|
ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Signs (monument)
<br />Lite Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Boof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Bouoh)
<br />Rough
<br />Service Meter I
<br />FINAL 6/7Alt7
<br />^/'ll'.
<br />;{,
<br />Notes, Remarks, Etc
<br />OWNER BUII,I}EX DEI,CARATfu !'I
<br />I tcrchy .mrm unLr p.ulty {'t rErrury rh,r I d cien!, rD6 rrE ( i,nhtur' l-i(nr t w aor l h. follo*ing Rsrm ( s.r 7(r.l l 5
<br />Bnrftlt !d Pn,fcrii,n C.iL) A.t Cny or Cou y *h.h EnuEr . Fmir ro Nnrnrl- s. iqto\t. d.mlFh.r EFit ey
<br />stMtuE. pri, ro ih nsu.R. al$ Equn.r rhc o|lplic.nl tu u-h Frni! ro lilc r siEmd rrd.mnr rh!' rE or nE n licntd pur|rd
<br />ri' rh. F)rnb.r of rlE ContEkri l-Rn€J t * (Ch.Pd 9. ConENinS $irh SErir ?(XI) of Dirkbtr I ol th. Blrim.r ..d
<br />Itmlcsi,r Codc) or rhrt h or sh is crcrpr rh6.rrom ! rh.Ush,rnrr.rllcs.d.rcr{'lhn.AnyvidllionofsNri,n70.115bynny
<br />apfltlnr roi . Frmil rulrr.d\ rlr ,tpltmr io r .ir'l p.Mx, ot ft m,. rh,n lrv. hundEi dollu! (tlx,)
<br />_1. !( owftr o( rh{ FoFnr- 'i cr.Lln cly codrld ing eirh lkn{d .o.rr.kr (, $nqdd rlE f,mFr ( Ss 7O4r, Brtt(
<br />rd Pnnissir C-odr Th. ( onr{lor'i L iccnsc tru dcr r, .mly ro m oucr of ropcn y sL hoildr or imtmv.r thcron.
<br />..d *ho snrE_-h f{, iEt F'Fdr rnh r Co.rdm{r) limr.d pohud t,rlECrdrdri t-t.re l.*r
<br />LcrcnTr urtld SNrx,.
<br />l)rr. ()in.r
<br />]taBf,r&i-r9NIrNsAlIO!I|rrXlllLtl
<br />I h.r.h) iltr.' unJ.r p.trrkrofltrpr! om olrlf, n,lk,$mg,l.ch,riox
<br />-lh.v..,n*illmi.nr.C.niarlrcofcl,ndrt'S.llldrtd@k6oqE.di,...3Fovij.dforb,S<rb.r7(notrrrtrhr Giq l llE txrf(llmm. or tlE wolt nr whth th. F.mil ir iss!.d
<br />-l hrvc 0nl *ill'nrintain sorkcr'cofrp€nrtrrt'n i(\trrnnrc. as rcqun.d bys(ri.nl7u)ollh.lihor(,dc. ror rh. ndronMrcc or
<br />lE *ork ld Ihthrhh rB'ni n i.rErl My *orls. oqE.qri,n insor.rc..ff.!n Jnlt) numtEi E
<br />l..di! rhsr in rh. FrturnrRc oI lh. *uI loi shth thi{ Itrni i\ nsucJ. I \h'll rtn.nqrk y lnr r..q,n in.ny numr
<br />$ s r' lEc,m {ul'Fll. rlE r rlsi .-ntEnqri,. l,$r orcalifim!, atrl 4E rlu f I rlnuld lEor hFrrotlt
<br />*orkcn compcnsrion pr,lisi,n ofSccrion.1?(X)urrh. bhtr (ixlc- I rh.ll. inhwilh o'nply *irh rlh{ pm*i)nr.
<br />l).1.r Appllerl:
<br />r rrFrsm((wrrrcnrl
<br />DEC|IAAI&A
<br />I lmby sfrnn und.r Fnhy oI Fr0ry thd I rm liln(d unlcr I'ovisih of Clunrs 9to'j@nin3 wirh Sdirn TlXrD olDivirbn l
<br />oa rhc Brtiftss ud Pn,f.sion\ Codc, on my li..nr a m tull for.! a l cff(t
<br />g,NII8IJII]QUJ.EBDI!G.A'iE!II
<br />I h.Et'y afirn u6dd ,rrlty of Frru.y lh.l rtrc h r conslMh. lcndinr a8.fty ro. rrE FrormN. of rh. so for $hih rht Fn- t
<br />irsncd rS( lo97 ( it C )
<br />l. Lr'r N.m
<br />-
<br />AIETTNIDIiCUAAII!}N
<br />I h.rt', anim un&r Fnax y ot Frury om ol lh. fol!,tr inr dN&,01bnr
<br />D{mn ion Pcrmik A.rErnr Noiifi.rran F.&rl R.8!lrri)n( frIh;!). Pan6)
<br />RcqriR, lr(d nf l*{'r.drrr
<br />I.drfyrh, rlE f.rrcr.l rcSuldioo\ E8arliry,{E{lor rcmr.lm nn qTl.sbL k, rhn [mFl
<br />EI
<br />Site-Work
<br />Under Slab / Floor
<br />Meter Release
<br />L n. owmr of rlE Fotdy. ft my.r?bF.< wnh $.Sc. B th.r sL mnqErF.ti,n. *ill d, rlt f,rtt.rn ih. (dr ir ml
<br />irtcrldl or orYcEd Ltr sL (Sa 7(X.4, Blcitu3s and Prof.sions c{'ds TIE C.nr&lor'i Li..n* Lq &Er nol !ppl, k, u o*tr or
<br />rlr FlEry wt- txildr d inFr6 rt.BE .rn rll, &r. ut qrt hirell or Lrcll or llmu8n fin d ts o*n.npl'f6.
<br />I'rovid.d rh.r rEh imFmEmn! e Bn inl.idcd n ofic.rd fin {L li bseEr. rn hildin8 o. ir!ffiftd h $E *rhin o* Jte
<br />orsry rim.
<br />'tE
<br />orE BlirbI ?ill lrE llE hrd.. of rrevn! rltr ,E r ilE dU d t iBd iiF,E irE FtF yfdrrrF,FEor
<br />PokvNun6.r'-
<br />WARNINC F,ilurc Io su. srk ^' on{Ensli',fl ovcEsc ir unl,*tul. rnd rhlll suhj(l !n .nrpkrFr l(' qi'nnll Frlri! xi
<br />dvil fi . up ro oE hundEd ihousn dollB (llm.ou,). in .ddirit ro irE 6i ot or{lnslion- d.nr!6 8 lhr .n for rrt
<br />Sdion :10?6 of th. l$or (.d.. intcE$ ud rlrormy\ tar
<br />-l.drfyrh1r
<br />I hdt E.d rhis lpdt,ri'n J dar.rhdrh.rh,1. 'nr.rmrir. ir cdNr I a[,e b c,r9l, tnh rll c !.d(-.rnry
<br />orJiMn($ and Slarc l,ws Eklins h hoiklin8 Lond cri,( rat rFrchy .urhtr,. EFcicnloliv.t af tht Cn, 'nd
<br />Cou y t' .nrd uFn lrE
<br />lhrw mnrmd fmFn, ntr insFrrion puqrr
<br />Applist or ,{a6l sl|DluE: - thl.:
<br />I
|