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APPROVALS DATE ID/SIG.COMMENTS OMd-Auiftls Delsrror
<br />I h.r.by lfiim u.dq p.n lry ofpBjury thll I n qchpr fom th.Co r.do 'Lien*Lrw tor tl'. fouowinA rarcn {E 70,I5 Buri.G$
<br />!i Proft.rion Cod.) A,y Cny o, C@.ty rhich r.quts. psnn ro o)lfu, rlrq, inp.ov., ddtrolirh or rc?nr uy ttMn, Fo. b rilulE,.lb..q!iddE.pplidlorshFnnb6l..,so.ddqid rldh.d,Eilc.n*n Fill[r b 0E pwtDsof tlI
<br />Co'rr.cd! Lie.t d Lw (Ct lr 9. Colrllffi'n8 snh sdid 70m of Divi.io. I oI d!. aui.a !n Po&.&d Co<L) d li.t l* d,* it smp' tls.6om rd r[. b.!ir ao. dE .ll.Acd a.dpr'6 Ary vi,ohlon of Sdion 701L by uy.prlid fo.. Fni.$id! dE
<br />rpplioi ro. cirl p.{lty of.oi m@ rlu 6v. huidr.d dollu ($too)
<br />I,! oMs 6fln. pDpdy, or my.nploya tfi wra.. .r rhct EI. 6hr..stiol\ *ill do fi. e.l .nd rlE daN n mr id.!d.d
<br />or o66td fd t l. ( S* ?044. Buur !,'d Prcf.lionr Cod. Th. CM.dd r Li..@ L.w d€ i...rrly ro e olE of tL. poFty
<br />i,lb buil& d inFoG lls@lt !n etlo dod Eh m* hiD.ll d lE lid dr@Bn hi! d ha 06 6?loy..ri FdtLd lh.r rd
<br />inFolllrdr u. nd id.rn d q of6.d fq Eh ll hw.G, ttE boilditr, d '6Fm@ir r Fld dlir N yd of @,!plaoo, ln.
<br />Olr@-AurBn wll h.E ln. hr.r.n of preung (lEdnEdhlilddiEprMfor E plrpo- oad.)
<br />l, a owr oath. prop.riy,.m q.lu3iv.ly @nr.s,r8 wirh liccnlcd co.r,.croB ro @.!t^cr rh. pror{r ( Sc 704.1, Burn.$ Dd
<br />Po,.sion Cod. TIE Contnoor'r L'en* lrw dar rcr .pply b m ow of prcpdy who buildr q mpro6 lh.r.on . r.d who
<br />6.h.ri aor Nclt projeli vnn . Comr.cld, lic6&d pu,u b tlE Cont.dof ! l,imr t * )
<br />I e .r.nF u& sdio..A & PC forrnn r.q
<br />uaaEE8tcau$!5Arrc!.-Dlqiaar&!
<br />I hcr.by rfnrm unds p.Dhy oapqJ!ry om ofrlE followins ddlmrioB
<br />Ihlwrnvilritui.radifid.ofcle rosdfnlEmtuwtd qhD.drbq ! FoviLd fq by sdis 17@ otth.
<br />Llbd C6d., fd.lr Ff@ of .ll *dt fd whi.h th. Fhn i. iqld
<br />I h.vc od *,ll m.in[in wort.r, @Ep.Ntion inturmc., u r.gun.d by S.crion ]?00 ofd.l,.60r Cod., for rh. p..f.!mne ofd.
<br />e,k ao. whici d'a !.mn a io.d My e*qr' @Dp.nrrion iNme csi6.d poli.y .uhbs s.
<br />PolicyNum6d Expn.s
<br />(Thi3 sdo. nc.d nor b. conrld.d ifrhr p.rnii ir for oh. hundr.d dolltb ltl0ol or bsn
<br />I..nify LhI In th. pcrfomrtr. of rh. ro* for which rhi! p.mir ii is.J,I rh.lld dproy rny Fr$n in
<br />b*rtu ,!jd to tt wrt6 trFurie l.vr of C.nfomir ud .gre
<br />id do;!i.n! .f SariM It-J$ I z
<br />?m oalh. Lrbo Codc. L{ll,xWARNINC Friltrr.ro k ur. wo,l.c c.np.ni.ron unhs6ll, ud th.ll sbj6t m.mployq toqihi..
<br />fins up ro oc hu,rdrc.l rne$d dourr (t I m,o@),ii .ddir D. lo th. oi of @np.n io{ d.mB.. s provid.d fo, th. Sexo.10?6 of
<br />tlE l,!.r Cod.. i od.rldlEy r ad
<br />ucElstlcoxlxacrcxlIliclaSdrlox
<br />I h...hy rmrn unda p.rhy ofFiury thrl I m li6r.d uds proyi!,o, ofcuprd9 (@nm.n.'ns enh Sd'on ?0oo) ofDivrnon, of
<br />rh. aurinc$ r.d Proa6.ioE cod., ud y lic.M tr h tull lora Md .fd':lle&-z-;T<-W -; i&'
<br />CONSTRTICTION LEND G ACUNCY
<br />I hd.t y rfiim u6dd p.mny of p..rury rhrr rhc. ir . @ntlrudid l..din! l8.*y lor fi. pdfodna ol th. w(k lor vhrh fiit p66n i!
<br />it{.d (S.c 3097,Civ C )
<br />Lndd r Nrn. _
<br />Attr rcaNrs DEclrf,anon
<br />D.tuftb. P6nl^rb.no. f.rorl6 cn'6 F.ddl R.gul.id! CfirL ,r0, Pd 6)
<br />Rcqui.d L.nd of Ndilicrlion
<br />I qiry $r dE f.<ls.l rcSul.rio ..Srdins lbdoi roEnl r. mr .ppli..bl.6 $jr prqcr
<br />I dit r I h.v. adrhi.pghol6 $d ri\..hoE ilflfuio r @nd I .,rE ro omply wirh rll Cny lld Cddy
<br />nd'o&o..d Su. bw.dt.n8 ro rcred.lv.r of dfi Cny rnn CB.ly lo .nra upon E
<br />ftov. m.nloncd prop.ny
<br />//-
<br />P.mineEE(pnd)oE t4+t.q l,J.z
<br />.&_/z
<br />Site-Work
<br />Underground
<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
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torquing 3lrtlr5 /,+{c)y'tl .rlttul //e,fiiz ,-V s.ttrlz\
<br />Sub-Panels '/SuD Pftcls) 3 tt.'r t,i<-
<br />Air Conditioners lr'l4,'.4, / 2 .rrr,:i s,oc
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Ro ugh
<br />FINAL 4-t-zt L LtsP eP4n3r1
<br />Notes, Remarks, Etc
<br />ELECTRICAL.INSPECTOR RECORD
<br />M \WP51\Pomn-lflp€crDn Fm.\Ei.cher-risp€.ro^ Roqd de 03 31 06
<br />Pole Bases
<br />Service [\Ieter
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