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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communicatrons Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rough I )
<br />Service Meter / /
<br />hIilETI tE%
<br />Notes, Reniatks, Etc
<br />OWNET BUILDER DELCARATTON
<br />'I h6.4 .ttm undd Flhy of pdjury rhar I m Grdpt E h rh. conrru.loB tnde L.w fo, $. roldwiis l!&i (s*.701li
<br />Bcin6 d Prcfdior Codc): Any Ciy or Co!flt whsh r.qriB ! Fmn lo otrrod, .116, imF!v.. domliit o q.n Dy
<br />lrtr*re. Fior rc h! ilMe .ho nqui6 tlE apli&l for un Fnn 'o
<br />frh . rign d irald lhr h. or dr . l*6.d FBdr
<br />ro lh. FrvirioB oa l,r Codrrtm! l-6!.d lr$ (Ctu9ld 9. Coffiin8 f,nh Sclior 7000 6a D i.bi I oa lh. 36iB !4
<br />PDrgFdCo&)orrh lEd3lE!o g rhrdron .d th€ h.rG ror lh. dks.d qoFion. ADt vioLlion of Sdrbn 701Lt by &,
<br />.rplic t for r pmir lubjct! rh. itpli@l to . civil p.rdry oaDl mor€ lhe fivc hunrL.d dolle3 (1t00).
<br />I. ! dG 6lrlE Ftdy, or mr crpb'6 *nh s.s6 B drn $E onF!.br wiu do tlE *qt .d tlE idft i br
<br />iddrLd or olfaGd lr EL (Sa.7o$, Doli'B od P,!ldi.6 cdlc Tt Cod,a6 3 tr6* L.* d.6 ml .rdy to D o*E of
<br />rh. FDrEty *ho hril& or inp.lE tfi.ur !n *ho dE *h s hiMlf or hdxlf or llEwt hn m ha om a"pk'r6.
<br />pmvid.d thd such ihprovdErls 4 mr i o.lrl or o,Ed aor $lc ll ,Iow6. llE huildinS or inFo@l b pE *nhin on. Ja
<br />otcon4liir^ 6G Osc &ild6 *ill h!v. tlE hr&' olFovre rht tE or d! dd ml hild n EFow dE FDFq tu dE FtrFEoa
<br />L B o*E otrh. F$Fty. m dclui!.ly codr&l ins wilh licoE d cod&1@ to {.fud rlE p.oFl (Sr. 701'1, 86n6
<br />a l ltol6sin cod.: Th. conraclor'! l.ic.* Llw d6 not.pplylo 6 owna oapropdly who buit& or impDvd rhso,r.
<br />&d who ot r.cr! for 3uch F!jd. *nh . Codn ro(r) licasd p{Bu&'l lo lh. Cotu!.lot ! Li.@ t w).
<br />I m .rdF undq Sclbn-
<br />llaaKEES:.cAMrIxiAIlQ!
<br />DECBAAIIAN
<br />I hd.b rmm undq Frlt. oaFjcry dE of th. tulr,$i4 d.(lrdirB.
<br />- Ih.v.idvillMi .i. . Cdiar.!. of CoMt lo S.lf-lM to, *otr4 mrFuaior, 6 Frv'd.d lo. by S4rion l70o of th.
<br />klot Codc for ln. Ffolruc. ot lhc w for whicn 0E p6dil b BUcd
<br />4frc.td vill Mut.D *ortd rompa6.ion iEue.. s rqut.d b' Ssrio.l7m orrh hbor co<,.. ror {t Ffol]r&. ol
<br />dr *o rs utth lhB lann s q.d My *uts etp6rbn iledE 6it lxl Flty nunbq &:
<br />,-'. (O-rP ttt.,r! co
<br />,,",*".o,1d4 y -rf 6234L I u,,*,-€11,-12?
<br />-l
<br />.d.llfy $ar ii rh. Frfoll'4. of rlE wort ad whah lhir Fhd n is.( I dr,l nor a,Ploy .ny F$n in &y n,ry
<br />$ B ro beoE. snbJcr ro rhc wo d'cospdlli'on Ls olc.lifomir. Md4Ettu if I should D6oG slbjat lolhc
<br />w 6' cotrrFElrion ,rovaioo of sdio. l70o ot lh. L.bor Cod., I idl. fonh*nh .omPly * nh lh.E FovirioB
<br />WARNI|IC F.itur. ro re N d snF6dbn t\'648. i! unl&ful !d iuil iubirt D dploF ro ainin l FEli.! ind tc.ril 616 up ro on. hlnd.cd lhou!.!d doum (llu),000), i.ro ifi. cod of .onp.Mrioi, dr,[e6 6 provid.d 6r lh.
<br />tihrr Code in6cn ed arom.lt
<br />I I 2.4
<br />DICIJAAITON
<br />I hdcb, .lltrn ubds F dly of psjury lhd I d licrci urda Fovilion of Chplq s (.oMftiol wifi s.clio. ?000) of Divnion 3
<br />oa rh. auilE.nl Pmf6ioB Co&. rd oy ltog a 6 6rll foE. dd.Ed.
<br />C'24 'lt*'Lb,
<br />Itx:l Cn f
<br />,lzrh.-
<br />COIEIAI TAIi.LEdDIIC.E(iIICI
<br />I hdcby amm udd Fnlny of Fjury lh.ltlEc a. con ruclioi Lndsg lsdcy lot tn pqfotuc of lbc *.,1 for *t'ich thi9 Fhh i
<br />isu.d (SE. 1097. Civ C )
<br />AISIICANI.DEqASAIIO!
<br />I h.tb. .fm !qt< F.rlt, or Fju" oE olrlE lolb*ins d..h.dbE:
<br />D.ml(K. PcTeArhdo fJorrfElon [.dd.l R.auldoN (Ttl. :l!, Pd16]
<br />-R.quird
<br />t 116 orNditu&i.n
<br />t< t.ait ttu i, en F{LuLr.d csrdias 6b6tor rd!.] r. d Tplr.bL ro rhs Fol.d
<br />,4dlrtti- tts. @!tt6'DplE.h rd rrc rhr E.bov. ilfooltiotr irffi.I.srro 6o9ly *irh rll cny.d cou v
<br />o'ninffig sd Sralr Ls EldilB ro hlildirE cotrnd.lior &d lE.by lulhornc ,cFg6l!riv6 oathL Cily .,!d Cooly ro @tE upon dE
<br />a!ov.
<br />'nortun€d
<br />pop.ny (r
<br />.Upt.r6l or Asdl siamlure
<br />C ,La. 1 A. o. -t
<br />t l>t 7<)
<br />WlKDt"',G7r7rEl-
<br />II
<br />Rev.0B-07-2015
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