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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG,COMMENTS OWNER BUII-DER DELCARATION
<br />I hcrcby .rtrfr undn pcn0hy of !.rrury rhar I m ercmpr fmm rhe Co.rEdoF Lkcn* kw ro. (h. follorin8 rca$n (Ss.70.11.5
<br />Busine$ .trd Ao{c$ion G'dc): An, Ciry o, G,unry which rcqlircs . ,innr to .onstrucr, axcr, implovc, dcnolhh.r rcpln ,ny
<br />nrudui.. trior b irs nsuanc., dh EquiEs rhc oppli.a lor su.h lr.mir ro ,ilc ! siricd d,rcftar rhar lr or shc i li.cncd l1usuant
<br />b rhc rovhionr ofrtE Conrra.ior's l-icc.Ed bw (chafld 9, comnrmios *irh Scclion ?dlo ol Dilti.n I or thc susi.css.nd
<br />PoiasbnsC.dc)orrh,rtuorshcncxcmpllhcrcriomatrdlhchasisforlhcdllegedcrcn/bn.AnywohtrtrofSdion?0ll5brany
<br />{plicnnt lor . pcnnit subjNts rlE applicoDr ro ! cilil Fnalry oi nor mrc rh,n nvc hundrcd dDllrs ( 3500)
<br />I. a\ osi dfrh. ptuFdy. or my cmployes wnhwag.s$rhct v'lc dnnpcnsarnn,, willdo rhc sor*.ild rtE slnrrurc h n.r
<br />irlcn& or orcrcd l'or slc I Sff 7(11,1, B!si@$ and Pdassioos C.dc Thc QJtuador s Liccnsc tiw docs ml lpply ro d o*n* or
<br />rh. poltny shl ttuildr 6r inFos rlrmn. and who dxs smh w* himsclfor herelaor rhDlsh hn or h.r o*n.mplorcc\.
<br />pmldcnrhar such mlmrcmnr\ arc mr inrend.n oroocrd lor sali lt hosclti rhj hildin8 or nnprcv.mnr issoli$irhinonc Jta
<br />or.oriplcrir. rh. ownd Buill$ will hirc lhc burdcn .f pruvirs rnd hc or shc did mi t{ild or inDi(,v. rhc p$Isly tu lhc DurPoF of
<br />L u{o*ncrotrhcl,rotcdy. !m cx.lu\ivcl! .onlricrirt qirhli.ctrs.d co.lrrcr(trshcon{dcrlhr ti{rjNr(scc 701,1.8unocs\
<br />d PdassrD Codc Thc C.nra.roi\ l,i.cn\c tjs doc\ n riflrlyl,, rnowrcr.fri.tr ytrho buildsor imtrovc\ rhcr(,n-
<br />,n! sho.onrmcrsturnrhtoJ.trswirh!Qnnmcn'(\rl(ctr\cdNnu ll.rhcContactoisl-tcn\.LN)
<br />I nr.r.mfl uidur Sc.rnnr .Il. & P.C.lnrlhis rcason
<br />Dale: - Oqrc.
<br />woRxERsiCoNTPFN.sATmN
<br />lrricldBAr.lltx
<br />I hcreby rffinnundcr Fnllry ol pt'j$y onc orrhd nrbwine &clddions:
<br />I h.v. orl will nrint.in. CcnifEarc olConscnrro Scll lnsurc f{r $orko\' .omlEnerion, $ tmridcd for b, S.crion:170ootrhc
<br />tihor Codc. ror rhc pcrformncc of lhc *oA tu which rhc ltrmil i\ hsucd
<br />_l hrve and will mainhin work.^ .n'np.nsari.n insur.n.d. rs r.qutcd brScctionlr00oflhc LahorGd.. rd rh. lcrlonutrc ol
<br />i\ p.rn,i n i$ucd Mytrorltdr.onin \rri({ nr\urrr...rrlcr rrlF,li.v N hr rr.
<br />f.
<br />ft ", t .\.\ ',
<br />l6nifyrhnr ni rh. p.rfonunccolthc work Lr trhichrht pcnnir is n\ucd.l shnll nor cq)loyan, Jfnun ir snytn mr
<br />s sx,hccom suhjsl rorhc workcr\ compcns n,i h*\oacrlir.min, rnd dgrc hd ifl should hcconE \ut'jer r.rhc
<br />workcrs.onrrcn\alionpmvni.nroaS.crn,n-17{DorrhuLihrGdc,lsla,ll,nrnhwih.onrlyPilhthoepnrriri.i.
<br />cilil firc\ trp b otrc hrndrcd rhou\rtrd dolllrs lslll).lx ),nr, dilioo h rhc con olcoh,fi:n\rri
<br />",.itie"CI5'
<br />ii, inrcrc, and allomyt fcs
<br />_ ' Applloni:
<br />I hdrcby ftmundcr l.nllryolpcrjury lhalI Mr liensLal undq rDvirionofChapr.t I (co'bntrncine with Scclion 7(rOO) oroivnn,n.l
<br />ol rhc Bo{msand Pturdssions Codc,,.d mylicn* k mtullioreadcfisl
<br />0 oq49Q
<br />"f,,ttG$8 2010
<br />rL, .
<br />CQNSIBIJI]UQNj.EIDNC.AIiEIC.I
<br />I hcmi,y drfifln undcr FMltyolperjur, rhar rhcrc is a colsrrucrioi Lnding a!.ky ror rhc P.rfornroncc oithc work ror which this Frfril h
<br />is\ncd (Scc .lO9?, Civ C.)
<br />AIfIICANLDECLABAIIOI!
<br />I nod,y altm und.r Fnalry ol r.rjury onc orrhc lollo*ins dcclarorhtrs:
<br />Dcnrolirion Pcrmirs Asbcsros Norin arion Fcd.rd RcgularionslTirlc 40. Pon6)
<br />Rcquncd k(cr of Noriil.arion
<br />-lccnilyrhrr
<br />rhclcdcrulreguhrnnurgednrg ash.{G0mvdJc nol tflic.blclo rhhpmrccr.
<br />-l2cqD r hr t h$ c rcdd rhtr q,plrr [n dr]d nJrc rha, rhc 0hovc intunnarn]n i\ conc.r I ag,N ro .omnly wirh all cir y and counry
<br />nrEiliiirr 0 J\r rttrs<(brnar.huiL rns(otr{rucrtr'n.flxlhcrchyrurhoircrcrrc*nrdivcsorrhisciltindCouniyrocnlcrlFnrhc
<br />{hovc nEnriancd pron rly for inspe.ii{,n
<br />ADpli(nnl or Aacnt skr!lurc
<br />c. I
<br />/n4
<br />,,i\lt,,rn21 $
<br />Site-Work
<br />Underground
<br />Liqhl Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lite Satety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq i UFER
<br />Torqueino
<br />Sub-Panels
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />IVleter Release
<br />Rouqh X/2zttv ,\65
<br />Service Meter
<br />FINAL 4 /a1/,u 9t>66
<br />Notes, Remarks, Etc.
<br />Pole Bases
<br />Translormers
<br />Air Conditioners
<br />Es^4
<br />t.tr.t.,'. 4.i,1,..\
<br />f-------T------
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