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ELECTRICAL-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNER BT'ILOER DELCARATTON
<br />I hcroby arilrm und.r pcmlry ol r.rjuy rhar I m cxcnrfl rmm rhc Co.ro.los Liccnsc hw for thc followins rcan,. (scc 70.11 5
<br />BusiDcs otu Proltssion Codc): Any Cily o! Counry shich rcquircs a rErmir !o conntu r. ahr. in{tuv., d.nrkh or mttt $y
<br />rd.rurc. pri{n t, irr hsun c. {l$ roquirN rh..pplicnnr r.r qu.h Frfrir lo fik { siSncd sr0tcn€nl Ihol ltor shc k liccn*d poronlll
<br />ro rhc I[,vhions oi tnc Conracnn * l.iccn$d liw (Chaprcr 9. Cdnrnrncin! Nirh sccliotr 7u)0 of Divhion 3 ollhc Bulincs and
<br />Pr.Lssions C.d.) ur rhar tE.ishc iscx. rpr rhcr.fon afrl rh. basis tor rnc rllcgcdcxcrytioo AnyviohlioiofSNril)nT0ll5byrn,
<br />fl,Jffiilffi ;il#;d;ffi;; J*il*il * *,,,,,.*,
<br />thc pmtcny *k' tlild\ or in\roRs rhc@n- atu lho d{rs sucrr rorl hnns.lfor hcr\clfor thmqh his or hcr own cmployccl.
<br />ntuv idcd rh.r sDch inpmwmnrs m mr i cn&d or off.rcd lor s0lc ll how$rr. rhc toiklin-! o, nq,ovemnr t srLl rirhin onc ,fr
<br />ofconDhrion. rhc Ovncr Alikjcr willhlr rhe burdcn ofprovins rhar hc or shc did hr hlild.i inpmvc rh. pml.nt ror lhc pu{$s of
<br />lb**'
<br />I hc..hy rlfirm un,lcr p.nrlrl ol pc'lury oDc ofrlr lnl[,*i',
<br />I lrlc dl will tuinrrh x ccdifi.rrc or con\cnr ro s.la l,Nuro r(n f,nlkd s .omnctrsrr ion- as ptr)vdcd aff l,y sc.r io l7(x)ofrhr
<br />lilxr Codc. 16r rhc pcnordaNc ofihc work for {hkh rh€ pcnnir h isucd
<br />I hi\r rnd will maiar in rorkcrs .omp.n\arion insrrrmc. r\ rcqumd hyS..rn STmolrhc L0borCodc. Inrlhc pcrhrnrnccof
<br />rhc work ror which rhis nrnlnr i\ i\\kd My workc^ .. ,p.ieri. rsura ft .rnicr Md Nti.y nu.rbcr irc:
<br />WARNINC l,,ilu. t, scurc workc,J conDcns{ion .o\rru8c l,Jrcr trn c [loy.r ro .rinrinrl Fnnhis Md
<br />;*:'-,'{"ii?JT#
<br />lltrr\ rlllx)lIxri i]r r,l(liriotr ki
<br />I hcmhy amnnundcr Fnalryol tr.jury lhrl I lnr liNnscd undcr fDvKn Chrnld S (.omnEncins *irhSccrt,nT
<br />CONSI8ICUONIINPINiTGENII
<br />I h.6by.rrm u.dft IrMIlyofpcrjuryrh.r rh"r k a mnsl clbn hndin8.ectrcy aor lh€ Frformnc. ofrhcw..k rarwhichlhk pcmril is
<br />isslcd (SE 1097. Ci! C.)
<br />APPI (]ANT I)FCI ARA]-ION
<br />I lf,'r$y rfinn und.r rcnrlly orprrjury orc orlhc nrhwnrg dccldfurioN
<br />Dcnnririn Priitrirs shcno\ Norifi.rlnr lrdd.ful RcAUhrtnrs (f irlc.$, nfi6)
<br />Rcquncd b(cr of Norifi .rtnr
<br />ft&
<br />lhd $c icdcrdrceuldions rcBrdin8 ashesos rcnmv0l 0rc nol apdicahlc t,rht rr+tr
<br />r I hnrc rc rhisrpflicarionartn crhnrrhcrt r int rnuriotr i\ cor.cr I raarb.ontlysirhrllciryrtrd Connty
<br />Sfurc Lnss rchrirg r. huildlrE ( nvr C,rn! o ctrurr!{rrhc
<br />d pop.ny tur insF.riotr pur
<br />-'"Uhtlrb pplicxnl or AsrDl Sixnnlun
<br />Itmrilee nsnr lr.itrt ):
<br />ruclnnr. ud lrrchy ruilnrizc rcprc\cniariv.\ ofr
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm i Dampers
<br />Communications Cable
<br />Buildinq
<br />Bonding / Groundinq / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Flouoh)
<br />Meter Release
<br />Rough
<br />Service Meter l
<br />FINAL a /22//n -1R6-/,rtJa) /
<br />Notes, Remarks, Etc.
<br />APPROVALS
<br />Under Slab / Floor
<br />l. Nowncrof.hc pmrny. rncxctusivclyconrroc,ins Birh iiccnscd conrrlcttrs b c.n{rucr rh. !ri..r rscc. 70,1,1. Burnc$
<br />ud l\nli\sirn Codc: Thc Cnnrracror's l-iccnsc Ltrw dmr nor aptl, kr Mownrr.fprop.{y sho builds or n.pnvcs rhcrcon-
<br />.trd who cotrimdsl suchpNj.crsqilhiConhcrn(,liccnscd puGuanr rorheConrrlcrffs I-tctrsc us).
<br />Crnicr:
<br />r ir rhcticrfointrtrLrorrhc aon( tu wni.h r[i Nrnril h isu.d.l shrllnor cn[l,,yany p.r{,n i. y trir.trcr
<br />conucn\rri,r f0vi\nn,\ olS..rid.l7lr0olrhc lf,hn (i c.l \lx'lL tunh$irh..nrrily Lvnh rh'{ J'tr,vi\ion\
<br />of lhc Bu\ind$ Jnd t\ofc\\t,NCod., MJ 'nt lrcn\c i\ in full f{tr.c rid cllr.r
<br />Liccn\cchs\r l-i.ctrsc Nutr Er
<br />Dorc ConlDctor
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