|
ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS olvNSiR tt|[,t)t1R DM,('ARA I I()N
<br />I h€rebr rmrn und$ pcn.lry ol pcrlury rhar I mcx.m fmnr lhc ContrloF Liccn€ Law lor lhc irlLsing rca$tr (Scc 7oll5
<br />B$inc{r and Profc$ion Codc): Any Cn! or Cou.ry *tth quncs . Pcrmir ro 6niru.l- .lrcr. iq,otc dcmlhh or EPit rnv
<br />fflcturc. prio! ro irs issurtu..,Lso rcquirc\ rhc apdicsnr for such Frmn lo nha si8trcd slalcft.r rh.r lEorshc n lienql Pursmt
<br />ro rhe reliiions olthc ConrEcloas Li.cnscd Llw (Chutler g ConlmcminB wirh Sc.lion ?o(x) ol Diviai.n 3 oflhc ltusinc$ 'nd
<br />Phrc(t,nsC.dc)orlhulhcorihckcxcmplrhctc{rom(ndlhcbasisrorlhcalhs.dcxcmPtion.AnvrioltrrionofSaliriT0Slsbrtnv
<br />applic,nr lor ! Frmir sul,jc.k rnc aPPlicanl lo rcilil0cnalryofnot morernln nec hundrcd dollds ($50o).
<br />-1.
<br />!\ o*nfi ol rhc pmp.dy- or 6y cmpk,yes *irh *xscr a( rhdn sok comf.nsaln,n. wi dn llE*oAatrl rh. slEr@ k tul
<br />n dld.d or offcrcd ltr sl. (se 7044. Busincs and Pioltssions Corlcr Thc G)nu{clols t-iccn* tnw dcs nor apllv h 0n oq Nr or
<br />rhr p,Dlicdy *ho tlilds or inItus rhcNn. and *ho dds sth wo* himtlfor h.rslfor rhmu8h llk or hcr o*n 'rplovccs'pn"U"a rir ","t' impnrcEnrs ft mr i .rdcd or offcri ror sk. l( hoNcvcn 11* builli,B or i,r!'ohmnt is sld wnhin onc )ttr
<br />;f .orylcrion. rtrc O*er Buildcr will hat rrr burdcn ol pmvinS rhsl hc o. sh. Jid
<br />'Dt
<br />buiu .r in{xJrc lhc PDFrv ror tlE puqn* 'f
<br />-1.
<br />$ owno or lh. Iopcny- am cicluriv.lr conrEclirl8 $irh licdn*d .onrocloF kr d,Nrru.r thc ln'jccr (scc 7tll 1. l'jtr'i*R
<br />ind Plorssbn C.3c i h; Orrru.rors LiccNe t-aw do* n.r slPly nr !n owi.r of trolc v*h.buildsorimProv'irturcon.
<br />*nd qho contb.rs rn such pnjcch {nh a Cotrtncro(t li.cn\cd luru,nt lo theConradols Ltensc Lrw).
<br />-l
<br />!'n cxcnrU un,lcr sNrio
<br />lhl(
<br />\\'ol{(llRs (l)NtPltNsi Il{}N
<br />IrKL -tsdlLlJtl
<br />I hr,.h\ rlltrn' utrd.r l{0,Llr1 ol lxrrttr\ od.,,lrh. tu ki*rDg r!.rlrrLtr\
<br />l.rhr (i\lr. llr rh. t).,j,f 'r .. !l rlr \.il l(n uhth rh. |xrrrr r N{'.(l
<br />rhc xork for whirhrhislEnnir i\ hsucd Mysorkcr'co srtotr rsnn...nricr dkl loli.y nunftcr dc'
<br />l.orily ihrl ir lhc pcrfoirnincc oilhc tork lnr hlhis pcnir is issucd.lshrll .r c'ntl,ry 0ny !c6on ininyfl'!nncr
<br />$ !s ro bcotu subjccr b thc uorkc* compctrsilion law! ofCrliromir. rn(l asrN rh,t iil should hco@ subiNl lr)
<br />sortcF compen\nriotr trcvisions or serion :l?U) ot rhe lj}x, Codc.lshall. ll'dhwrh cotrrdv wirh rhJ* liovnnrns
<br />WARNINC: tjuilure ro surc $tr!kc,\' c. m!.ns.r tn covcnac is unhsrul. nnd filll suhidr 0n cnulord r' diminll FMItr rtrd
<br />.Nil lifcs un ro otrc htrndrcd rhounhd d.lltr
<br />Se..li(in.1076 ofrhc l-rhtr Codc. irrrcrcd rnd rn.
<br />irnnr 1,, llr cod ol .onD.r$lion. drnu!.c r\ nr,!nlcd ntr rhc
<br />t/rtl14,
<br />peg,axdlxlN
<br />I herchy affirm!.d6 Fn.hyofpcrjury lhdr Ln lien$t !.dc. F.!i$ion{fCluptc 9 (.ommmins sirh s(lion ?ftr}) drDivtion:l
<br />or lhc Busircss and Pofcssions Codc. dd ny liccn* n in tull rorcd,nd.ittct '?:tq t1(o:'.- &o{q lit)
<br />g
<br />a/ttl lA
<br />C(TNSTRUCTION LFNDIN(; A(iT'N(:Y
<br />l icrcby lflirnund.r Nnllly oiFrjury ih.l llErc h !.o.{o.lil'n l.ndills ogcnly f(,lhc P.rio'nunc..flh. worl ffi which lhh p.rfril is
<br />rs'.d rscc :1097. Civ C.r
<br />APPLICANI NECLARATION
<br />I hot+,y affld u rdcr pcnrllyofperjxry unc olrhc aollowins dc.ld,rions:
<br />D.mlnion Pcrmik Ash.sos Notincalion F.d,rlRcgulorions (Tirlc 40. Pdr6)
<br />Rcquircd l€rrcr of Ndincorion
<br />-l.dify
<br />rhd rhc fcdcr.lrcCularions rcSoding tr\henosicmovrl.rc nol tPnli.$lc ro rhn projccr
<br />I..n'fv rh{ I hlc ru'l rhr rDol
<br />.^r'-**i,"1 S'.* r"". "rn,,y'i.dh\c Nn,i ncd nmpciy r'n i?/ltd
<br />icarionrid s c rhd ihcah.\c infonndn isconctr IrgraloconDlywirhallCirvsndCoutrrv
<br />huildiis..trsdcriotr.0ndhcrcl,y,trrh.rizcrcPrcemrir.sofrhisCirysndCounlvlocnr(uflnlh.
<br /> tIliunl..AB.nl Signnlufr
<br />""-n* **",0n*,,.{ }L \'.P L<((*- -7llt ltt
<br />Site-Work
<br />Underoround
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Grounding / UFER
<br />Transformers
<br />Torqueinq
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Solfit Rough
<br />Ceilinqs (T-Bar Rouqh)
<br />lvleter Release
<br />/A
<br />Rouqh -7'Zo-lY h\u1Q
<br />Service Meter Y/\\
<br />FINAL K-lt-lK h,wtLl,
<br />Notes, Remarks, Etc \_7
<br />Sub-Panels
<br />Air Conditioners _ F\rirc.
<br />I
|