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ELECTRICAL-INSPECTOR HECORD
<br />APPROVALS DATE ID/SIG.
<br />Site-Work
<br />Underoround
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondino / Grounding / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment r
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Solfit Rouoh
<br />Ceilinqs (T-Bar Rouqh)I
<br />lvleter Release q blng ..-9r4,)
<br />Rouqh alolQT+?/,UIService lVleter
<br />ir.r,,^o *P ,))FINAL ttl%ln'I
<br />Notes, Remarks, Etc U\It
<br />\
<br />OWNER BUTLDER I'ELCANATION
<br />I hcreh, umrm undcr Fndhy or Friury lhll I m cxcmpl fmm lh. ConrrcroN Ltc.s. tjr lor lh. n b*ing rcas. (Se 70ll 5
<br />Bus,ncs and Proitssion Codc): Any Cny or Cololy which Equir.s , IErmil ro on(ocr, ,hdr, i"ll)bvc. dcmlisn or rcrat y
<br />sroclur.. rior b ns hslamc. lho eqlies rhe appli.ur ror su.h ,Emir to filc a sis*d dDrcNnr rhd tr or slE h liceo*d puEunnr
<br />ro rhe pnvhnrnr of rhc Contrlols Licc.scd tiw (Chrylct 9. Commn inS wnh Scction 7mO oI Divi\ion I ol trE Businc$ ltd
<br />Pnrrcsions Codc) orrlrl tEorsfic is cxcar0t lfiercft,dund rhc hrc,s r(tr (hc 0l lcScd cxe mpl io. Any vitnarionolSslionT0.ll5 bydny
<br />appli..fl for a p.rnnl suhj.rrs thc Bppli.,nrr.acivilFnahyotnorrmrcth6nnv€hundr.ddollm($5u,
<br />-1.as6wncr.rrhcpor.ny.ornrycmtlorocseirhesEcstrsrh.irwn
<br />o,nP.nsarion, willdo ih. wmk,nd thc struturc n nol
<br />i ctrdod o! oficrcn ror slc {Se.^ 7044, ausincrs and Pmlcsrions codc: Thc Co rucror'! Lhcns. Lrw do$ mt annly ro an owncr .r
<br />rhc Imp€dy who builds or inpn'lrs ltE$n. sJd *ho dms such w)* htnsclfo. hcsclfo! rhouah hi\ or hc. orncmployccr.
<br />Imvidcd rhar such i'npovc'rcnk d. mr inrcrd.d or ottcEd lor elc lt no*c\ti thc h.ildiu or iqmwmnt is suld wirhir onc )eu
<br />of co'r{,lcr6r lhc Owncr Builds will hrt OE bur.h. or pmvi,IS lhd lr or shc dil ,br hrilil or inpmE lhc lmPcn, lor rtE Purl[s ol
<br />]ff,. *.**, r,* n-,-y. amcrcl!\irly contacrins wirh liccn€d conhcton k, Ln eocr rb pmj.\t (se 7o+r. Busids
<br />rnd PDf6si,n Gldc: Th. Conrr&tols Licen* ti* des nol !Ipl, io ai owncr ofropenywho buildi or imrrovcs thcrmn
<br />!trd pho.onrE.lsfor\uohpu..kwirh!Conlmdonr)liccnsdpuFnMrrorh.cohrocblsLi.ctr{Lrwl
<br />flr "",""",,pr -"t* s"r
<br />(,.,"'e*/tr{2-"ttB ?r-iE*t Ll4{4]ta[$iBltlruurNs,L]tor
<br />DIiILABAIION
<br />I hcrcby rififlnund.r pcMlryorpcrrury.n. olrhc lolbshS d$lmlbn\
<br />Ihrrolrrlrill.Eir lir ! (td ilicar. .l con{nr ro sclt- lnsurc lnr $orkc6' comFn\dn,n. os providcd lbr by SNrion l70o oI rh.
<br />Ijho. Codc- tur r h. p.if.flrurrc ol rh. q'ork fff shich rhc Fnnir i\ i\\u.d
<br />-l
<br />hrle and $ill n.int.in sorkcr' conFnurion i'rsurrmc, ,\ rcquncd by Ssrhn 17fi) of rh. tjbr Cod.. lor lhc Pdf.rmmc of
<br />rh. w.rk r.r whi.hrhk pctrnit i\ issu.n M,worlm comp.nsa'ion insutancc @tricr a'ld ,olty .un$.. uc:
<br />Polic, Nombcr
<br />-Erlncs
<br />[94.J *diryrhd in rhcp.rr(trnDnccorrhc wort ror whichrhhFrnir is is\kd.I sh,ll n.r c,nlloy rny I,e Nn ,n rtrymanm,
<br />! i s r i bc.nnk \ubF! r ro r hc wmlc6 ..qrnqrs,n lnw\ of Crlitdnir. aDd aAEc rhar if I shouu tEcom suhjd lo rhc
<br />*,kfli.umnnsornn!m\i.ron\olS.crio.l70Oolrh.lf,htrG{c.l\hrll.lonh*irhsnlJll}tr[hrh.{nntrni',ns
<br />WARNING F,il!rc r, {curc vortcr' ompeneri.n ovcrs. i* unh{rul and snau subrc.r M ctrPlo)al lo oiminar Ftu[a\ and
<br />cilil lin.s ut ro onc hundrcd rhousand dollE ($100,fi1o). i6 addirion ro lhe cod or cod{rnsrion. daescs ai p'.vid.n ro. rhc
<br />S(rion -1076 ol ihc titn Codc, inlcrcsl and aromr\ fer
<br />t3-5 ?sr€Rr ?$nf^
<br />ucirNtnLrcNr.E clll-B
<br />DIICI,A.BAIION
<br />I hcrcby.fltm undcr Fn,lry ol Frjury rhll I am lie.sd und& Provnion ofCh!0tcr 9 ic.nnrcncing wilh Sdion 7O0o).fDNi\ion 1
<br />of thc Blsircss Md Plrfcsions codc. dt my liccnrc k in {ull lncc and cffc.r
<br />ConlBcior:
<br />CONSTRT]CTION ! TNNIN(I AGFNCY
<br />I hercby .rfir und.r lrMhy ol pcrjury lnll rh€rc is a constocrirn k.din8 c8crcy tor rh€ P.rfollM.c of lnc work tor shih rhis IE nil is
<br />issucd (SE. :1091, Civ. C ).
<br />tJ nd./, NJm
<br />-
<br />-lc.nifrrhr
<br />h.i.dcntlrc8ularionsrcsardinsr\b.no\runn,rrl,.n.rumlicablct,rhnpruic.r
<br />c.difyrhar I h crca riis atpli.lrn,nxnd (dc rhrrrhc.hovc irhnMrion ncorc.1.I rPretu.onr yairhollCiryrtrdcounrv
<br />oidin.kcs,trd sfurc IiqsElaritrs 1,, huiunr8 .oniru.rn,r, tu lrrchy0urhori?.rcpdsctrhirv.sofihnCnyandCounrytuctrrcruJ$nI
<br />r|i,!c ncn(tnrcd l[)|Eny li, ir\t{cr
<br />,\ppli.ant or,\8cnl SirnDlure
<br />OE TEA {flAM
<br />be ltt lzot 8
<br />I COMMENTS
<br />AfII.IIANLDECI.ASAIION
<br />I horty allm under penalry or Frjury onc ollhc follorins d(ladrionr:
<br />D.mlirion Psn ts-Asbcslos Norificdio. F.dcnl R.Bulalio.sOnt 44- Pan6)
<br />-Requtcd
<br />Lcllcr ol Norili.arb.
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