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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE lD/stG.COMMENTS
<br />Underground
<br />Pole Bases
<br />Pool FountainsSS
<br />monumenlSiNS
<br />Life /Low Voltage
<br />Frre Alarm / Dam pers
<br />Communications Cable
<br />sBuildin A
<br />Under Slab / Floor {-t11K kt4;h)
<br />Bondin / Groundi / UFER t)
<br />Transformers
<br />To uetn
<br />Sub-Panels
<br />Air Conditioners
<br />Roof To ul mentE
<br />Walls Conduit
<br />a t-29'ttr .*.vro\
<br />Ceilin hSHard & Soflit Rou L294tr )-wbl- r\7
<br />Ivleter Release
<br />Rou h
<br />Service [t/eter A\
<br />FINAL t -71-ly Y-WAl
<br />Notes Remarks Etc.
<br />OWNER BUILDER DELCIARA'IION
<br />I hcrb! arfifln und.r pcnalty ol pcrjury lhar I m crcnfl lmnr rhc Conkacron t-icctr* ljv for rhc totlowing rcdv,. {a{c.70.1t5
<br />Burin.s Md Prolcssion Codc) Any Cily or Counry which rcquncs o Frnit to consrtu.r. atrcr nnl,()!c. dcnrti\h .r rcr,t my
<br />slrucrurc. pna ro ir ksuane. al$ ftqlircs lhc epli.am ro, such pernir ro 6tc ! (igmd sl.lcm.r that hc or shc k ti.ctrsd purlml
<br />k, rhc pDvnions .rrh. Conkacrols Liccnscd Ltrw (Charlcr 9. Com rming wirh Secrion 7qD or'Division:t .rrhc Burincss and.
<br />Pmhsstunc Cdc) or lhur h.or!h.
<br />^cxcdtl
<br />rh.rlror r.d rhcru\ir i(tr thc otlc-lcdcxcryrbn Anyriot ionofsslionT0lt 5bttrny
<br />lpplic0nr lnn Fm,ir subjcch th. rypli.,nr ro a cilil penolry ol nor ntrc rh,n fivc hundrcd dottaG ($50o)
<br />-1.
<br />rs owncr oa rhc pm,rcny, or nry snDk,rccx rirh wn8.s * rlrir vrh conD.nsltion- *ill d. rfu wo* t l rhc jndm iqrr
<br />inlcndsl or.lLtd nr ehlS(?(!44, Busincs{ rnd Pnr|s nsCdc TheCoDrr.ror'sLn{trpLrsdocsnorapptyloanowncrof
<br />rh.rn)Fny sb Soilds or nnlnvc\ ENn. ,rxl who dB Mh wrt hi$sctf or hcr{tf or througt hh or hcr own cnrrtoyc.\.
<br />prcvidcd rhd such nnrtuKmn^ ,rc e, i"tcnncd or ofrrd fo vic. l[ hosers. rttr t itdiig or iqmrcmnr is $td wirhm onc }trolon{rklion. rh. Owncr BuilLr will hovc rhc hufthfl olptrrinS lhd h. or sh. did en l,uitd or im[ovc fi. rmrxi, for rtr purlDr ot{lc,
<br />l. ds o$ncr oi rnc pmNnr. m cr.lu\ikl, conlraflin8 virh ti..n\cd .oftrcrn\ ro cor(rud lhc ptuj..r (sm 7041. Bu\inc$
<br />anl Pnlc$ion codc:'Ihe Conlrdor's Liccnsd Ltrw dcs nor apolyro r. ostr.i orprop.ny wno build{ or inrpr.\ts rh.rc.n.rrd who conrm.h lor sxch pmJcch witha Cora.krG) liccnscdl}usurtrt lorhcCinnra.nr'sLiccnsc tjw)
<br />I amcxcmrrund.r Sc.ron ,B &PC torrhnElson
<br />Date - O*ner
<br />wonxrns' colrpels,rnolr
<br />DECI,IIBAIION
<br />I hcrdhy urfii,n trnd€r Ntr.xyorFrjuryonc olrhc lnllowin8 dct.Etioa!:
<br />I lrvc r *ill rmintiin a Ccnii.riE of Conscn o Sclf.lNurc tur w.rlqi onrp.trsriotr. is rft)vid.dforbySccrnrn.lT0Oofrhchhn C{rlc. nn thc Frronnn.. o r rhe wo* iorwhi.h rhc fknnit ir hsucd
<br />_l luvc rtrd rillnuinrain soikcs .onlcnrnrio! innmncc. rc rcqun d hySc.rton.t700ofth. Ltrbor C.d., r(r rhc p.rforrorce oflhcworkfoiwhirhrhisErniliiissucd.M,*orlssconp.trslri.nirurr.c.cricrsldInlicynunrhr.:
<br />Policy Nunhcr F\ntr.. _
<br />I ccdify rhll in lhc trrlormmc ol rh. uork tu Bhhh rhis r.rmir h issled- I sh{ll nol cDptoyary lc(od in ntrr, Danrury, 6s ro b..oft sll,jd b lnc wor&cr{ co.f.nsarion laes ofcaliroilin. uM 4nc rh r irI sh)ltd t8om subjcd ro rh.
<br />workcn.onD.n\!lionrnvnionsofSccthnr7(nofthcliborCMqIshrlt,i(dhsirh.omd,*irhrho*,rovnians
<br />$ARNINC Frilurc h $rurc *or[cr conrpcns.lion d)vcrrgc h !trlawlirt. atrd {rhrc.r xn rmtnoy.r n, .ri,niMl |titrIlc! n0
<br />.ivil fincs u! lo onc huMrcd rh.ns id dollsr ($tfi).o(xD. in addir con'pcnerio . dd r,sc\ ar proridcd tr thc
<br />Scri(n 1076oirhc LilnrCodc. ir crc{indrrormy sttcr
<br />I hcrcht annhr.dcr D.nohyoflcrjury lhal I rn li.lnst undcr tmvirion .rChaplcr I (mmnErcing wirh s.crb6 7mo) otDilision j
<br />of rhc Busincss and PmLssions Codc, od nrr liccns h in lttt f{trcc ud crin.-r
<br />C(TNSTNIlcTION LENDIN(] A(;FN(:Y
<br />I hcth, lliim undcr lf,n,hy or pdjxry rhlr rherc t u co.sflcrirn lcndins asercy lor rhc pcrlomn( ofuh. work r.r which rhis ltrntir is
<br />issEd {S{. lO97. Civ C )
<br />,{PPI I(]AN'f I}FCLAqATION
<br />I bdry ![tm utrdcr Ftralryolperjry orc oithc rollo]nrg dcctoations:
<br />Dcnmlilion Pcrnns AstEstos Notifi.ation Fcdcml Rcgnlations (Titlc40. Pdn6l
<br />-Rcquircd
<br />t xcrof l.llllific{iD
<br />-l
<br />(ni!that rhc acdcrul rc8u l.r io.\ Ngrrdn's ashcnos rcn$val ffc nor rrpli.,hlc ro rhn noa.l
<br />_lccnil_vih lhrv. rcad rhi\ lmlicatiofl urt sdc rhar rhc ntFrc iitu'rndion t corcci t,gr€roRrnptyrirha[Ciry.ndCounr,
<br />.diMtrccs md Srrtc t!w\ ElliinS to buitnr8..nitucrion. aftl hcrcbylurh(tri^ rctrds dilcs ofrhis Ciry B.d Counry ro cnrcr uFrnrtE
<br />!h.vc nrriiomd prnl)cnylor irsoc.lion ,)uqbqs
<br />,\ppliutrl ar tt l Si! xrtrrr ue6 ",,, Vb/rA
<br />Site-Work
<br />Liqht Standards
<br />f
<br />Factory Wired Unit
<br />Walls (Rouqh)
<br />a
<br />Ceilings (T-Bar Rouqh)
<br />I
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