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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Unde rground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm i Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundino / 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 />Ceilings (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rough
<br />Service lvleter It
<br />FINAL 9lllr/4tt q 01 t)
<br />Notes, Remarks, Etc.
<br />OWNER AUII,DER DELCAR.ATloN
<br />I hcrchy lffiln undd peulry of p.ijury rhd I m ci. lPr f,ort rlt ConteroB l-i.cne bw fo. rh. followinS rc0en (Sc.?0ll 5
<br />ausnrss Md Pr,fcsion Cdl.)r An, Cny oi County which Eqnim a ,.mrir ro .onerud. allci inprovc. dcmlish.r Epdi .try
<br />srrucrurc. rior to ils issu0mc. olh rcquncs thc Errltant lor such Frmir ro lilc a si8rcd nalcmnr rhlt hc o, shc is li.cn*d pu!$anr
<br />io rhc povnbns oa rh. C.nrtucrois Liccnsd law (Ch!flcr 9, Condcncing wnh S.cdrn ?fiD oi Divhion 3 oflhc Blsinc$ ond
<br />Pmic$ionsCodc)orrhdh.orshchcxcmprrh.rcfrom0ndlhcb,s[rorrhc,llc8cdcxcnpliotr.AnyviohliotrofSeti,nT0Sl5hrsny
<br />oppliclnl for a pcnnil suhF sthc arplicanr lo scivilrnallyolnot rrcrethatr fivc hundrcddollEs($500).
<br />-1,
<br />as ostr.. ol lh. pmt ny. o. my cmllorNs with w.8cs $ rhct $k smpctrsalion. *ill do rhc wok $d lL srcrm i\ mr
<br />iorcftH or olicrcd for elc (S( 70r,a, Busin ss ond Pr.r'cssions Codc: Ihe Co"hi{n s Liccn* t:w tktr mt ard, ro !tr osntr ol
<br />rhc ropcny who bdilds ur irfmrc\ rh.mn. uil wlm d*s sNh qo* hinNlf or hcr$lf o! rhmuBh his or hcr o*n.n{iloy..s.
<br />Fovidcd rhnr such itnprornrnh m ior i .dlcd or oflctd for slc lt hNr*r. rli huikling or inqro\um is soh wirhitr orE )u
<br />of con{,hlion. lh. Owmr Buildcr will hrw ltE budcn ol pmving rhd tr or shc dil mr &i[ or inyrorc ltc Impdy nn rtc tn,Fi* .f
<br />-l
<br />nnqeflrpl uxlcr Sccr
<br />Oln?r:
<br />}IaBTE&I11:I,IIIINSAIII}B
<br />D&SLAAAIIO!
<br />I hcrl,y rni'r unJcr |Inxlry ol p.rjrt onc of rtu lnlk)tri'rE d..hmrion\
<br />-lhavcandvilltuinuin!Cenific,reofCon\c
<br />roSclllnsorclor$orkcE.\,mFnsrion.rapovid.drorhySccrhn:l70Ootrh.
<br />ukr Cde. for lhc I'.rformncc ol lhc eort aor whi.h lhc ncrmil t hslcd.
<br />-!d-'""ridwill hn rin sortc6' c.nrNnsarnr nr\rran.c..s toqntcd bf Sccr k,. l7(x ).1 rh. Lrhor (nJ.- tnr rhc Frfom!tue ot
<br />pcirnn k ksucn. My *orkcrc' .onrc.salioo insurarc! cntr and F,lty nu'lher 6c)-Ft&/LS lAkr-ao n* /o c
<br />-l
<br />ccniryrhlt inlhc pcrlarmlnccofrhe work,i,! whichrhh pclnir h issucd.l shall nor cmrl{,y rny p.rv,n in rnynrnmr
<br />s) rs b tf,(om \ubj.\r tu rh. wof*ds .omtcnsdn,r hws orc.lirorni,, and.BEc rhd if I should bc.onf, sunrErr h rh.
<br />qorkcN'coq)cns{ionpn,vkionsolS(tionlT00olrhctrtF.codc.lrhall.lonhwirhcnnplywirhrhoepn,vttnE.
<br />WAXNINC: t'ailurc to surc workcrs'compcnsalion covcmBc n unhwful- ud shtrll sthii an ctr9btti k, dimiml Fndrics ,nd
<br />civil fitrcs !p k, orc hnndrcd lhousa dollais (Slm,(no). in rddilion ro rhc cod ofcompcn\arioi. dnmg.s 0s Providcd lbr rhc';::u/;/bdc. intcrc( md atlorrcy s lccc
<br />8 ,rppti.,nr, -Z-r !( FNSrn (oNT&l('ToR
<br />DECI,I.BAIION
<br />I hcr.by firftrndcr rcnrhtofpcrrrrr rh.r I am li(n*d und.r pRrvhion.fChnflur 9 (coNrErEirlg with S(rbn ?0U, ol Divnion.]
<br />ol Ihc BusircssaM Prnissnnxo)de. und nyliucnsc n io aull torcu anlcffcrr
<br />C:ZO a6719=
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<br />CONITIAICI&TIEIDIIG.AGINC.Y
<br />I hcrcby lrtum undcr rEnohy.a ncrjlrr rhnr rherc n !.on(rudion lcndinB aacfty rrtr
<br />'h.
<br />p.dormnc. ofrha wo.k for whkhthis pcrmn n
<br />i$ucd (Sc 1097. Civ. C.)
<br />A.TIIIIAXIIJIIIA.BAII9!
<br />I h.rchy Umundcr lxn{ll, olDrrjuyonc olthc f{,llowin8 dcclfolnrns:
<br />D.mlirion Pcirnit$Asb.{.s Notifi .ation Fedcr0l RcEUirrbfl ( (1 irlc.l0. Prn6)
<br />-RcqDtcdt
<br />$olNoriarclrion
<br />lcrdifyrhar rhcLdcrrlrcguhri,'n\ rcAuding r\hcdo\ novrlar. n.rrtrnli.$lc n) rhi\ !tuj(r
<br />I.cnrfyrld I h,vc tundihis rrfli.0tiotrold st.tc rlhr thc trhrlc intonndiotr n.oFccl lo8rel
<br />ordinrk.1.trdSrdcl-awsftlalinShbuitnrg.on(ru.rn,n.r l hrrcby rxrhorir rercscnl$ivcs ol'
<br />rhok nriri,,n.d pn)F-nl lnr i
<br />Appli..nl or Agent SiSnaluE
<br />P t+(,Ct-->^-tc,{9.
<br />o comrly wirh all Ciry and Counly
<br />:,:'7-; "', .
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<br />osovrcrolrhc rmr.ny. !ncictu\nrlyconrftlri.B wirh liccnscd connldn\ r{, con{rucrrhc pr+.r (sN. 7(}:r4. Bx\irc$
<br />dnd t".russbn Code: Thc c..tr.ttr ! Li..nsc Ldw docs nor npply b a..sndr orptupcny wl$ builds or nnprovc\ lncrcon,
<br />and who co.tmcls for such nm]ccls sirfi a Conlock'n s) lienscd pusuotrl lo rhc ConIrrcr(tr s l.iccns tjs)
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