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ELECTRICAL.INSPECTOR RECORD
<br />APPHOVALS DATE IDiSIG.COMMENTS
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />It/eter Release
<br />Rouoh
<br />C^.^
<br />FINAL
<br />Notes, Remarks, Etc
<br />t*
<br />(,WNER BUII,I)ER T'ELCAR{TION
<br />I hclcby al6!n undcr Fnah!.r pcrjury rhd I am cxcnDr rio'n rhc (ntu&xtrr Liccnsc Lj$ for lhc r'ollo*ins r.r* (s.t.70.115
<br />Businc\\ iM Profcrsi.n Codc): Aflt Cily or Couniy which .cquncs u Frmir t, coo(dcr. rltcr. improvc. dcniolish .r En.ir rtry
<br />$rudur.. 0rior ro ils iss,orcc. ala rcqutcs rhc arplicanl lo! uh p.,mir b lil. r sismd urcnt
<br />'ho'
<br />h. or she is litcn{d purtusnr
<br />k' rhc nrcvtn,ns ot rh. Cont,.ror's Li.cnscd tiw lch.!r.r 9. c{mmcncin8 $irh Scrlion Tixro or Oirisi.n I of rhc Busincs ond
<br />Pr,r.st,*cod.)oirhirtrorsh.iscrcnDlthcr.liomrndthclxshlorrhculLEqlcxc'npri,tr1 A.yviol,rionofSccrionT0:ll5$yany
<br />srplir.d n)rapcirnir {uhjals rhc rpplicanr ro rcivilIl.i,lry.fno' nrrrhitr lllc hundrcd d.1la.s(S5(x))
<br />l. ,\ owmr of rhc pmpcny. or trry employes $irh waScs as lhcir ele conf(n\d( bn. *ill o th. wmk Md lhc slmrw i\ dn
<br />inrcndc.l oroflcrcd for qlc (Ss.7Or4. Businc$ od hotesrnrn\ C,xlc ThccoDkr.loasLiccnetiwdoc\noraprlyrornowncror
<br />thc rrJpcdy who builds o. iqrorcs rtumf. nl wtr dms fl.h M!( hnnscllor hcnclfn rhmuh hn or ncroNn eq)loyc$.
<br />pn,vidcd rhar such i'npmvcmnh m mr inrcndcd or ollcrn for sk l[ ho*cri th. hildin8 .r imptuvcmnr is $ld wirhinoic rd
<br />ofcollll'Llbn,rh.ONnrBnilrkr*illh!v.rhcbordcnoff,mlingrk!hcorshcdil hnikl or inDroE th. !$p.ny forlhc Purlx,sof
<br />L r\.N cr olrh. p'otr'ry. xnicx.tusivcly..nnn.rinE rilh li(cf\cd .ontr.rtr' r) coidnr.r rlt frclc.r 1Scc. ?O'11.Ilu\nc\\
<br />r lhnc\\ian(inlc: lhc Contr.ntr \ I ir.n\o,-rq.loc\ or rt)tnyro rr os mr ol polrcny $ho huild\or nnpor.\rhcrcotr.
<br />rnd {ho coitr.r\n, \uchtn'Fl( wir[i Contkk)arr ]i.crr\ci lunurnr h th. Contlttr \ Li.cNr Lr()
<br />_l trnrxcnrpr undcrscrion .B &PC lorlhhrca\on.
<br />Daler o*ner
<br />w()RKFRS', COIIIPEN\I',nrtN
<br />DE TIAAIIO!
<br />I hcrchy ufilrd und.r p.mliyor!.rjury onc olrhc tbllowir8 dNlffolions:
<br />*lhrrcMd*illnuinrlinoCcnili.dcofCoscnrn,sclfln\urunnsorlcrlcompcnsirion.aspovidcdfoibys(rintrll0ool'lhc
<br />titltr cdq rorrhcl.rrunemc ollhcnntlnr whichlhc lcnnl is nrucd
<br />-l
<br />hdvc 0trd $ill ui ain $orkcrs c.nr.n\irio inrurrkc, sr r.quircd hySccrion:l7U)oIrhc liborCodc. forrhc rdlinninccoi
<br />lhc rork for which rhis pernir is h{t.d. M,wurkds .o rp.trsrli.D nNurtncc cmicr and Inicy nunh.r tuc:
<br />I'{ni.y Nun*,cr
<br />-Erlnc\
<br />Iccriifyrhalinlhcp.raormncc('frhcNorktffwhichrhisrcrmirisissu.d.Ishallnolcmploy!rrypcroninnynDtrncr
<br />s 6 ro heo.E sltJccl h
<br />'h.
<br />w)rkrJ .o,!rnsd ion laws or C.hronria, atrd asrc I h,r il I 3h6old b..om suhitl ro rhc
<br />workcr coEpensarion pi(,vi\i.nsorS(tion lT0oorrhc tibor Codc.l shrll. nrdh*irh co,nply wirh rhos [nvisions..)
<br />IVARNINC: Irai]ff. t, {cnrc *o'l,rr\ .o ,rc \ rtr"i ..\crr$ r\ urrowtul- i rhall n,hl.ci rn e
<br />.ivil lincs up lo orE hundEd rhor\ nd d.ll{\ (51(n.UXD, i'r rddirtr to llE 6{ .f co datuecs as p('viJcd hr rhc
<br />ryru'-
<br />I hcrhyslti,nu dcr p.MlryolNrjury rhil I anr ri.ctrkt undcr tmvtion ofChrprcr nn ri. e $irI S..ri{nr 71xx)) ol l)ni\i,n,.]
<br />oI rhc ll',\i',csrr lrolisnnN Codc aDd n! lic.n{ is ii tulllarccrtrdcllccr
<br />LLc.sc Nx
<br />I hcRby rnirn und.i pcn,h, ol r.rjury lha' ln.rc k a .o
<br />hsucd (ss.1097. civ c )
<br />in8 +.trct fu rh. FrlnrnM.. oi rhc *ork for $hich ihn Frntir n
<br />Lcndcis Ad&c*
<br />-
<br />AIILICANI.DECLABAUAN
<br />l,Erhyafmn!.dq pcnllry ot p.rjury om oltlf, aollowine d..ldlthfls:
<br />Dcmlilion Permirs'Astcsros Notificarion Fcd.ral Rcguhri,ni (Tirlc40, Prn6)
<br />-Rcquned
<br />Lctter of Norifi.,li,n
<br />_l ccrliiyrhar ric lidcrrl rcgu ld io ns rcgrrd nr8 osh.nos.cnsvJrc tror
<br />l.cnrlirhr I hrk rcld rhi rytliclrionad isrN loc.nrfly$nh rll Ciry.tul Coniry
<br />ordinrNc\ i0d Sratc t;r$\rclalinglo hui rtrc.dlrhi\C ) JRlC unryr'rtrrcr ulnnrhc
<br />rtxr. nrnrtr,rd pn,I[n,lar r,\fr.r
<br />Appli.snl or AEent Si,tnnlorc:"1?4,
<br />I
<br />Site-Work
<br />Service lVleter
<br />/a/"//,r *tt;z-
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