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ELECTRICAL.INSPECTOR RECORD
<br />ID/SIG.COMMENTS
<br />I rm.rcn,pr utrJ.r Scrrtr)
<br />^7/z+l tg os
<br />.UllBri}itsli:1!1l!!.!rllll)Ii
<br />ODIIAEAIIgI
<br />I hcrchyalitruDdcrp.nnlryof |t trryom.frhcfirh)wiri8dc.J rrions:
<br />l hnvc dd w,ll nuint0inrCcnificarcofConsc b S.ll:l|surc fur workcr'co p.nslrion. os p(,vid.d lorbyScdion:lTnOofihc
<br />Itrhtr C{ .. r.i rhc Frlonnanccoflhc wort forshichrhc pc,nrir n isskd.
<br />I hrv.a.d *illnmn nnr wortc.r co'nFn\arbn in\xrni... r\ aquncd h! Ss.'lion:l7lx) ofrhc tjbor Cbdc, for thc pcrtnrfr,tuc of
<br />thc wor* io. whicn rhh lcrmii ii i\fl.rj. My qork$J .on EnsrFtr i.suramc ca crrnd ntytrumb.rar.
<br />RnicyNumbcr:-Ex|lncsi
<br />-lccnily
<br />rhxr in rhc p.rronEn.c.lrhc work br which lhi\ pcnnit is issudd. I \hill tror cnlPloy ony Pcron in uny nunmr
<br />v, Nh h..o,R subjd 11)rhc workcr'comp€n\arion h*soaCalir{riia. rnd,8(rlhrr ii lsh.uld bcc.nlc suhi*l tolhc
<br />workcn..mrcnsdiotrfmvtio,sotSccrion.lTmorrhclitxtrCodc.lshrll.lodhwirhcondysirhrl[tlrovismns
<br />W]\iNINc: FailxE ro ccurc workc,s compctrsalion covcfusc h u.lowtul. and shdl suhjccr d .oplorr ro ni'ninal [rnalris $d
<br />rNrl fin.\ up ro one hundrcd rhousnd dolhF l!100.(n0), in dditiotr ro rh. cosl olconpcnsarion, d,m8cr !s rovidcd aor Uc
<br />Sc.rx,n l07t ol rh. trbor Codc. rmc,$trnd lr rr.,cs -,
<br />"","' 71ztl8 a\-"' z'/ae-e--
<br />tl ,/ \ Lr(t'NsEp coN'rlleroR- \ uElt aaarllla
<br />I hcEh),llirm undcr prnJlry 'n Frlurt rhd I am\rctrqn undc. pmvhion oaCh{'r.r 9 (.onmmin8 wilh Ssri.n 7fix}) .r Divtinn :l
<br />.r rh. ausi..ssond Prcfcsions Codc. iJd nyli.cn* i! in rull foEc and cntct.
<br />CANEIAIJCIION.L8NDTNIAAENq
<br />I hcahy |iltn undc. pcmhyorp.rjurrrhar thcrc is r c.n{rucr6.lcndins asency ror rhr lalonMme oflhc $ort ror *hth thh rcrmil k
<br />i\{ul(Sc. 1097.Civ (')
<br />AffUllNtD[lJrIAAIIotr
<br />lh.rh) auinnun.lcr p.nrhy orpcrjury onc olthc lolhwin8 dccltrrdn,n\:
<br />l)tmolirion Pcflnirs-A\hc(os Norill.ari.n Fcd.rdl RCEUlarnrns (Iillc 40. Pan6)
<br />Rcquiftd Lcll.r oi Norifi.rri(tr,
<br />l.cnilylhal I luvc rcad rhisrprlic,rion,il{.tclhd rhcahovc infofln ioniscotrccr'IagrccrocorPlywilh!llCiryi dC.unry
<br />or(lirnn.cs {rd Slrrc l,nrv\ rcl ri g .nd ncrchyruthori/c rprcdrrivcs olrhis Cityond Counry k, cnts tr|x). rhc
<br />nhovc rtrrioncd !Np(rly li,r ir
<br />\rpliunl or,\xr l Six nl ;, 1p4 tt
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilinos (T-Bar Rouqh)
<br />I\p
<br />Rouoh ,6.-t]Ut ;tg td$l!
<br />FINAL r-tLr9 Dt t<+€-etng
<br />Notes, Remarks, Etc ./ t- tt .-{
<br />APPROVALS DATE
<br />Meter Release
<br />Service lt/leter
<br />OWNER BUILDER DELCARATloN
<br />I hcrc$y amrm undcr pcnrlry of Frjury th,r I m cx.m,, rm r rh. ConrrhF' Li.Tn{ tru ror dE r.lhwin8 EsQn is&t701 I 5
<br />Burincs a.d Prcrc.sion codc): Any Cily or Counry which rcqui,es a lrmh k, onstrucl. ollcr. iryrovc. thmlisi or E oir any
<br />$oclrtrc. prior lo ns issuancc. !l$ aqlias rh. .ppl,.a lor sx.h Frmil io tuc a si8fled slulcdnr rhar tr or .hc is liensed !!rs!anl
<br />nr rtc pmvnionr ol rhc Contr.lols Li.en$d L,w (Ch0plo 9, CommEinB sirh S.clion 7()O0 of Dirision :l .f rhc Busin.s {nd
<br />Prufc$ion*Codc)or$nlhcorshchcxcmpllhcrctonondlhchaihlorrhcnllcgcdcrcnlllion.AnyviolarionofselionT03l5byany
<br />rpFlicatrr for ! permir subiccls thc utplicrnr to a civil Fnrhy or nol mrc thon fivc nhdrcd d.llas (S50o).
<br />-1,
<br />4\ owm, or rh. th,rdy. or my cmplorcs with woBcs r\ rfict $lc 6qxnMio., *ill do drc qut and lh. rr lmn ml
<br />inlc cd or ofr.r.d for sh (Sa.?044. Bliicss dd Prc&sn,ns Cdlc: Th. Conlraclois Ltcns L5* do6 mr tnrly lo on oqner ot
<br />rhc pmFny *ho buiMs or inpmrs (h.mn- ald *ho dixs sNt mrt himr.lf or lE s lr ot rhmugh his or lE. own cqrloyell
<br />providcd rhlr srch imprcvemds d mr inrerldcn or odcEn lor sh. lt ho$eg. rhc boililin8 or in{mrcral is w,ld wirhin onc }ut
<br />of on{,hrion. rfu O*mr BuiUs sill h6ft rhc bod.n or povinB rhd lr or slrc dil mr bitl or inlmE ihc tmtEly ftr rhc l,lqxE of
<br />-1.
<br />trsowncr oI lhc lmncfly, om dcllrile l, .onracr iie *ilh li.cnsd .onlrochs lo cl,nsrd.r rtu poier (Se 7O{4. lruiin€$
<br />lod Piol6sb. Codc: Thc conractols LiccD* Low docs Nr afply h ai owncr or ti(tpcny who builds or inlpmvcs rh$Nn.
<br />and who conhcts l'or such pmFck wnh r c.ntm.ro(o lkctrsd pnhunr rolhc Conl[cror'. Li..nt tjw).
<br />Liccosc cl,*:-l-i.cnic NxntErr
<br />-
<br />D!l(-
<br />-
<br />(o mclor.
<br />kndcr\ Addrc*
<br />I.cniryrhar rhc rcdcrll rcaulrlioos rcsudina ash.{os rcN,,al arc tror,pdtlt lc lo rht porccr.
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