|
ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Liqht Slandards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueinq
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Bouqh)
<br />Ceilinqs (Hard & Soflit Rouoh
<br />Ceilinqs (T-Bar Rouqh)
<br />Rouqh
<br />Service [/eter
<br />H/[/k (t\61F|NAL tlfri>
<br />Notes, Remarks, Etc
<br />o\\'NIiR trt tl,lrl,R Ll,:1,( .\R \ I 11)\
<br />I hcrch, lrfin uhdcr pcnolly {)t pcrjnry rh,( I .m cxcnPt lmm lnc c.nrrcloN Liccn( Liw lot thc folhsi'4 Msotr (Sec.70.ll.5
<br />Buri..s and Profcsion C.dc): Any Cily or Counry ufith rcquncs a pcnnil ro connrucl. allc.. imnrovc d.mlnh or rplt anv
<br />idcrurc. ri,l ro ils h\!!h... rlso rcquncs rhc lpllic!.r for \xch Frnit lo filc n riencd s{rcm.r thsr he or shc is liccn{d Pu^uin!
<br />ro rhc ptovirion\ or dE CofllEclof! Li.o.sd ljw (ChaPIcr 9. Condcn.inS wilh Stcrion ?uD of Divhion.! .rrh' aurnrr nd
<br />ProL$n,nscodc)orlnarlEor\h.iscxcmptrh.rclrcnandrhcbasislorlhcaltscdcxcnPrion.Anrviolarionofscctiotr?O3l5bvinv1
<br />,pplicanrlbrararmirsnbic.hthc.mlicaorroacirilFnallrornolmorelhainvchundrcddolhd(5500).
<br />I. as owncr of thc ItrolEnr. or my c,nPloles uilh wa8.s ar rhir $h cnmncnsar ion. will d. lh. 'ok ard rlt imtur is nor
<br />inlcndcn orolltcdfors0lc(SerO44.Brsincsn.dB'ofc$ionsC.dcrThccontd.rolsLicenEliwdo.!notofdvror'o8 $or
<br />rhc pmr.n, who hilds or nnF)vcs trson. ond wtn dB sh fr,* hntrsclf or ncr*lf or lhmu8h his or h.r own cmplovccs-
<br />providcd lhal such iqnowmnk oc mr inlcndcn ot ofercd loi {L li horcver. rhc btrilding or ii{,rotmnr ir sld within om J@
<br />;r co'nddi,r. rhc owncr Buildcr sill htrk rh. ttrtrd.n or omvins rhd tE or \hc dil *n hoih ot nryok rt* pmFnv n)r rhc Nrr$* of
<br />L nsowns.lrhc poFdy. ncxclusilc,yconrrucring wnh lic.trrcd conrllctnro onslrucr llE lroicr (Scc 7Ol4. Bu\i'cqt
<br />lnd Pmfdrix Cod.: Thc Conlrlcroas l-iccn\c Lrw does nol t,,Ply ro anowncr of,noFnv wh. builds or improlB rhuon.
<br />a.d wno conrrlck r.r such tmjrcts wilh a ContDcro(9 ln.n*d I'uNsnr ro rhc Conrrbis Liccne Li*).
<br />I exc'npr unddS6lion-, B. & P.C lorlhirEasn
<br />]UlErEItE(OllrENlArlllN
<br />DICIAIAIIQN
<br />I hcrchy ainm undcr pcnaxyol|Erjuyonc orlh. r.lk,$irA d€lamrions:
<br />-l
<br />hrlc and wiu minhin a CenilEarc orcotrelll ro Sclf-lnurc for work 6 conlenslrion .s lmlidcd lor b, Sdion l'7{norlhc
<br />tib.r Codc. lor rhc !c,fo@c ol thc work for which lh. p.rmil is hsucd
<br />I halc nnd srllm.inrrin *nrkcr\'comPcnsati.n insu!!ncc. as r.quncd hySecrion:17fl)of
<br />rhc work forwiichrhis pcmit is issucd My workcrs .otrtFns.riotr insurancccrdicr *n p.li':
<br />rhc t{hor C.dc, ,q rhc pcrlbrm&mc of
<br />&H.l 4oP'v@tut
<br />l.cnilyrhal inihc pcrfornuNcolrhc work ior shichthi\ Pciinit is issuctt l fiill nor cnrployrn,!.4otr itr 0nvnEtrtut
<br />$ ^ b s.cu!f, subjNr ro rhc workr( coqrnsar iotr liws of Cllirdni,, md !8rcc rhtrr il I shou ld lEconrc subjfti r. thc
<br />*ork.6 co'nFns.rion pnlnioB ors..xon 37(xr ollhe Lltxn C.dc,I shrll. thnhsirhonDly airh rho{ Povhiotrs.
<br />IVARNING: hilurc r. *.urc workcr' conpensdri.n .ovcrasc is unhwfxl ,nd shall suhjccr an .mll.vtr to criarindl r.mtics 0rd
<br />ci(il lirN\ up lo onc hundrcd rhous(nd dollan l$lu).un), in h Ih. cos ofconlrcnsarn,i. d mgcs r\ nrovilcd tir lhc
<br />:::WI;:ffi n,,,,
<br />DICI.AIAIX]N
<br />I hcrcby ilfirn undd l.nrlrr of tcriu.y rhnr I m li.ctrs.d und.t pmvisb. of Chqtrct 9 (comtun in8 qnh Sclhn 7000) of Division 3
<br />ot rhc Busine$ and Ptur.sn,ff Codc. a mr liccn\c is in tull lnre ond cflc.r.
<br />z-?-l
<br />u""6 .*,^^* fu.
<br />COM:IBUSIIQNIDNDINIiSGEIII
<br />I hcEt y affirfr xndd Fnalry ol Frjury rh,r dcru n a connruclion lcndinS oscncv lor rlt !frrornuncc ol rhc *ork lo! which rhi\ Fmir ir
<br />ksucd(56. :109?. Civ. C.).
<br />bndcrsNomc
<br />-
<br />lftLICANfIl[lI4lBAI]AN
<br />I trR't y aiim undcr Pctrrlly ol P.tjury oN ofrhc lnllowirg dcchrari{,ns
<br />rlc'noliri.n Pcnnirs Asl,c{os Norifi.dion ,rcdcr!l RcEUl ionllTillc r0.l'jan6)
<br />-RequiEn
<br />L.ltd of Ndifgli-
<br />I cenify thar rlE f.dcEl r.Buhlions Eseding rsb. os Emvrl oE n r ,lplic{blc ro ltis pmjccr.
<br />-l
<br />arlil, rhlt I havc rcad this lprlicarion !d stal. lhor lhc sbtc inrdrfrlhtr is cotr*r' I aSrs lo omplv sirh aI Cnv lnd Counrv
<br />odinutuc.;.d Sl{lc Llws Ehlhg lo buildin! consrruclion. !d h.i.by t!fiori* Eltc*.ldiws of this Cilv ,rd Counlv b cnld lFn Itt
<br />rt{*. nrtrrtri rtlf'of.d, nr frApplic!nr or,\Hdl SiAtriltr t o.|P -r"r"Dl4oe&4a_
<br />ID/SIG.
<br />Under Slab / Floor
<br />Sub-Panels
<br />Ivleter Release
<br />Lo t4aao-
<br />I
|