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<br />ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE OWNEf, BUTLDB DELCARATION
<br />I hcEby rfrrn unLr FMhy ol ncrrury rh.r I m.t.r$ rmr 0t Cddi*h tj(6< l* ror rrE follovin8 Erb. ls.<.m-rl t
<br />AuriRr: rd Phfc*b. Crd.): Any Cny or Counry whih Eguinr r Ismi k, oinE.t, .lrs. inqoE. d.mlnh or r.Fn o,
<br />!MUc, Irhr ro iri irsum.. rls FquiEs llE uppltanr l'or such pcnir ro fik . si3Nd (rr.ftni !h:r tE or !r k riccnEn pllller
<br />ro rhc Fovr'i,ni ol rrE Cont-rd r l-Bn<d t,* (Chipr6 9. Conmrng *nh Sarh. 70@ of Oitiri,n I of llE AuriEn .d
<br />l'rolc$i)n\ Codc) m
<br />'h.r
<br />lr or nE n.r.tr{,r rh.r.lmm dd rlE h.\ir fo. rlt alt8.n.khFn. Any ti)liii.,. or sdbi 7o.ll5 by rn,
<br />upplicur lnr 0 pg6t subixrs rtu apnlionr ro s civ il p.ohy of noi n$rc rh,r 3v. hudr.d 'lollus
<br />( J500)
<br />_1. !r osftr of rlE FoFny, d my crrloFr $dh w.g.r
<br />^r
<br />rlEir $l onp.ndhn. U&llE*(i!ddErrElEiml
<br />htcn&rl {r ofr.Erl lor slc ( Sd.7O44, Burirc$ .nd ADac$hnr Cod. Ti. Conk&ror's Litn€ tlr &E. nor rt ly ro rn owd o{
<br />rh. FDIEdy ulD huik! or iqmB rlEn'n, .rn *b iL-s rkh srt him*lr o, h.r*lf or rhb!8h hi! or h.r orn rr{,Ly..r.
<br />liovir.n rh, uh in{rcEmdie d irdicddofidEd lirxl.lt bkE.llE hildin8 n ulFoEfril t$U uath oE Fr
<br />or sq'tiha llE O*rr Auiu.r rill l[E rlE hrdcn or Fovi,8 rld h. or rlr dil Bn faild or dtn& 0E Frr6y ftr rlr lt.im ol
<br />_L &s orE urrh. f.frFny. rr.r.turnrly coddrra *nh lf,Esn oln&1oF nr ondBr ilE FFr (sd ?oq. au\trs
<br />d thlsiirn Co c: Thc ConrE olr l,kcnsc li* dr* tur lpply h r. oskr .r l,mFdy eho bu ilds o! impii,wr rh6on,
<br />lnd *ho.on'r-rrb.su$lmFkwnhrcodBronsllf,.nsd,'ur\uu ro rll. Coflrr&xn r Lt.dr l,w ).
<br />_l m .i.r'!r undd Seri,n_, B lt P C for rhn rcasn
<br />tlt)Rtit-R$ c()lrPtls.tl(r\
<br />Dl:rlr!-B^ll(2!
<br />I h.rchy JlrrD trft1.r Ntrnirr-,'l tkrjrv,trr 'n rhr n,lL)q nt tl.(lrBri(n\
<br />_l h.r. lrl sill rumt.in ! Ccnifrolc of CoNd t, S.ll-|tr!u. fc krt6 or{Etrr.rir, rs prDviLrl for by sdron l7m of rlE
<br />tlbor Cod., ror rhr pcrfomn( ofih. mrt lor vhkh lh. Fsni' is Gsucd.
<br />_l hr\r.nd *ill minuin *ort6 tuitEdr'n i. f!, .r Equn.n by Sdrn l't(r) ol llt L.bor Co&. ror dr Fl(tlr1lN o,
<br />'hc
<br />hrt ,or *hih rhir p.mi' ir ir$.d My e6.rft onrEnqrDn inrulu. ffi.r .d l[lat numhn re.
<br />_, edirt rhlr in rrE Frrornm orrlE *or* ftr *hrh rhB Fm' n sq.d. I rhlll mr ctrphy.ny Fan in.ny nuEr
<br />{, ast,t om ruhJc.r b rlE s.rl6 $qrcnrll.n Lpi.rciifohn, tnd i{B llur ifI rh,uld lE$ft bi{r ro rlE
<br />wod{cr' .utlp.nslri)n J,tuvirions of Scd inn 3?00 or lhc L!hr. Codc. I rhlll. fon h*irh 6nrpl, wirh rrnc pbvirionr .
<br />WARNIN(i F.ilurc x, wE u kc6 (otrqrnFr$n ovcB8. ir urL*tul md \h.ll \rbFr m .nrtlr,ycr tu .rimnd tEut6,Jd
<br />civil ftE\ up to om hundEd rh.usnd ddlss (Slffi,o(x)). in dddnn,n b rh..oi or.o'$.nsorion. drm8.s rs provid.d for rh.
<br />Sdi'n .1076 of l& l,tn CnL. hrcE{ rd ltlotEy r far
<br />Lhl.: Appll l:
<br />l rcENsirr c.oNTR croR
<br />Drcl./tlarxlN
<br />IrEEh,rmrmundsFMxyorFriuryrhdIulNdr.dunit Fovilhn of Clq'rq 9 (sn1rlsing *nh sdb.7flI)) orDitih ]
<br />or rhc BuriR$ snd Pmlcsioni Cod.. !d my ltrnE ! in flll rbG ,i .,T(l
<br />glluBltqlxN.rElac-a{iElll
<br />I tErb, lrm unL, IEMlty Df Fjury 'h{ Er i! r 6NMbn Lrnin, l'wy fo, rlE p.rfLx@ of rtt wl fo, *hih rnn tEni i
<br />n\ucd {sr l(B7. civ c,
<br />AIILLCANI.DEI!.AMIIIA
<br />I rDurq dtrm rnL, FnrI y oI Friury or nr rlE ftnbwi.B &.bdi,nr
<br />D.ftnnn,n PcrmnrAstEsos Norificornrn F.d.ftI R.BuLtio"\ (TnE4,, P!n6)
<br />_Rq!n.n k!!.r of t*ria.rm
<br />l..rrlyrlrrrlr l.dcdlrotuhrrin\ r.riudirt!\rr(oIrN'vrlrr. n.rrI,fl'.rhL k,ihir t(,Jc.r
<br />-l
<br />ccn ify lhd I lEr rarl rhil rmltd i,n !d rrrc rh4 rlE ft)h 'nftrdi,n i! ()ld. I .EE ro mrfry lith .rl Cil, !n Counry
<br />ordi.amci lnd srrrc liu. rhrin8 ro brikhB cotr{rcra,tr ild hcrcbt.urh,ria EF.Ed.lircr olrhir Cny rid Colnryb.nrd upon
<br />'lE!h)v. tunri,rd pf,rFn, ro. iNtrction purpoes
<br />\ppli({trr 0r \a.nr sia'urtrn
<br />Site-Work
<br />Underoround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER I tL,vt Drgr
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />lvleter Release I 1n 1 \rkW
<br />Rough I
<br />Service lvleter t lt7-LI rfr-eg{
<br />FINAL t lcol '?-t t4,*/l
<br />Notes, Remarks, Etc II
<br />tD/srG.COMMENTS
<br />I
<br />R.,v On-07 2015
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