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APPHOVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lire Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundino / UFER 7|fl lte 1r^r/7y
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilinos (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Flough)
<br />lrleter Release
<br />Rough \
<br />Service lVleter -7-74- tK 'rNryv)
<br />FINAL a- -a-2\'L*+ilYa
<br />Notes, Remarks, Etc I
<br />\
<br />I hcrcby ailnnr utrdcr pcnahy ot pcrjury rha! I m cxcnrir trcm rir ConracbN I-ic.n{ bw ior thc lollowins rclqrn lscc 7}:ll 5
<br />Busnr$ and Profcsio! Codc): Any Cny or G,unry Nhth rcquncs r trnir b cotrsrucl. .r. improlc. .hnnish or rpair 3ny
<br />{n.rur. pri,tri(, ira is$!ftc. {lr, rqxins rhc rppli.ld ror su.h Fnnir to lilc ! sj3tred slllcmrr rhnr hc or shc ir lrcnscd l[mudnr
<br />Io rhc rovhion\ ol rhc Conr,acx, r Liccn\cd Ijw (Chapr.r 9. ComnEking rirh S.dion ?Om oi Divnion I of rhc Busi.c$ rnd
<br />Prof.sbn\C.d.)orrhar!..rshctcrcnllrh.eftornandrh.hrlhf.rrh{nllcgcdcrcmarn,n.AnyviolaraonofSc.rbnT0ll5hrrny
<br />spplr,trr(irr.hfrxbjsr\rh.aprli.MrtoacivillcMlryofnornmrclhanfivchurdrcddouaB(3500)
<br />()\\Ntrt Bl ll,t)r R r)r'r { \R \ I lr,\
<br />B & PC hr rhn rcrvnr
<br />l, !s o*ncr oirhc popsry. r'n.xclurivclyc..tt.ring wi'h liccnscd.ontn tns lo cor(ruct lhc pojccr (Sm 701.r. Bu\inrs
<br />md Pioisriur Codc: rhc Co rl(1n's Liccnsc liN des not 0pp ly lo nn o*ncr oi |n |.n y *h. bu ilds or inprcrts lhcrcon.
<br />nd who .o n ( rr \x.h rrojc.h wirh r Conlh.turl o li.cnscd ptrrsurtrr ro thc Conrrrcrois Licetrs ti*)
<br />I)rrr Orne.
<br />]}!8KE$:rOrllENSirll)NDI;IIAAAIA!
<br />I hrrrl,v rnnmutrdcr prDrlry.f |trjtrrtoncof rlrc lnLINi,r! dr{h'nriirN
<br />I trNcrcnrpl und$ SNino
<br />qzz-1 tlE,- z'.'
<br />Cto 93tv<-r
<br />\Zolz< r f Vr tr"5r1us-L
<br />LL
<br />.onr/y Pnh ollCiry,nd Coury
<br />hisCiryo, Counly to cnlcr ufl,n lltr
<br />,^," tlzllg
<br />I hrv. aJrl *ill roinrain r Ccnific.t of Con$.! to Sclf'lnsuE for sorke^ .ompen\lrion, N pmvidcd for bySNtion.l?()() of rhc
<br />lj&,r c(dd, for rhc l. fom. of rh. "u* lor *hi.h $c lcnni i{ hsucd.
<br />, havc i *illn{irrlin wo rkcrr .o
<br />'np.
<br />n\rr bf, i'xura'rc. rcqundt hr" skri, lTrx)ofrhc ljbor Cndc.lor ihc pcrbnnrn..of
<br />rhc work lor *hi.h rhk rri i k\r,l Nlv sorkc comDctr\rtoi n\ufui(.dirrr nd Jrni.v nu.rncr rrc
<br />3 L
<br />I h.Ehy 0flnn und.r pcnahy of pcrjury rnd l.m li.ctrr.d undcr pmvhn,n otCnopr.r 9 (.ommn.in! wkh Sdion rm(r) olDnisi,,n.l
<br />of rh. Bu\inc$ r.d Ptufesnrns Cod.. rdd nyli.en{ is in tull rorcc dcnc.l
<br />LS
<br />I.cdilyrhrrhrhcncrionn!mc,,lrhcwo'kfrrshichrhi\pc' rir i\i{!u.(1.I\hrllD.rcnDloyrrry|trsoninrnrmrtrrr
<br />v) a\n, tr(m srijLt blhc so*.n .. rt,cDs ion litrsolCrlilonrin. nml qr.crhrr il I \hotld bccon{ \uhj..rt,lhc
<br />qo,k.r( ro t*i\rri(,rt)n,vnii)tr\ol Scdiotr 3rUrofrhc trEtr Codc.ld(ll.l;nhwirh.onrply wi(hrho{ F,visi(,n\
<br />WARNINCT FuillE xr Ecurc oorkc Lannp.nsdrion colcrnrc i( utrl,wtul. rtrd shall suhid an cmployer ro simnd |fnalri.s Md
<br />civil linc\ un ro one nundr.d rtx,raand dollafi (Sl(x).fi)O), in iddnion ro lhc.o{ ofcompcnsalion- damE.r ar ri.vidcd ror rhc
<br />SNrion:1076 oldE Lrho. Gxlc. inrcrc{ snd dnormy r fc$-l tl|l ^pprio,, Ur?fi\h- F$,n41,
<br />LTCENIEO-(l)Aff,Al.IOf,lrEg,axauo!
<br />-\l),(u
<br />cQNjtIBlJsUONtlltllNC-AG[llr
<br />I hcEbr.lllrD trrdcr ncmlly ol lxrjury rhar rhqe i\ a con{rucrion Lidi'rg rlcrky Ii)r rhc Pcrl'onnancc ollhc $ort ttr qhich rhi\ p.rnrii i\
<br />issu.d (sN 109?. civ c )
<br />AITIICANLIIECI,AAAIIAN
<br />I hcEbt afnn undcr Fn.lly of pcrjury onc oflhc followinS dElaBrinn\l
<br />Dcmliri.n P$nirs Arbeskx Nl i6.alion Fcdcral Re*ulatio.s(_fnlc 40. [un6)
<br />Rcqlircd kxs of NotifEalbtr
<br />l.cdifyrhdrl hrv. rrldlhrsnp,rli.ari(,.od{arc rhd th. rhle innmhri,)n h cor.ct lrgroio
<br />ordi'r'rcsand srar. t 'usrul ingtu huildinSconnruclior md lrcrchy Nrhorizc rcprcsouri!.lotr
<br />otc lmnriorcd pnrFar lor insFcrioi purFres
<br />I.rnilyrhrr rhc f.tlcrrl rcfrhi,,i\ rcerrd gnslr{o\ rc i)vrlmc mr itflr.rhlc n, iht !(+cr
<br />i.{nl orAa0tSi[nnrure
<br />Voty r o,
<br />ELECTRICAL-INSPECTOR RECORD
<br />-l-
<br />!\ owmr or rhc polrcny, orhy.6ployes wirh waCc! ns rhcir $lc co.rFnsari(,.- silldo rne wort ad rlE iturft k n.r
<br />inrcnddl oi oficrcd ftr elc (Sd 7044. Busircs atrd Pmicssnrns Cdcr Thc Conrruci{r\ Li.cns. tjw do.s not .p!ly lo m owncr o,
<br />rhc ImFnt wb hild\ or iry)mB rtrd( dd who dds skh wo* himsclfor hcrslfo. rhmu8h hn or hcr owncnployc.r,
<br />,rovid€d rhar such impmvorcrrsuc nor irr..ded qoi'cr.d torslc.la ho*dd, rh. tuil]in8 o. i.{,mttE Lssldwirhinomylr
<br />.f.onpLtbn, rh. Owmr Buikl:. pill hart lh. burdcn of pmvinS rhd h. or shc dil not huikl oi i,.{,ow rhc tmpcny fo. llt ,,nrlns ol
<br />t ndcis Addrc$'-
<br />\^y'
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