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ELECTRICAi:-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS,OWNER BUILDEN DELCAR TION
<br />I hcr.by.mnn undd l.nalry or pcrjury lhrl I ad cx.nrr from rh. Grnh.b^ Li.c.sc tiw tor ihc rollowin8 rcr$n (5(?011.5
<br />BuFincss and Profcssion Codc) Any Cily or L'ounr, which rcquir.s r Frmn lo .onstdcl, rllcr. imlmvc. dcrmlish or rcl'on any
<br />smclurc. priorh ns nsuoncc, olso rcqunes rhc applicanl for such Fcrnril lo filc r siEncd sllrcmnr lhol hcor shc n li.cn*d pursudnr
<br />lo lhc pmrigions or df, C.nlmcrofs Liccnsd tlw {Chafler 9, Coomncin! wilh s..rion Tqlo of oivnion I of lhe Busnrcs and
<br />Pmrcssiotrs Codc) or lhu t hc or shc k cxcm ln reaon a.d fi. ersi lor rh. alhScd excflrplion Anyviolalionofscclion?O:lltby,iy
<br />upplicrnr for a p..nir ruhFrrsrh. rlnlicanr t, !civilpcnalryoinot mrcrtan nvc hundrcddollaB (S50o)
<br />fll!.^""*,"rrr,"p-pny.o,,ycn,frol*sw(hwoscs,srhcirst.ompcns iotr. wirr do rhc wort ud rt'c nnrrld n nor
<br />inrd&d u o lTcrcd for qh {S( 7(lrl4. Bulirc$ ond }t lcsions Cod.: lle Contreroi r Liccnsc La* doe{ ftr lPply ro an osnf or
<br />thc pmtrdy wla) tdilds or ifrpmws rhemn. and wh. dds tuch krt him{lfor hctrclf.r lhsuah his o. hc! osncmployccs.
<br />lrovided rhlr suci impomnls @ B, hrcnh n oarcNd lor sle lt lnsckr. rhc hildins or inDtutum h $kl wirhin om tBr
<br />of.onrphlhn. rlr Owrcr Builll6 willturc lft hrdcn of pmvine rhd tE or shc di] ml hill or irrmrc lhc poFny for tlt p!,rrEol
<br />-l
<br />aneicmnl undcr S(t
<br />/6,- "*p,*:S_ii )o4 c\
<br />rl2t3trllBs:laurlNt -1.!!2NDEUIIBAIIA!
<br />I hcrcbyamrmuodcr pcnalr, ofpcrjuryone ofrnc iollo*nr8 d(lai0lions
<br />I harr dd will tuinrdin n Ccdrfi.rrc ol Con\cnr h Sclf lnsrrc f(, worlcb compttrs on.ns proridcd nrby56rionST0Oolihc
<br />Ijhfi Code. ror rhc pcrturddc.ofthc sort f.r *hich rhL psnir t istrcd
<br />-l
<br />harc alld will mainhin wortcn cotrDcnsarn inntr.ncc..s rcquireJ 6y Sd ion :l7rx) oi lhc tiho. C.dr, nn rhc l.rron'urc or
<br />rhc so* forwnichlhn pcn.ir is n\ud Myqorkcs compcnerbn insurume.lricr ffil Bnicy number uc:
<br />d,:);::rin rlr r--rfondnc.ol rhc worl for whi.h rl,i\ pcnni i\ n{r.tl.l \lh ltrur c rfl,)yr , tf,so i|
<br />s .s to hsm suhirr ro rhc worlcJ onqEnsari hwr oicaliroinid. ard a8mc th.l iil should hcconrc subj$l ro rhc
<br />$orkcn'conp.tr$rionpovisirnsofSccrionlTU)ofrhchborCod.,lslMll.fonhenhcomtlywnhtho$prolnn'ns.
<br />WARNIN(;: Frilure b rcurc *orkc .onr!.n\rri{m covcr+c i\ trhslnl, rnd shrll \uhtcr m c lroiu h.rirninrl Fnalic\ ul
<br />('vil fincs rn k, onc htndrcJ rlDu\nnd dollrs ($I(X),(XX)).
<br />Sc.Loi :1076 ofd{ Lf,tItr Codc. nrcrc( Md adDrtuy \ tu.\
<br />rtldirion ni llt ron ol .o rr \dRnr. dnirgr{ i! t,nvtlcd lnr r1r
<br />".'.,-Ft Q - Lglt noou*6+I
<br />DECIAMIION
<br />I hcrcbynmrm under Fnally of rcrjury lh.t I am li.cnsd undcr pmvision olChtrpls 9(co'rmncitrB uilh Sdion 70OO) oiDivision I
<br />ol fie Ausinc$ and Prote$ions Code. ,rd hy licrns is in tuU foG a.d ell(r.
<br />LianscN!ntE.
<br />(AISIAIJCIIONIIjNIIXIi.AGEIICI
<br />I tudby amrn rtulcr Fnrhy ofFrury rhd rh.r. is r.odsrrudiin kndrng rg.tr.y for rhc trlfonutrc ofrhc $ort lor u,hkh rhis lclnrir is
<br />ksocd {Sa.1(.97. Civ C )
<br />ASEIICANLIIESAAAIIAN
<br />I hnht amnn utol.r p.nrlry.tp.lury onc orrhc f.UowinE dc.larariois:
<br />Ocmlirion Pcrnrih Ashcsros Norific.rion FedcrulRcsuhhns (lirlc 40. Pan6)
<br />-Rcquircd
<br />l-clrcr oi Noliriorion
<br />-l
<br />cenify &ar rhc fcderal rcsnl irns esardins arrrnos ..m!d arc nor aprik,bbt, rhis pn&.!.
<br />@cdify lhd I h0vu roid rhir npplicdrion flrd earc ltur rhc 0trw i.rorm ion is corer.I trgre locomllyuith rll cil,and Cornr,
<br />,ftlmr cc\rtrJ Srxrr I rss rldint g.otr{rucltrr,. turch!nurhof/.r.pr.lenturn.rolrlrisCiry,trxi(irlr,cfrduBnrlr
<br />ahr'c n,cnlinL\l pro|xny ln! inlpccri{nl h
<br />-)
<br />Applicanl or AA$t Si,rnalrr€4 t b:h/
<br /> etUrro --Fq o*, -,- o dtt4)- !
<br />Site-Work
<br />Underground
<br />Light Slandards !
<br />Spas, Pool, Fountains
<br />Si gns (monument)
<br />Lite Safety /Low Voltage
<br />Fire Alarm i Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq i UFER
<br />Transformers
<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 & Sollit Rouoh
<br />Ceilinqs (T-Bar Rouoh)I I
<br />It/eter Release ?UUrB Jc31-
<br />I
<br />Rouoh 0lrL\lB JFEk
<br />Service Meter
<br />FINAL f-lzglc /U4q/f',)
<br />Notes, Remarks, Etc.
<br />Pole Bases
<br />-l-
<br />aso$nc,oilhcpr.l)cny. !ncrclusivelyconrroclitrB sirh liccnrcd conlmcton ro con(n,d lhe nnjccl(Scc 71144 Bd\incs
<br />,nd P.olcssinCodc: Th. Conka.ror'! l-ic.nsc Ldw docs nor apply k rduw..rofp'.Fnywhobuildsornnprovcsrh.rcon.
<br />and *ho <, mcls for such omlcch $irh r Conk{ck,.lr) licc.scn l]Ursunnr ro thc Cotrrrldols Liccnc tjel.
<br />L''l'. JJ'C'.
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