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tD/srG.COMMENTSAPPBOVALSOATE
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor Jt
<br />Bondin g/Groundinq/UFER U4/ll0 2ulittlh 76/
<br />lL
<br />Torqueino
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Solfit Rouqh
<br />Ceilings (T-Bar Rouqh)I
<br />4..1A1*rr^,lVleter Release QohQ I r?-/
<br />tl
<br />l*tl rttb-Rough I Uclta /<r2"'
<br />Service [t/]eter ltt
<br />FINAL ,fl,,ffi,E
<br />"/{s2-1a lo*
<br />Notes Remarks
<br />, LO U 1
<br />OWNER DUII,DFJR DEI,CARATIoN
<br />I hcrchy ilfirn uM.r l,.nalry of Friury rhal I am.rqi ron rhc Co.krcloN Licctrrc tiw for th. Lllouine rclsn lscc 70:ll 5
<br />ausincs rnd Profc$ion Conc) Any Cily o! Counly Bhi.h rLlnircs r pcnnir r. consltucr- ollcr improlc, dcmlish ot qriruny
<br />ntocrurc. prio!ro irs issulncc. lho rcquircs rhc lpllttrnt for such pcnrir ro ril. r siSned iar.ftnr rhnr h.or lhc h liccnscd puru.nr
<br />ro lhc [ovisions ol r,r Cotrhctois Li.cnsd tiw (Ch.prcr 9, connncminA yirh Sccriotr ?()O0 oa Divtion :] ol rh. Busincs\ rnd
<br />Proicssions Codc) or lhll troishc ncicnrfl lncrclionond lhc b!si\ rbr rhc rll.srd.xcn{rn Any vii,hrn orscdionT(rll5hyany
<br />upnlic!trrntr!lcrmirslhjc.r\rh.lptli.,iitJd.ivilrrnalryolmrtrKrha.fivchundrcddollr^($500).
<br />I
<br />l. !s ovncr or rh. pn,tEny. or my cmplo)Es qilh wtrgc. $ rhrn sh comFnsal ion. will do rlE sorl and rhc ,erft h k
<br />inrcnded or olTcrcd rbr slc (SN.7044. BLsiesr and Pmrerri.n\ Codc: 'I'h€ Ornt,cr{n\ Li.cn$ Law ddr not ,prly ro M o*trcr ot
<br />rh. DNpcdy wtrr buillLs or iqroRs rh.mn. md who dms skh $o* hinrclfor hcr*lfor rhmu8h his or hcr outr cnpl{,yccs,
<br />providcd rhrr 'ch imprcunEnk m mr i codcn or orTc'ld for slc. la hrwcwl rtE huildins or inI,Dwnr.r is $ll lnhin .k ltir
<br />of complcliotr. thc Ovrcr Buildcr *il! harc rhe burdcn oi Drovins rhd rr or shc dil ml buid or inDmrc $c pn,Fny for rhc In,rxNc or
<br />-l.
<br />a!.snc. olihc protEny. x cr.lusilclyconlrr.rinssilhlicctr\cdcotrtr.lo'\ro.onntudrh.I'nr.{tlSc.701'l.tlu\irrr$
<br />rnd Pircssnn Cod.: Thc Conk kr'\ Li.cnsc L.w docs n.
<br />and who Lrn'mcN for such nrote.is wilh ! Codndo(9 I
<br />Irrrywho huild\or nnfr y.! rhd'.otr
<br />I rnr cxcnr|, trrdcr Sc.lIr
<br />I h.rch! rflnm un,l.r p.Mlrv ofnriu
<br />I hrvc rDil *'ll ninrrinrCUr otConscnr b Sclf lnsur. f,, *ork.rr.onIxtr\rrnnr. r\ t()vidcd I(trhvSc.ri( 17ln ol rlr
<br />l-alnr Cn'ic. rbrlhc pcrformamcoflhc wort lorahichrhe pcrmir h Gsucd
<br />Ihrv.nnd*illnuinrnnrwork.rJ.o rpcnsr!. nruRicc. rt r.qunrd by Sr.r i({ 17u) .f rlr Ltlbor (ide. i(tr tlE pcrlb x'n.col
<br />rhc tr.'l fttr whiclr rhi\ p.rnri! is i\\u.d Myq.rkdrs.on{f,trurn,n i {rrn c.aftdr xlNli(ytrtrtrrhurtr
<br />-l
<br />ccf,ilylhlt ir I hc pcrlormrcc ol lnc wor[ Ior ahicnnris pcirni is isucn.l rhlll nor co,r].y uny r.6on in any nDimr
<br />$ r\ n' bcconr {h]ccl lo rhc worieh o rprisdn'n h$s oi Cllifnnriu. and a8ec rhnr if I \l'.uld h.cotrf, \ubi\t lo thc
<br />s0kr.s dnndrsrri,,r trovni{in\ olS..ri,fr.l7ln)rl rrr.lilu Cinn..I nuiL. kflh\rirh.,trntly
<br />WARNING Failurc ro surc wo.kcs conDcoqr
<br />.i!il fincs up ro onc hundrcd llDusrnd dollors ($
<br />an cmDlovcr l0 oiDinalFulrhs and
<br />i,D. drrrg.s r\ t,r)ri'l.d lnr rh.
<br />s..ri,r tor(,.rrlt l, htr (i,,lr. i .r.{]tr,|x
<br />I l[frhy artu'nr rrpcmrry.ll,LrjuryI 'r pofi\nr of Chrprcr 9 (.onnk . tg(irhSr.t
<br />or rhc B!\inc$onn Pr.n$i,,nsC.dc- and
<br />'ny
<br />liccr$ t
<br />CONIIAICIIOIIENIIIIC.ACENCI
<br />I hcEbyoffiirnutucr pcn lyofp.riuryth.tdrchaonnrudionhndinS,qcn.ylorrhcpcrlonmnccolthcsorklorshichrnhpermin
<br />tsu.d (sc...1097. Civ C.).
<br />AIELIC NLDEIIABAIION
<br />I lErcby ullinn undcr t'cn0lty ollcrjury.trc ollhc hllosinB dNlarations:
<br />Dcnr,liri.. Pcnnirs \bcdo\ N.rin.dion Fcdcrrl ReguhrionrlTirlc 40- Prn6)
<br />Rcqutcd t.(cr of Nrificnrtrn
<br />irc nor rpplicL$!c h rhi\ pn)Fcr
<br />,rtui io n c.a c.r I .gN ro comfly wirh {ll Ciry and Counry
<br />hcfthyauloiu. Rrreqnkrns ofrhr Cr, ud Counly lo cnls
<br />-/l:* aK/tv
<br />P hn /*/e"m,*ru."r6.r*,/ B trU€k
<br />ELECTRICAL-INSPECTOR RECORD
<br />Site-Work
<br />Transformers
<br />Sub-Panels
<br />Etc.
<br />CJnic'
<br />Lkcnic Chsr_Liccnsc Nlnt r: _
<br />Dd. Co mtor
<br />L.ndci" Addf$
<br />I
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