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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS O\!NER BT]II,DER IJEI,('ARAT(}N
<br />I h.r$t rfiirm und.r pcnahy l,f pcijury rhlr I an cicmlr fn,m rh. Co.ta(kF' Liuosc Liw hr rhc tullowhg .ernrn (S& rol'l's
<br />Bu{nc$ Nni Pmlcsion Cdd.)r Any City or Conhry whch t quircs a ncrni ro con(ru.r. .lr.r, in{rovc. &elilh or rcpan ev
<br />(nErurc. p!i{n r, irs isiur.cc. ilso rcqri-r rhc amh.nr lot such Fmir k, Iilc a signed (,cmnt lh.l hc or sh. as h.cnsc'l l)urlhr
<br />ld rhc ,rovisions ol irr Conrmdnn s Li.cnscd L,w (chaprfi 9. Comtunc 18 wirn Sclrn'n 7000 oi Divhion I or th' Busin's anJ
<br />Pnrlcs!,ns Cod.) or lhrl hc or shc ir d.npr rh@tior {nt l lE basis tar tlE dlctc'i crenprbn AtrvliirrrnrolSe.li{'n 70.l l t hvanv
<br />,ptlic,nrrorapcmirsuhjecr\rhc.Ftlicanrloacivilpc."hrotNrfrtrcrh livc hundrcd doutr\ (S5tx])
<br />t. $ own rolrhc tmpe(y, or h, cmtby.cs wilh wiscs as rh.r tulc .omFnsari,,n. w l tio lhc wofi a'rl rh. slrtl@ is n'
<br />inrcnd.d.rdlt.ralb;;E(S(.?()44,snsmsandPrclcsioorCodcTheO r&toisLiccnscljwdo.snoraPPlvbanown.ot
<br />rhc B)pcny who hoildr or mln)vcs rhcetr, ud who
<br />'l.cs
<br />{c[ qnk him$lfor hcrcllorrhRtu3h lris or hcr own cmlk'vecr'
<br />F)vidcd rhrl su.h mprcrttu N frn it cndci or oll'.dtl lnr sh It, llwclc. rhc lnriljin3 or uq*ovcnEnr s sol! wirhn onc
<br />'ed;tcompkiirl rhc Owncr BuiUcr wi[ luv. rlr luilqolPn,Yin3 rhd hc or sltc Jil { briU or inrlew l]lc lopdlv t'! rtE Nrlrt* 'f
<br />I. as owncr oi I hc pmp.dy, r,r c\ulNrv.ly conkdins wrh l,c.nscd cont&r)u b c.n{rucr rrt pn+c! (Sc. 7l}l4. aunnc$
<br />J thnassr, C.dcr 'I hc Conkrcktr r Lic.nsc Law {!er nor rptly b Mowncr ol8)pcnv whr) iruilJs or mpnrvcs rhcrcdn.
<br />rid who conrrlu( Io, ruch 8)jcds rnh { ConrBC()n, liccnscd pusmnr b rhc ar)nrrac(tr i l-icctr* Liw)
<br />I !m.x.nrpr rndci Sccho
<br />aaSEIES:COIIIEIIAIION
<br />IECI.dEAIION
<br />I hcEhy ,rTirm undcr p.n.ltyoiperjuryon of lne louowinr Jebdrions:
<br />IhavcandwiumflainaCenili.ar.orcon(nrloSclltnsu(lorworkcsd'60.nsdtdn..sln,vidcdfo,bvSationr7morrh'
<br />trbor Grjc, lor rbc Frfol]Ma ol llrc tu* tur ehf,h lh. Ilcmn is issu.d.
<br />-l
<br />havc rti will fr,inl.in wo'lr.n orycnsarion iNlraNc. ar Equmd by S.crion 1700 ol lnc Lalirr CoJc. tbr lfic Per,omcc of
<br />rhc *ork rDr whth lhn 0.mr is L$Bl. My wor*c* qtn{Ensrion insuocc 6i.r a,n Fricv nunh.r fl:
<br /><'1., ta r",. j
<br />,qa'b1 l.\ttrc\V-sz
<br />I Lcni,y lhir m rft p.rtutmfrc ollhc *ork fd wheh rhs t'.mir ir tr{rcd. I shlllnor caPlov xn} Pcroo 'n 'nv nr'nncr
<br />y' as tr bc.om suhl&l t, rh. *o*.s conF.nsarion hws olcdl'fomi{, m! rytu rh.r if I du'Llh.toft suhjcur brhc
<br />woik.s' onlllctrsoi bn trc!(n,n\ of Sc.xotr l?00 oI rh. If,trx Codc. I shrll. tudhw(h conPly wlrh rhos Pmvkbns"
<br />IVARNING: I;ailutr lo suu. ktrkcs' uumlcusarion rovcBlc is u.lawlnl $d $rll suhirr an cfrplovcr lo dminal trndlEs an'l
<br />cdil tur.s uJ' k, onc lNndrcd rll,uslnd dollaF ($l(J(),00O), in adn i.n b rhc o( oi comP.n{Lon, ddnD3c\ * pft'vid'd fu rhe
<br />serion 10?6 ofllt L6tdrcod., hrcEsl d alloEy s r..r
<br />9 a.,I s
<br />UCDNIEILCANIBACIgS
<br />DECIdSAIIO!
<br />I hcrcby lllir u cr PcElly oI !.rjry lhal t !n lien{d ud.r PDvnion or Chrpt.r 9 (ommn.'r8 wilh Scclio' 700tr)trDivhion l
<br />oi thc Businc$ .nd PDfcsions cNt.. .,xl my li(cns i\ h tull roEc .d .ltcc!
<br />AB
<br />-L
<br />tr.r#z
<br />-2p't
<br />CONSTRUCTION LENDINC AGENC1
<br />I h.rc6y !r',im undfi pcmly o{ !.rjtry I hd lh.rc rs r .o"slrurion lcndin8 {8crcv n,r rhc Pcrlirmn c or rh' mrk for *hitt rha lrm n
<br />iisucJ (Scc. l(n)?. Crr. C.).
<br />I*nl.ii Nlnr
<br />-
<br />L.dfl's AJdrcs:
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<br />API'LlCr\NT DECI-ARATION
<br />I tErct y ,llim utulcr pcnahy ol pcrjury om ot thc r'ol!,wi!8 dc.lnnr ions
<br />Dcmnii,,n Pctui( Asb(sos Nolilication Fcdcral Rqulal!'ns (T L40 Pan6)
<br />RcqoiEd L.ll.r of Ndifrcori(x'
<br />I .cniry rh.l thc f.dcrat rlnlarions Eaanlina ash.rtor rcmval s Nl llplicubk lo thh Foj.cr'
<br />-l
<br />ccnily rhsr I hav. Ead lhn .ppli..l ion adl {ar. rhar lh. ahvc int mal,on G .orul. I .Ee b $mPlv eilh ,l! Citv and Courv
<br />ordsrn@s ann Srare Liw. Elariii io huiilins connocrioi, a,ri h.rchy rurhtrr. rcPEsnkrilcr or$n C v lnd Cotrntv to
<br />'ntcr
<br />utbn tlr
<br />rhok nrnrtr,rd lr)|{ny i,tr 'n\p{.rur
<br />]\pplienl or A!.nl SiAmlum
<br />Site-Work
<br />Underground
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lite Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />.Walls (Conduit)
<br />-Walls (Rouqh)
<br />:Ceilinqs (Hard & Sollit Rouqh
<br />-Ceilinqs (T-Bar Bouqh)
<br />Rough *z-
<br />FINAL t(r,{14 1 f'r}nlgd m)IT!INotes, Remarks, Etc.
<br />.?/
<br />I U I 00
<br />Pole Bases
<br />Under Slab i Floor
<br />lvleter Release
<br />Service [t/eter
<br />,^*,3-2o-/g
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