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ELECTRICAL-INSPECTOB RECORD
<br />APPROVALS DATE ID/SIG.OWNEI' BUILDER Di:LCARATION
<br />I hcr.by ofitrm unLr Fulry o( Frrnry rhd I m .r!i9l rm'n rh. Cn.r..h6' Len{ hw for rlE rolbeh8 E.$n (Sd.7011.J
<br />ausinc\s .nd Pror.svon Cod.). Any Cir, or C.E.ly *htn EquiE3 . It.mn to stretut. alrs. in{trov.. &tulnh o, Eru dy
<br /><elk- rFr ro ils is\ur-'c. rl$ rc{tuircr rh. apnlic.nr tor 5th Fhii h fik r risrEJ {{.trnl $d lE or $. r lic.ncd olNd
<br />ro rlE Fvnhro of rlE Conr.rtols Li.c.sd L.* (Cnoptd 9. Conwrins *nh Serirn 7m) ol Divirkn I.r rlE Busi*rs eJ
<br />Pmr*iions Ad., o. rh.r L G slE i! cbrt, rlE lren 1d rh. bris ror $c !lL8.n .r.nFbn Any vk Llio. of S&1bn 70115 hy uy
<br />stipli.r r(r!p.mn bF.h rrE at lkrnr t! r civil FMxy of mr mJrc lho fivc hudrd dolhs (55fi))
<br />l. r\ ovmr ol rtr F)p.n y. !m ci.lusively conrad inE sirh li.cnrJ contdm h .o {fur rlr In'J..r (Scc r(}l,t. au$rcs
<br />Irl l\blal\ih Cul. Th. Contu.ttr r Lrcn\c Lrw d($ nor rrrtl, r. !n or k, ol t (!F y *lr) build\ or iDt()vc! rhcrcon.
<br />Ind *h, d r$ lir \u.h lroFl\ wirh a ( onrhd,,n.) lccn{n p!^ud t) r h. Conra.n,\ l-icn{ L* )
<br />I lnrcrcnrp' u' crssri'n-. D &PC l(lrrhnrcrv'.
<br />lrcl. ()xer
<br />woRxliis' coMPFft
<br />^TrilNIIECT.ABAIIQ!
<br />I tErbyrmrm un!$ rEroh y of rEriury oN ollh( n'lk'*ini &thnrin\
<br />_l hiw ,n sill minr.in . CEnifE.lc ol c.rcnr !o Sclf.l nrurc 6r Mtdsi on{Ensl ion, I Inri!.d fn b, Sr-rion l7@ ot ltE
<br />bh, C.d., rr rtr Frfffi. ol ih. mll ltr whi.h rtE F.mr i n!!.d.
<br />_l h.v. sntl *rll f,'tr .rn m*.6' cori{,.ntlrirn iGUrrN.. .( rcqukn hy Sr--! ir)n lr0l} of r h. ljnoi C(j.. ror ilE Frldrc of
<br />rh. work for uhi.hrhF pcrf,it
<br />.-", i-\rrEU
<br />n ssEl My *ork6 mr{Ensrio. in{ffi. cut, ul Flt, nxnrrr *.
<br />CEI-{ Frra€ ENS\,?i\NC e aJ)q D'+ ^lar ltznu,,*,.*, n'7 c,-,ed| A€jgO63 ,.-,,,".OI ,l
<br />I c.nrtlh.r rn tlrFrlonmtrc.f rh. rul lr *hihllin pcmi, ir i\$cd.l sh,tl nor .n!)hy .iy F6.n r.&rtMF
<br />r,(rrtEom hjd brhcfr,rlR drnFtrsr.n b*r ol crlirttrnir. !d r8r lhlt rf l slnuu bcsN sul,Fcr k'llE
<br />$ull6{.o,!f,nsri,ntn,vnio.sorsdri,.JT{Dol'h.l,h,CdL,lrldl.fonhwithc.mnlyairhrlbepNrisn,6
<br />l{ARNlNc Farlurc ro wE pft r .!trFnsri,. orcnrc is unhwtul. ud \ldl subr.l rn sq,loF. ro {fuirr F ki6 rd
<br />civil rm.! !f b oft hundRl rh.usnl dollsr (SI00.OO0). i. ldni,n re or rc\t ofcomp.nqrion, d.fl8.s !r pturddl ror ih.
<br />ri.ri,.1076 frh.lihyC(i,l. i' .r.{,nd dtorEv'r fd!
<br />-,,, cll2q/a { rpprronr,, , LtcE\sED u6.D4(njt
<br />D}:{JAf,AIIAN
<br />! hcEbt.ntrm und.r p.MltyolFlilry dd l.m liensl un ls lx$vishn ot Oupr( I ($hfttuine *irh s.db. 7m)) rr Diti.bn l
<br />of rh. BunNis $d PmL!.n,nr Cdl., ,n ny l*cM t in full fore Nrn cflEl
<br />i>.r)nqoao(?or{is[zt
<br />l1al13!.Lr]!l.INr!!,r!Ll,(.!
<br />Ih.rbytrflirnu kr Feh, orlErlory rh{ llft n r $Blfrti'n Lndin8 o8cfty lor th. tf,rlolffi oa rlE R nn*hahrtnFdr i\
<br />i!{ucd rsa .!1197. cir c)
<br />ATILISANLIEITJSAII9!
<br />I hdrt'y rrmlnlfi FElry or F Fryomolth. fdlowin8 {k lmtion!:
<br />DcnDttn,n Pcrmtr!Asbcsror Norifar'hn tuc6l Rcruhi,N (Titk 40, Pan6r
<br />_R.qurErl trrrcr of l*r'frdbn
<br />-l
<br />cdif, rh.r rlE ftd.61 EBrhrnrnr Er{dins dlr{s Emhl e nn rofli.rbk ro rhn foi{t.
<br />&-ti di'ry rh, I h.E Erd rh'\ 4tpl..r r,n rn i.k rha th. rt$vc inlormrion is .mc-1. I nrc ro !-rply *nh .I Cny lrl Colnry
<br />onln!n..! ind Sr{c ljsr Ehring tu buillli.8.onru1i,n. !d h r rcIrcrnrariE\ olrhtr Ciry rl G{nry ro .nrc utbn rrr
<br />rbr.,mnrtr,n.d nn'p.n,
<br />Appllcrnt or 8.nl Shtulu
<br />T6ttkc \r,(1C\t-l> (-
<br />d)l
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueinq
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)I
<br />Walls (Rouqh)4 LqPL
<br />Ceilinqs (Hard & Soff it Rouqh --aCeilings (T-Bar Rough)D/,+W
<br />lvleter Release
<br />Rough
<br />Service Meter
<br />FINAL -1t-DDI]
<br />Notes, Remarks, Etc.
<br />Rov OB 07-201.rr
<br />COMMENTS
<br />Sub-Panels
<br />I
<br />D0t
<br />_1, I oBE, orrh. F,p.ny, or mt.nDloFr e h w.8.s as ilEir sL or{Ea.lion. sil dr IrE wt !n dE lllLl@ n ml
<br />iddrddl d oltcrcd fd sL 136.?014. Surircs etrd Prnrcsn m Co.lc: Tlt Co r-l( r Li.ne lr* dE ftr {rpl, to m owm. or
<br />E F)Fny ilr' hiildr d i,qftB dEsr. d *lo dd! uh k)rt hin*lf or hdsll or rhmulh hir m ls om ctt{iotlct.
<br />rrcvii.d 'hd
<br />rEh ir{mw . e d ir.nLd trofi.Bl lor sL ll tns.E lrE hiitliiS d inFuErd n $H *ihin om Fr
<br />of$nphti,( rlEOpd Buitkr *iI tEw !h. bd.noftlotnS rlu lt oi rlE dil r toild d irilmk rtE Frdy 6r rh. FtrFE of
<br />f z.i/ zr
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