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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lale Satety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFEFI
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Facto ry Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouoh
<br />ilings (T-Bar Rough)Ce
<br />Meter Release
<br />Rough
<br />Service lVeter \ .1 {;\,
<br />FINAL h\2gl
<br />Notes, Remarks , Etc."vv_V-rl
<br />OWNER BUII,DER DEI,CARATION
<br />I hcrchy om n und$ Dcn.liy of pcrjury thrt I m cxcm/ rmm rhc C.nrroclm Lic.n* tj* tor rh. folloNinB .cohn (Ss 7031 5
<br />Bu\i.ess dnd Proacsrbn Codc) Any Cir, or Colnly whicn rcquiEs a Fmn lo consldct. llter. imlNq d.mlish or Er'!n ony
<br />stru.lw, prior kr n\ i\{urn.!, al$ rcqun.s lhc anplic& br such oenil xr nb a siBncd shr.mm rhur h. or shc ir li.cnrd puru,nt
<br />ro rhe provhions oflh. Co.traclor's Lietrscd L{w (Cn rrcr 9, Co,nmncinS pith Sccltun ?oOO of Divhion 3 of rlrc Bosincss and
<br />Por.sioisConc)orrhlrhcorshchctmprrhcrclrcmandthcbashtorrh.allqedcic'nprion.Anyen,kionofS.crirnT0ll5byrny
<br />cpjlic nrn ann'hir.uhj,rNih.,ntli.rnrro,.ivrl|cnJlr)rfnnrmrcrh8nfiv.hundm,ldnllo\r5:m'It t
<br />,ffflr ,] .* *. or,r" p.r"ny. ur n') cn,Ilnler q h wa8cs 0s rhct slc comretrslrion. will do rnc wo.t ua lhc (*irc n mr
<br />'Xn{yt& -"n"..r r* *t 'sd 704.r Bulm m'l Pn,fcsio.s Cods'rlE Conr6ctr'q l-kc.* ligdo* o.r,rply ro an dqftror
<br />Ihc nn,!cn, wtF huilds or trrFms thcmtr. anl qh, J,{{ smh m* hinr.lfor h.trcllor
<br />'iou8h
<br />his or h.r o*ncmployccs.
<br />,rcvidcd rhlr ru.h i'Illormna e n inrc'dcd or o,fcrdl lbr eh lt ho*ckr, rhc tloildin8 or iqrovc,Dnt is $B wnhitr one }!lr
<br />of.on{,lctioi. rhr Ow.cr Auilld {ill hak rh. budcn of tmvin8 rhd tE.r chc dil mr trild or iqmr thc pDFny for rhc pnrlDr of
<br />l. nsosNrofrhc pn,Itdr. r.r.tu\ivcL!c. racring $irh liccnscd confactr\ n, conntucr rhc fx,trr(ss.7I).l4, Sunm*
<br />nidPnnc$hnCodc:IhcC.'llrr.loasl-i.cnscLnwdocsrcrapflyr)rtrsncrolI'roni!yahobuikl\ornnprou{lhcrcotr.
<br />r d *ho cotrhncilfttrru.hrn!..r\ qnh, C.nkrckn(s) lic.nscd pu^unr h rhc C.nkrcr, \ t
<br />Trt\il
<br />_.8 &
<br />t,U
<br />I hcrchy rffnf, untlcr prnrlr! ofntrpr) oi. otrhc follo{ inr ddc
<br />Ihr$ddwillnDinrrinrCcnifi.rrcofCon\cnrk,Sclilnsurclor$orkc6$mp.ns!rioi.a\pn,vidcdfffbySc.rtr)nlT0Oofrhc
<br />L htrcodc.nrrhcpcrform3nceorrhc$stlor*hichlhcpcnn i\nsucd
<br />IhJvcrd*illmrinrai'r*orkfiL.ortc.\rrionin\umncc.r\r.quncdnrScdbn:l7l).0ofrh.ttrborCo..f(trrhcttrrlonmncc.f
<br />rhcs.rkforqhichrlri\FnnirisNncdMy*.rkcri.oi1nctr\rri, nnurr cdrffiicr rlB'l'.yitr rh.r dc:
<br />4i***.*l************r*,',.r,,,.,,,ffi ,xnphyrnyFrs inrny'n mr
<br />hould lLtonf, subirr lo rtF
<br />workctr' c.m!.nsorion Fmvhions ol Scd ion .1700 oa thc trtrr Gi., I shdl. lonhsith $mply *il h th$ prcvision!
<br />gr i\ unhLrtnl ud shrll rubF.'r !n cnlllkDu r).tinriMllc,nlrid trid
<br />l[.o{ oi c.'nnrnsdrion.
<br />l herctyrntn undcr pcnrhy ol Frru.y rhlt I jD licctr*d und.r pflrvis olChxuc 9(comnrncitrg wilh Scction ?OO0) olDivhion l
<br />icnse NumtEr:
<br />-
<br />caxsrB!]qrlodtENllllc_dallgl
<br />I hodby rinn!und.r Fnslry or lcrjrry rhd rlrr. incon{tucrirn hndirgascky rurrl[ p.rr.r r..rrhcw.rkrorqhic[lhhl]cnnirh
<br />issucd rscc l0q7 Civ C I
<br />APPLICANT DECLARATION
<br />I tErr.mm undcr pcnally of lErjury o.c olth. followire d.ch,riotrs:
<br />Dcmnltun P.rmil\ Asb.(.s Norificalion F.d.ral Rc8uldri.ns (Titlc40, Pnd6)
<br />-Rc{un
<br />d krr$olNolilrcarion
<br />l._l*ali rh0rrh.lc.lc rlrcpu.dii,n. rcEddinF r\hca,rrc rur.lLrcn,iitf'rihlct'rhnrr.,cc,
<br />,lAl,,*,, n*.,*o,n* rrrrhcJ,Bn,JJd narrhd,h.,rn r asr,n, m.,) utr1a l
<br />orl aDr.r rfd Srlc l.rq\ tolarir[ tu h!'ldilu
<br />'n.
<br />rrl h.rchydrlDri/c rrnrcsonr ivo\ ol
<br />;t ii;$orc n'ctrrnnr.d pn'!.ny f(n in\Idnn
<br /> ppli.!nl or Aaenl SkDlurcl
<br />\\a l'H
<br />.
<br />nrclliflt
<br />COMMENTS
<br />l(
<br />of rl( Ilonnc\s and Prrc\sid*Code. x trryli.cn\c i\ i'r tull i,n.r rfrtcn.rr
<br />t-
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