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DATE ID/SIG.
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor It 4 Ir1 >t00afi n
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)I
<br />Walls (Rough)WMol | /'1
<br />brboel,Ceilin gs (Hard & Soffit Rough w
<br />Ceilings (T-Bar Rough)ti
<br />Meter Release atu/A 'tr 6JI
<br />Rough
<br />Service Meter I
<br />btuiln,FINAL a0 ir ,a,\
<br />Notes, Remarks, Etc
<br />OWNEI' BUILDl:8 Df, I-('ARATION
<br />I hn l., tllm undq pcn.lly or pcJury ln l t dn .tcmpl from !n. Cod!.cloR l.icoE L!* tor rh., followins t.&. (S.( 70:l l 5
<br />Auh6r .nd P.oasi)n Cod.) A.t ( ny or Counry *hrh r.qun6 . pamit r. ..Brtu(1. rhd, in!.o!., .t rmlLh or Ep.n lny
<br />slrudu.. Fu ro it! irw. .ko rcqurB tlE {pltml for 3u.h Ftu ro 6k r r'{i.n 3dffi rhr tt or dE i! lcqed F,n!,r
<br />b ih. rm\irirB of ill ConUdff! l-k6!.d rr{ t(-h!tr- 9, (onlltri.r slh sdi6n 7()o ol DNi.io. ! of rlE B6itB od
<br />Prcldirn! Codc) or rhll lE or {r n.rcmfl thstnom lrd lh. tGt aor th. .lktal .rani.n Anr \iohrio.ofs.<lion ?011 J byoy
<br />applilrnr for rpmi rubjehth. ltplic..r to a.'vilp.6[yornor 'no'crhs nv. hu6dr.d doller lS50o)
<br />l. B o*F of tlE FoFry, d mr dplolE qth *'.a6 a rh.i hk o,tpdsrhn. *i! do tlr * t!d ErndEirrn
<br />idarLd n orcid lor $lc ts< 7o{-{, B6i6 rd Prof6riE Cc,. ri. Cofrrlor ! LiEa L^ rh6 d pb '. M orc ot
<br />tlc FDFry sto hrik& q ir+rc\E rtEq rd $no dE sh sixt h'rolf or h*lfor rlrougfi fi! d hd os; mpby6.
<br />prcvid.d thlt ruch inFovdat! e ml inlorbl or otrald for $L. lf, h.$66.
<br />'tE
<br />hiuins or unpro\qEn n $E whrtu on, yw
<br />of.orphiotr dE o*M Bnil& win hr\r tlE hdar ofF6vi.s rhi lE or dE dd mt tndd o. in4.ov. fi. FoFr, t r tlE Frpo.. oa
<br />l. asoq€ofrh. For6y. m .rcUsn.b.odr.dinS snh lic.nrn.onrdoR h odrud rlE FoFl (S( 7(}1.1. t61!r
<br />ed r\,iiiir Co&: I h. (i'.rrlcroii l-ic.n.c I !w do6 not apply h u.wns o t po,tny u ho build. or ihprovd rhdon.
<br />an! who o mk tu such Foj.d. wnfi . (.nrmlon i) lic6r.d punod I. rh. (tnlrador3 l-t.M ti*)
<br />ldr.\mp' unLr SaiNn
<br />D.t. ()'n.r
<br />loaffa!:(autlitsallar
<br />IIECIJ8AIIa!
<br />I hqch) .mm unik Ful) of p6luR.rc oflh. nnlNt.t d..ladk!.!
<br />I h.r.liduill ro'd.u . Cdifr.lc oacorsdr ro S.la'lBur. ntrq 16 smrEnsdirn, s Ir!\idcd for b] sd'on .17(x) ot llE
<br />lihr (i{e aorlnc F nrmanc. of rh. worl for f,iich th. pdmn i! ii$.n
<br />I hrlc .nt wil! tu, .in *o.t6 conFEdion iNla. 6 r.qur.J tv S..rh. !7m olilE Lrh, co&. aor rlE Fa(,,rla. of
<br />rh. \ort fd f,hth rna F.mn t isEI My so*d on{E n. !Mm. ..IE in Flt, nunts c
<br />I csl,to lhd in rh. Ffomuc of !h. sort fu uhich rhir FCn" s s!cd, I Jh.ll mr d!h, uy Fsn h rrrndF
<br />s N tr tEom. 3ut dr $ rh. *r*d .onpal'lion h*r .fcrlironn, ed rsE rh,l if I lh.uld tFom subjer b
<br />'lEwo dJ conp@li.n rr.visioN of S.d io. 1700 df rh. Lrbor Cod.. I 3h.ll, fonh*i h .omplt *irh thoE pNvilioN
<br />d anDlols r. mml FEhE .d
<br />cnil fin6 up lo on. h!,rlEj lhouud dolld (tlfiJ,qx,r. in 6JJ mn to n,n. d.J.!*B 6 rrorid.d for lh.
<br />S6-rtrn, nr6 ofllr I nlitr t.dc. 'nrn.srtr ar
<br />D.,,,//'/'1-zo/?
<br />I hs.by.mrm undd toaltyofFnjury rh.l I e'd e (com,mcin* rnh Sciio.7000)of Di$ion lr
<br />ol thcIn6in6sa l'tuf6ioB(iJ., edny li.cnr.
<br />'s
<br />in full nnr. dxl.lf(rL-) - Zo/(
<br />eu-/,3y€6.
<br />or, /tJ
<br />I hd.hy lnim und.r lqulty olpqjury lh!] lh* ir t
<br />issu.d(s( 3c97. civ a ).
<br />irn ldxlins !soc\ lor lhc psfo.rMc. ollhr*o* fortrii.hlh$ Fn'l .
<br />AIILIC NLD'O.dAAI]A!
<br />I hcrr ,trm und6 ,(!lty of psrury or ol rhl toll'qirs dfrlsd irn!
<br />D.mhn,n Pmil^rtErc Norincdion F.dcEl R.Blld rns (Idl. 40. fd6)
<br />R(|utr.{ Ldr( ol' Norrfi drn
<br />I .d 'b rhd rh. tridal r+uhr ioB ..!edin{ atBror rdord d. nor pplic.bl. r. rhi pmj*r
<br />on &ld rd.lhd rh.at{r. hf.mdFn it.otrd I lsr k' omplj_ s'nh !I Ci' r tnd C.untr
<br />flrn6ofrhtr(\rlud (indvro drE ur)n rrE
<br />V 1L.,2-:?20
<br />ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS COMMENTS
<br />Sub-Panels
<br />A/)
<br />7/V,
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