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APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bondinq i Groundino / UFEFI
<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 & Solfit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />Rough {- 2r-/o J).Gf,, rf7)
<br />Service l\ileter
<br />FINAL !-Zf -rO J). d.'t (-vd
<br />Notes, Remarks, Etc.
<br />OWNER BUILDER DEI,CARATION
<br />I hcrcbt uflirm uMcr pcnally of lcrjury lnol I m crefrfl lmn lhc G,.rretn Liccns hw rbr lhc lollowin3 ENrr (s(?oll5
<br />Busitrc$ lnd Prcfc$ion C.dc): An, Ciry o. Counry which Blxn.s u ,cImit to .on(dcl. !lts. inprov.. {rcnBlish.r rcp.n atry
<br />srrucrlE- rrior ro ns issrlre. s6 ftqui$ rh. applkanr rur such Frmjt h filc a sisn d \l.lcmm rhrr h. or sh. is liccNn l)urrua
<br />ro rhc pnvnions of rhc Conrracr.is l.iccnsd l.aw lchiprcr 9, Co'nmcn.iir8 wilh Scclion T(xro of Divkion I orrhc Busi.cas 0.d
<br />Pn,rc$ions Cod.).r rhar h.orshc iscrcmpt lll.Bfmm a rhc tssis aor rnc alkgcd cr.npri,n Atr, violtrtionolsccrion?0.r15 by sny
<br />0mli.a.l for { !.nnil suhjds rhc lppliconr ro a civil peoalr, of nor mr. rhm fivc hu ndrcd dollas ($500)
<br />l.as osturofrh.p Fny. r nry.mphrccs *Ih wa8$ $ rhcrr sh cannp.ffnrion. will do rhc wori a rlT(Blmtr
<br />inlc cd or oficrcd tu $lc (S(.704d Busircss ond hotcr\ions Cdlc Thc Conrn.rois Li.cnsc Lu$ docs nol4pl, b dn owncror
<br />rhc rNpcny *hohlildsor iqr.K rhcNtr. dd Rh,dcs$.h*od( hiNcll orhcrsclaorrnr,lghhh r h.r oqn cmFloycc\.
<br />f.vidcd rhnr {.h impmvcrEflls m rer idcnk nr oficrn tor slc ll to*cE. rh. hoildinS or inqrntmnr i\ sLi wirhin ,,nc icrr
<br />.fc.hphrion,rhcOwnrBuildc!sillhrErhchud..otporinAdrlhcorshcnil n buikl .r intii,w l}a Oordly lor ih. Purln* of
<br />l. asosncrorrhc ln)lr{dy. rmcr.lusivclyconlndirs wilI lic.tr*dconl.!.rr\t,.rnrrfld rh. nhj.d (Scc 704,{. Bu\i'rcs
<br />o h)rs{n Codc: Thc ConllNlor's Licctr\c l.rw dm! noi E r l, n, ai osncr ol fmpc ywho builds or impr c\ rhc.con.
<br />rnd who conrrocrs fttr {rh tfi&.r wirh { Conrd.n, lic.trrcd purnnfi r. rhc Conk roi\ t-i.cnsc l-rwr.
<br />_l nncr.nrpr undd S(rtr)ll & PC lorrhi\ r.rvn)
<br />I h.r.hyrflnn,und.r pcmht of
<br />DIICIAXAIIIN
<br />I hrvr Mdsill nrnn.in 0 cediltalc ol C.nro o ScllrlNurc lbr workc^
<br />lltxr Cdlc. for rhc p(rofltutrcc ol rhc Eork l'or shth rhc pcrmir h hsucd
<br />pmvidcd i(tr hySc.rio :17( ofrhc
<br />_l hlvcrndsillm{inrrin Norksr .onFni,rnrn insuhn.c.,s r.quncd hyS.clnnr:ITOOorrht Lrbur Codc. for rhc Flhnrunc. ot
<br />rhc eork lor *hich lhisFrn,ir is n$.d MywoAn{ conFns,lion iNur e.aricr 8nd F)licynuBb.r e.:
<br />PolicyNumbcr-Expt s
<br />-lccnifythol
<br />inlhc pc o,roncc ol rhr sork r{tr which rhis pcrnn is isucd.I sholl nor enDk,,atyllcBon in unyn',nnct
<br />$ !s lo hccoft \uhifl !o rhc w.rkdn .omFnsalbn l.wr ofcalianio. nd asrc lhal irt shruL4 tt.om subjNr lo rtr
<br />wo c6 compcnstion provi\n,ns or sR..r.n 1700.flhe uh*Conc.l shlll. {.nh$irhB,nDl, sirh rho{ povhions..
<br />WAININGT FrituE to $curc *orkcr( comp.nliion d,vcrrac '\ctr{,lotq lo o@.rl prNlis sd
<br />ion. darue.s as pmvid.d for lh€civil fitrcs un io onc hxulrcd thorsand oll
<br />Scclnr 3l)76 olrhc hhr C,xlc. i' crc{ r d
<br />D.le:
<br />I horcbydllrmundcr Nnully ol ricrjuy nrn ofChrrrd 9 (connnctrcirc $irh Scrrion TlXxl) ol l)ivi\iitrr 3
<br />of lhc ausinds Md P$rc$io.s Codc. dr] my liccnsc h llll lbK arl cfld.r
<br />CONiIBUI.:DANIENOINIj.AGINCI
<br />I hcdhy urfinn und.r,rn.kyofI)c jurylhor rhcE n s con(rucrt'.lcndin! {cn.y r(x thc FrfornEncc ofrh. work tur qhi.h rhn Fmi is
<br />i\{rd (Suc :1097. Ci! C )
<br />A.TII.ICANI.DECI,A8trII!}N
<br />I h.Et, aEim nndr tr.alty or l).r!r, om of th. tollowins da,.,0l iofls:
<br />DcrmLtion Pcrftik-Ashcstos No'ific,ri.tr Fcd.ral R.eahrnn (TnE 4{). Pn6)
<br />-Reqoircd
<br />krrcrof M ifimrh.
<br />Iccnirirharrk(lcdcra|rcsula|i{,nsmlrdin8r\lf,{o\rn,rlrrcn.rnPfli.rhlck,rhnI'ntrr
<br />lhor rhc.horc inlonnalio, iscon..r I &gNrocomply wilh allCiryard Counr!
<br />io.. md hcrcbyaurhtriz. lctrc{nr,riv.s oirhn Cirylnd Counry ro cnrcr uBrn rh.
<br />nklak
<br />s/aftotY
<br />ELECTRICAL.INSPECTOR RECORD
<br />Communications Cable
<br />ltrleter Release
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