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ELECTRICAL-INSPECTOR RECOBD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDEN DEI,CAII.ATION
<br />I lEr.by affnn !nd.r p.nahy of D.i]ury rhd I d, .x.hpI t n rh. Co mror' U..tu. kw for th. followin8 Eaen (Sd.701 1.5
<br />Busincss &td Pr.lassion C.dc): Any Cny o. Counry which rquncs o p.!nt h on{DcL allcr i'nprov.. demlish or Rp3n ry
<br />$ruduE, !ri, o irs irsu0nc.. a]lo equircs rlE apDltur for su.h p.mnr k' 6L a sign.d sr ftnr rhrr lE or sh. i. lic.Md tuhud
<br />ro l& pnvkinns of$. Contrcroir Liccnscd lrw (Chaprd t. ComncncinS wirh Serion 7000 oI Divkion 3 ofthc BusiEss md
<br />Pbfesions C*lc) or rlEr 1r or\hc iscrenpr rllElron zJxl ttE baln lbt F alL8.d ex.q)rioD. AnyvbllrionoISrrionT0ll,5hylny
<br />applicint lor a r.mn subj.{ts rh. +plicdm ro rcrvilp.nnhyofnor mrcrh.n n!. hun'1rc'l dollr( (l5m).
<br />_l, a1 ouncr of rll. lfl,pcny, or my c'nprry.cs *nh v4cs ar $.n $k comp.nsion. will d. rlF rolt .id (h. {dE s mr
<br />i d{al o. olT.r.d rr {h (Sc 7Or.1. B!Ji,r.s !trd Blrcs$iotrs Cod.r TIE CodRrois Lic.nc bw Jcs nor 8ppl, ro m o}mr of
<br />the tmp.ny *ln bditl! or iqrovcs rllfrm, uxt who dd! sfth mlt him.lf or lp6elf or rhruu8h hh or lE own.mploye.s.
<br />,rovidcd lhal such impoEmnlsmmrn. cn nroltcrcd Id el.lt horcw. ilf,buildi.S or in ovcm is $H wi6in orc )td
<br />ofcoflrpltbn. E owrcr Buittrr sill havc lhc hrrd.n ol pmvins lhdt lE or $. dil ml buiu or rnFok L'. prpdr, ior l}E p!.!os or
<br />-L
<br />rsownd olrh. rNpdy, r.rciclusivcly Ntrkdlrila rnh li..M'l conlrsro.\ ro oDnnd rlE pmj.d (sd.1044, Burin.is
<br />a,rd Psli\liot Co{., Th. Cont'acrol ! Lr.ok Lar des rct appl} to m orr., ol p,op.ny who btildr or ir9roBs rh.r.ot.
<br />and whl, con@.k for itrch pr+crs *irh a Co'{6hns) li..nll pu6xMr to itr c..b&tocs La.M t:w).
<br />ldrcrLnu uM& s.cnu .B.&P.c tu rhirrcr{r
<br />]!9ts[Eaii:cQllrrti' tla!
<br />DEELA.BAII9!
<br />I h.rcby ilrjln ukL.r l[trrhv olncriuryrn. olr1[ rnl[,wi'rs rlcdiraionr
<br />-l
<br />h.v. rlwillounr( rCeniltntofcoDs.lrroS.lflnsur.Ior*ork.6.omp.mdion,rr If,rvid.d for bySarion 1700ofrh.
<br />V;*rrrv
<br />ntr (b. pdlnlw. ol th. *ort foi qhrh rh. psnln s n\!cd
<br />wrll rtr'ir[rn workcN ..nl|xN nor irrurar., as ,lquiE l byS..ri,n, ]?00ofrlE llh- CoJ.. nn ilt Frtunn c.of
<br />*hkh
<br />'ln:
<br />jrcnd
<br />'r isslcd My!!trkqs .on{r siritr'trhu . N aryl pli.y.uni,.r ac:
<br />Llco (
<br />t)hl-L'olqOl tn+A /n
<br />_l ccnilyihat in rlE F-riornEncc otr|. work tor uhich tht Frtrir is nsu.d, I ll,nlls( cnfloy my tEr$n r dy Mnct
<br />e asro trmm sut er h rh. so*c^ c.mp.i$rion la*s.fCalj|mi., and agrcc rh.r rrI shuld b.coD rubjcd biE
<br />wo.t.6.onp.nsdiotrpm\i\ioBotS.rti)nlTl)0ofth.bhorCoJ.,lshall,fonheirhconDlywnhrlrr*povbions..
<br />WARNING l_triltrr. b kcurc worlc* $,np.nsdion covcmg. is unliwtul. and shall subJ.d on .r.ploy.r to oimindlF@his {nd
<br />civil lin$ ut' b on. hurdr.d rlDdsand dollrm ($100.000). in aunioa ro rl* coi of.u,ry.,Lsdn,n. dmlg.s s trovid.d for rhr
<br />Secrion 3076orrk hh.rCodc. inrcrcsr lnd urmyil!.i
<br />'' rrcmsto comlet:rr_F
<br />DES!484!!ON
<br />I hcEby affr rndd p.nal(yurpdjury thar I.nr lic..stund.r povisionorchlprd9(conmftint wnnSctbn?000) ofDiviiion l
<br />ol rhc Busms ind PDlsions Cod.. !d ny lii.nsc t in ru0 ro@ 0d .rr*r.
<br />c45 A"L4
<br />1
<br />go&trBlc!9NtENpac.agElgr
<br />I herby aitm u^d.r p.nahy o{ p.rjury (h{ rh.rc is . on$ru.iion bndiry racrcy for th. Flormrc or rfic edk fi, which rhi pemn il
<br />issu.d (s.c. 30e?, cir. c.).
<br />AIELIEINIDESIABAEqts
<br />I ffiy,Irufl undq ll.nllry of pcrjury o* ol rlD nnbwitrs deLndioBl
<br />Demliioo PennBAshcnos Notificarion F.dc'rl Rqulrb.s (Inle 40. Pd6)
<br />_Reqoncd lartcr oi NirifEtion
<br />__al.dLr rhd rh.,.'ladl'.tul iaB r cSddrn8 rO.{.\ rcrm\ al m n.r anpl,L abk 'o $h rr.Fr
<br />L.,tzdrty rld I luw Rrd rbs dpnlrasun rl {dc rhir rhc ah,v. inrorndion is cDd.I $rro onrpty uilh a Cnya Coutrty
<br />oilmk.s Md Slar. bls rchri.3 ro ildiq .onnDdi.n. ajn hcrcby ,rtsria r.pEeui!.s or rhk cn y .nd
<br />trbov. nEnrion.d pmpeny lor
<br />ADlrlica l ur,,lgol Si,jnrl!
<br />Z
<br />,,r" I I I
<br />,LO
<br />Site-Work I
<br />Underground Htloo HbrA ,tut"
<br />Pole Bases
<br />Lioht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Itrleter Release
<br />Rough
<br />Service [rileter ^l^t-1t ., a"/
<br />FINAL t'l'1tl ar/uq4t l/N
<br />Notes, Remarks, Etc
<br />Fev.08-07-2015
<br />IrnJ.: \ AdJ.\
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