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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDEN DEl'ARATION I hmlry .mn. unds poalty ol Dcrjury lhal I M .rdpl non rh. Conlrado6 Licm. li* fot thc folk'wins rcer {5(.701 1 .t a!ti'ro! ud Prot63ion Cod.) Any Cily or Cou y vhich r.qun6 s pcnil to cotrnruci. dha. impror.. dgnolish or E d My rrncruc. For ro ilr isruuc.. rl$ r.qutd th. lpplicMr lor surh pâ‚¬mir io fiI. ! sisr.d srarodr rhlr hc or ,r b li.od p6u&r lo lh. rovili.s ofllE (-ontracrois l,i.cm.d kw ((i.rr6 s, (om6.inx snh Scrion Turo of l)ivisio, I otrh. tnainN Mrr Pruf*dr(od.)orrh h..rihri!cr.htrrh6.6omDddr.b6iilo'lh.dlLs.d.rdliion Anyriohrion.fsmirnT0ll iby&y lpplicanl lor ! ,cmil 3ubj6ls lh. .prlicdl lo r civil t 6rh) oa mr m!. ths fiv. fiundrd dollrs I $500) L a omd of rh. Fstxny, or oy @plor6 with *!s6 a rh.n $b odpaadio( sill & rlE wt an rlE n^tlm t e'r rnldrl.l or ofr6.d for $L (S< 7044, B6ind ud ProfBFB Co<L: Tlt Con..clois Lkos t * (tE ml q,ply h 6 o$ffi ol rh. F.Fry s ho lxil& or inF.rE lhqoc &d n ho dc uh tr!* ninElr or helf or llmueh hir or lE ow hpl.rE. provi(H lill $.h inF.wl! R mi iddxLd or olE d 6r $L. l[ lb$nd, llE tlildi.E or trnFlrqEil i] nld wihin M _\r ol coi{,ldia ft i)*ffi &rilb qill law tlE hJd., of F.vi.g lhd lE tr !& dn m' hild or inp..\t th. p.lFry fr'r llE F,pos ol l.6oursof rh.ImFry. ucrclusiv.ly.onrkin8 rnh li..c.d co rdm ro o6tud rlI pmjd (Sa ,orr. BEiEs 3,rl Pi,f*in (o& Ihc Contr*roir Li.drc L,w &6 mt .rpl! ro m o$Td ot FoFrr y s ho b!il& or inpro\ d rhdsn- sd qho snudi for e.h Frldr $ih . c6dd.(3) lrdx.d ,,uM 16 rh. Codidof 3 Li@ tr! ) I u.rdD't ud6 Sdion ]LoarEas:caufENtallor DEC,I.AIAIIO! I ha.$ 3m,in undd Fn l'! olFjur-.mol'h.folh\i.$ d<l&rri(r6: Ih.\.!dwillmi.n.Cdifkd.ofcoMrbS.la-llM.'|r$rt6'.ompcibn.BFlrital6rb,Sdl{!7uJor'& Ltxr (-db. lr th. Ffolrre. of th. qut fd $lii rh. Fsi ir Lsrd I h.r r and s 'll nlinrao tr ortc' corF6.rFr iNraN.. as r.qun.d ht Sd nn :r 7(xl of lh. I lhor C{d.. ar rfi. dfomu. of rh. *o* aor *hrh rha fdrn il i$6d My\omF6rirn idffic @iF rrd polic\ nunhq E I cdr& rhd in fi. Ffo.rm. of rh. uort fo. $hih rhir Ff,n B is.<L I ddl mi nnpri! mt pd$n i..nt n.l:E n a ro tEom $bj.(l lo lh. trqtd'omFEiio" Lu3 of C.tiromL d.srlhr if I sbuld t'Gom sti-i lo dt trlrld onFEdin I'lrunB ol S6lFn 1?& ot lh. L.tor Co<h. I s|rll fonhuth omgly wilh llD* FDvitir6 $'ARNIN(; Frilur. r. Er. rvt6' omFBdh ..Gr!. i! dli.$ful rd shrll qbr.d 6 aphF .nn fi6 op ro oE nu.&al tnou{i dolc lll in rddnion b rh. cor ot.o.rrEd Sdrr 1076.arh.l,hn (-eL mrdd ".,,-io/rt/1( pli r \R \ ll()\ I bdd,r .llm urdd pquXy of Fjuy lhr I o li.qt d urd6 Fo\ tion ol Ch.pls 9 tonltlBins *irh S..rnn 7{m} of Dn i.ion l ot lh.ltlrilB !d Pm&snE Cod.. rd my lte it i. tul lore id.ltd 11 /tt6z776Lrlr COIiIAUEIqIIEdDIIC-ACI!(T I hftl, rffm uBhr Fn ny ol Frury rhr lha. i! ! odndb. lddilE .e*y aor llE FaM. ot tlE mrt 6r $tth rha Fhi ir isu.d (sft lm7. C'Y C, knn6'. N.m. AISIICAdLDECI.ASAIION I hdd't lfrm undd F !l', ol Frury oN oarh. aollowi.B &.hrdiom ftn.hion Pffir!-&bdror Norific.r ion F.d6!l R.suhrio {TnL40. Prn6) R.\tun d I nr6 of Nolifi.alEn Icdrftthd rh. Lnnd r+ubrnrN r+enin8 &rb6ros rmo\ al a. nor amli.abk ro lhi! pmjer I c6nr! rh.l I ha\. rdd rh's Eprlicalion ald st . rh8l lh. atF\. rnlnmalion ii cor<1 l{, comtn rnh rll ( irr and ( ounr} iv6 oflhB Ciry dd Counrr r. ord uF,. fi.odiuncB dSrar. tiqrrchriBlo tDildin8 .onnruc1io.. and h6.bl_ alntEtu. 1q14//r Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Bu ild ing Bonding / Grounding / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilings (Hard & Soffit Rouoh Ce ilings (T-Bar Rough) Meter Release Rough Service Meter FINAL ll lllL{-iT tru*1.14 l?r) Notes, Remarks, Etc.rl UL i:,^,^^;:::ryru Under Slab / Floor