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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Under round
<br />Pole Bases
<br />Li ht Standards
<br />S FountainsASPool
<br />Fire Alarm / Dam
<br />Communications Cable
<br />Buildin
<br />Under Slab / Floor
<br />Bondin / Groundi / UFER
<br />Transformers
<br />Air Conditioners
<br />Rool To entEul
<br />Factor Wired Unit
<br />Walls Rou h
<br />Ceili hST-Bar Ro
<br />lt/leter Release
<br />Rou h
<br />Service Meter
<br />Notes, Remarks, Etc
<br />OWNER BUILI'ER DEI,CANA'IION 'I h..chy lfinn xndcr lcn.lly of IE jury rhll I m .rcnur 6om lhc Conrn roB Licc.sc lis for th. iollowi.g rcason l sr 7031 5
<br />Busi.css nnd Profcsiofl Cod.): Any Ciry or Cou y whi.h icquncs a Fnnir k, consldcl, 0ltcl. impt,vc dctrBrli\h 'r rcNt ,nv
<br />slrudurc. Drior ro ils irsuone. alq, requir.( rh. rppli.mr ror such lcrnrir io filca sigtrcd (.tem rhd hcorshe i\ li..n(d Pusurnr
<br />ro rhc povisionr orrtE conkacktr\ Lienrcd llw (chapr.i 9. comrcNin8 sirh s..lion 7u)u ol Dilnid 1 ol lhe Brnncs and.
<br />Pofc$ions Cide) or rhlr hcor ahc i\.rcnu rhcrcfromand rne b$is ror rhc ulk8.n crcnv,rion Anyvnnrlion.fsNrilnT0ll5bv'trv
<br />ipFli. t ror a Nijnit subjNls lnc opplicanloacililpcn,xyolnor morclhan livc hutrdNd dolhis ($5fl) ].
<br />-l-
<br />N o*nc, ot lh. phpcdy. or nry cnplorccs Bilh w!8cs as rh.i $lc (,nPc.srio.- sill d. rlE tr.rk m, rtf, nru-lm i\ mr
<br />im.ndcd or ofcrcd for srlc (Sr ?044, Au\irc$ dd Pr.r.sion\ Code: Thc GJnracM\ Ltcnr€ hw doc\.ol lrplv !) m o$Nr or
<br />rhc Impcn, wb builds.i irpmEs rtEN.. o"d who des lEh s{n( hinslfor hc^ctfor rhmu8h his or hdr ow.cDlnkry..s.
<br />nmvdcd thar slch imlrorcmors !rc mr inrcndcd olf.id fur slk Il howcRr. rh. tdiL]ing or trpmEnEnr is $ld wirhin on' )otr
<br />.f c.'rpljrbtr rtE ovncr Bu ds uill haE rhc hrden of pmvihg iln[ hc or shc dil mr hild or inpr.k ihc l)nlEny f.r rh. purF){ of
<br />L asowncrofrhc pmpcny.anciclusilclycodrlcring wnh liccosed co.rEc ttrs lo c. n strucr rhc rmFlt (Sd 7U11. Bulires\
<br />and 0rf6si'n Codc: Thc C.nt..ntr s Lic.trsc Llw dcs nol anrly x, M owtrc, of PrcPcny who blildr o. imProv$ rhcrmfl'
<br />a.d who conhcrs for ucn nroj.rrs wirh ! C-o.tr.b(s) lkctrrcd puruunr t' rhc Conlracrois l-icttrs L!s)
<br />-l
<br />om csnrpt undcr SR_rion-- A & P C. fd rltis r..son
<br />t sl€ O*nE
<br />womeni' cotrPers,rrlotr
<br />I,IECI.IIEAIII)N
<br />I hcrcby lturmunder Dcnolry or pcrjxrt onc olrhc lollowirr d(l$oln'ns:
<br />-t
<br />h.vc mn will roi.rdn , ccnifi.0rc of Consent n, Sclalnsurc lor wtrkcH corlt'.n\lrion.as pmvidcd lor bvs&1nrn l7(x)dflhc
<br />rjlitr Codc, rbr lhc I,erio.mnc. orrhc w.rk for which lhc rcnni k n{uud
<br />-lhrrcand*illNrtrrirq'ortc&conrFn\arioni'r\urftc.rrrcquitd6yS.crn]7molrMlil]{trCodc.forrhcPcrionEm.otrh. sork f(n *hi.h rhis Ernril is issucd Myworl.rr.. Dcnsrli(in insurrncc c rid nM Flic) nututfr ur
<br />Poljc, Nlntui.-ExPtcs
<br />-
<br />I ccnifyrhrr irrN jErlornrd..orrhc qnrk Inr !hichrhi\ n rmir i\ ir\u.J.l shnllnor.nrnk,!'an! Nnon io rny m ncr
<br />$ ro hc(nN \thlcd ri lhc trorkss conrP.trldbn l ws ofcrlilunir. ud !!rcd drr ifl slurld hcconc srhicd brhc
<br />*rrkcr\'convcn\rriontovisiotrrofSccrion.lT0Oofrhcl-nhnCtic.l\lull.f.nhsirh..mlly*ilhrho*rftrvi{.f\
<br />Frilurc h) \c.urc workcr\ coDllcn
<br />b onc hundBl rhorsltrd doll.s
<br />rrl. r null \uhiccr an cnrploJct ro cri iril tlcn,k$ rnd
<br />;i ro rhc co\r otconp..\alion. dom8cs as lrovidcd lor rh.
<br />b1
<br />,rrn. tlto, Cna".,,r","r,4!
<br />I h.rcby rlftr utrd.r l.nnlryolt'crj(y nidcrfrcvkiotrolChafr.r9(.omnEnciig*irhSc.rbn7OD)of I)ivisn :l
<br />of rhc Bnsirc$ Md P'r,fc\\nn1s Codc. myliccnsc
<br />a v]t
<br />I hcrchy rfi,rinuM.r p..oltyofptrjrry rhar
<br />i$uc{l (Scc :r(r)7, Civ. c.)
<br />irn lcndnrBr8crcylor rhc p{rrDrnutuc ol th. work ad Rhi.h rhn{'crnrit i\
<br />lr crs Addrc\sr
<br />-
<br />APPI ICAN'T DECI ARNTI(}N
<br />I hctr$,!fimundc.pcnrltyoipcrjury.n of rhc followi.Sdalarurioni:
<br />Dcrm&ion Pcrnits AstEd.! No'incalion ljedcral Rcsularions (Tirlc40. Pnn6)
<br />-Rcqutc(l
<br />tf, rlcr.f Mnifi olion
<br />rtuns na$din8 a\hno\Enrrlnlarc nor nPPlic$|.t, rhis Pmjc(r
<br />cthir lhcrt{vc int,nwn iscn,rc.r. l asrmh..nrplysith0llCiryanrlCoutrry
<br />rhorrr rr$nt.lncs olrht ciry nnd Couly ro e cr utx,tr f,
<br />$urJ "7'{a
<br />Sions (monument)
<br />Lile Safetv /Low Voltaqe
<br />Torqueinq
<br />Sub-Panels
<br />Walls (Conduit)
<br />Ceilinqs (Hard & Solfit Rouqh
<br />I
<br />144.^F|NAL 1l /eq/fr,,;I
<br />tl
<br />rnnri".,r *,rx-r/,,,.-
<br />Pcditk\m. rpdhlr
<br />fT
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