl or i'q,n,!c rhc poFny n,lhc puq$sol
<br />-1.
<br />!sowncroirhenx,ncrrr. amrxclu\ivclrconrracrins wnh li.cn\cd c.nrrrt,^t,.otr\rfl.rrhc ric.r (scc 704,1. Bu\ils\\
<br />d Pnni:$i) Cod.: Th.Conkrcktr s Licctr\c L.w docs Dor rrplyto Nowtrd ol J,roncnywh(, huild\or i'nfrovc\ rhcrcon.
<br />rnd who conractsln,surhltrliccrsliih!Conrrrror(Ilicctr\c(lpusu n)rhc(hnt kn\ I-i.ci\c hw).
<br />-l
<br />unrcxcnul undcrScclt)
<br />O*ner
<br />1IABK!&ITAMIENSA.IION
<br />IIECIA.BAIION
<br />I hcrchyrinDun{lcr pcnllryolr.riuryoncolrhc lollowinA J..larnions
<br />lhrlc rlNill.EinrlinaC.dilralcofConscmt,SclrI'*urfrtrwork.s.onlrcnsrri(xr,0r [ovid!'dlorb,Sc.rn,n]7(Doarhc
<br />Llhor Codc. r'or rhc I'c,l'ornErcc n, rhc tork tu which lhc Frmil i\ hsucd
<br />-l
<br />hrE rnd *illn[inhi'] $orkcrr..nrFi\rrii)n inslr nc., r\ rcq nc hySc.rotr lTrx)olrhc Lrh.r Codc. lor lh. F-rfomrN. ol
<br />rh. ro hr shich rh( Fnnir i! n\ud Mysorkcn coi .sdi{,n insurmc. .micr dd Inlicy nlmbcr e
<br />lccrriryllul iilhc pcrlofl*rrcc or rh. $ork lbrrvhichthis |xmll is is$rd- I rhrllnorr rk,y r ytc60tr iI rtryn'rricr
<br />vr tr\ri,hc(Dr s,lrjccr rornc sorkcli.o lrnsrrion hw\ol(llitunris, rn r!r.c rhar ill sh)uld tErom sbjccr tolhc
<br />$or[c'r.on'pctrvrionpmvisiotr\olSccri,nr37($olrhcl-ahtrCoJ..lnrll.Lnheirh.o'nflywirhrhoetrovnions
<br />WAnNNC: Fr,lurc ro rcurc *ltrkcn .onllcNilion cov rn cDlnkitdr h ri' flrl lr0nlricr rtr(l
<br />.ivil fiks np t. orc hundrci
<br />I tcl.Nslil) ((JN I R ( ll)R
<br />DIIITA.B^I]ON
<br />IhcEhytrfinDunJcrnnrhyoltrluryrhdIarli&tr{duidcrpn,visim.lChlprcr9(.rnnmNinEsilhScciion?flD)olDivi\i{'nl
<br />oi rltr ltu\iN$ md Pnr'c\siorN Code. ml nry lic.nsc is ir rull lorce Mt crc.r
<br />)p \ / r-t.^" ruu,t",,1ae1414W;1*
<br />(]ONSTRTICT(TN I FNDIN(; A(:ENCY
<br />I ncrcby.Lrm undcr pc, yofFiurylhlt liere is!onerucrirln ktrdi.g.semyforrhcpdfonEnc.or'h. wor,( aorwhkhrhhrnnit h
<br />kslcd (S.c lor?, Ci! C )
<br />ATILII;ANLITEILAf,{IPN
<br />I hor$y!!tin! !ndcr penalry ol pclury otrc of rhc followinE dccldralions:
<br />Dcmolirion PcmrirlAst{sros Noriucario. FcdcralReEuldrions('!irlc 40- Pan6)
<br />-&cquncd
<br />lJrtq of Noriliori.n
<br />I ccnifyrh,rrhc fcdcral rclul ,rN rcFnilrn! nsb.los tu u rl rrc ior ardicink lo rhn nr, cl
<br />l.cnifyrhr! I hav. rcrd rhsalrli.,nrrion ncord llgrst
<br />ruthortc rcprcsnralivcs.fo'rli'rn.c\ r d srrrc Liw\ rrhrnS
<br />rh\. nrnri{i ul|[,trn, ntr
<br />AIDliunt or AE(nl SignatuN
<br />c\6-e7\
<br />b!l,s
<br />DATE
<br />Communications Cable
<br />Air Conditioners
<br />I I ',\_-.,-
<br />6
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