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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS
<br />Unde rground
<br />Pole Bases
<br />Lighl Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fi re Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Translormers
<br />To uerng
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />fqctory Wired Unit
<br />Walls (Conduit)(t.l,d 1 \-(J..
<br />Walls (Rough)'l ltb t t'\o-4,-
<br />Ceilinos lHarO a Sotlit nouoh
<br />Ceilings (T-Bar Rough)l:7c46-\NA+L {rlY I
<br />Rough
<br />Service lvleter
<br />FINAL 7-t," -tg.J) e(s+,(vt)
<br />Notes, Remarks, Etc
<br />OWNER BT'ILDER DDI,CARATION
<br />I hcrchy rfirm u"dcr Fnrlly ol pcrjurt
<br />'hd
<br />I m cr.f,pr fn,n rlr C.nrBctrd Liccnrc l js ntr rhl nnhwirE tua$n (5c. 7o:l l 5
<br />Eusiress id Prolc$ion Cdc) Any Cny or Coutrty $hich rcqun \ 3 Fnnir lo onsrru.r. .lt.r, inDrolc, d.frnhh or rpnir rny
<br />ntucrure. prhrro irs issuancc. aho rcquiEs lhc lpplicanr lor such JIflnn ro filc! sisnen nnrcm rhnr hcor she n liensed l)urqrnr
<br />t, rhc pmvnions olltE Conrraclff\ Liccnsd tia (Chanrcr 9. Cormcndir8 sirh Scclion 70(D oi Divkio.I ol lhc Busirc$ rnd
<br />PmLsso trs Codc) o' rhrr hcor sh. ircrc.ll)r rhcrfronand rhc hrst l,n rhe lllcAcd crcmprirn AnyliohrionofSccri,nr T0.ll5 hyany
<br />aptlic. l'nraFrmir rubr.clsrh. amli.anr b rcivilr.nrhy.fior m.r. rhan fiv. hrndrcd d.lla6 (S5(n)
<br />l. * own.r of ihc I,I.peny. o, ny enplo'[r\ c iih *rsc\ as thct $l€ c.',pen{ar hn. will do rtr *ork !d rhc (nld& i\ nn
<br />i cndcd or oficrcd for s6lc (Se.70.1-1. Busiftss ond Prcfcssbnq C,)dc: Thc Conha.ror's Lk.n* taw docs nor lPply ro an owncr of
<br />rhc pmlEny wh. h{ilds or inqmvcs ih.mn, dwhar ch srk himrclf or hcr€lf or ihmu3h h! .r tur owr.nDbycc!.
<br />,rovidcd riar su.t imprevenEnrs @ rer i.rcnd o! oficrct fo! ek. l( ho*cEr. rnc hildins or inrotBnl is sb wnhin oic Jtr
<br />of co $kli'n. rtc Owmr Buillc. will h!rc fE budcn ol l,n)in8 rh,r h. or ehc dil nn build or impmvc l,t FmFny for th. puqne of
<br />_1. 0\ o*mr oi $c pn'pcny. rn crclusively confuring wirh lien{d ftntr .bN
<br />'o
<br />co.sd.r rhc l)roi.r (se 701,4, Buinc$
<br />,nd PDliss i,n Codc: 'Ihc Conl6cl(\ l-i.cnsc Law dmr nol arrly lo mo$nrr ofpiop.rly who build\ or in'nmvcs rh..co.-
<br />rnd who.onrmchlorsu.hpn,FdrwirhrContfo(rlicn\.dpu uanr r. rh. Conkrdor'i l-iccnsc ljw).
<br />-l
<br />omcxrnrpr trndn S(rn)ll & l'( ntrIhn r.nntri
<br />uQxtrE8sjqllflNrar9N
<br />DECIA.EAIIO!
<br />I h.r.hyxilitnrxi,l.r pcnrhyorp(rirry.ncnf rhcf.ll,'wiix d(hturi.n\
<br />-l
<br />hrvc rd will ,Mirldn , ctnificatc of cone.r ro s.lr h$un ror sukcs omp.ns ion. m pmvi/lcd for by Scction :1700 ol lhc
<br />hllr Codc, for rhc rdfomrc .frhc wod( aor whi.h thc p.mir is issucd
<br />rhc $rrk turshicl, rhi\ I'cnnir i\ n(trd Mr- $ork$r c.n,Fn\rri,rn nNUr Nccrric. md Ix)lirynu *f,r rrc
<br />PnhcJ Numbcr
<br />-Erpnc$
<br />I..niry rh.r in ihc p.rionrEftd.rrhc work tirr ehich rhk ri.lnir i\ n\ud- I \tuU nor cnplor 3nr rkr$n in rn! matrtur
<br />$ N lo tNonr subj.rr ro rhc wo c.sconpcnsnriotrl,wsorcalironni.rndr8rccrhdifIshouldh.coNsubjsllorh.
<br />*orkcr' compcn\0i ion pmvisions of S(l mn l?(D nl th. Uhor Cod.. I shrll, ionhwirh smply q irh rhn$ pmvisions..
<br />WARNEi(l: lirilurc n' {rur sor[q\ (nnpcn$li,'0 g)vcrr8c i\ unhslul. J \h!ll suhjccl u cnlnl,'ycr h fti i'[l pcMhics rid
<br />rNi rnr.s trI ro nn: t ndr.(t rhotr\rnd no tm\ I ). ir ddirion lo rhc cosr oi cornpcnssri,'n- damacs Ds tbvi(lcd ftr rhc
<br />Sc.ri1n,.1076ol rh.lrhtr(i{1.- dr.('*d-,//a
<br />uflLluuor
<br />I h.rchyr!firmundf |tDiliy.l n{ijnyrh.r I mInctr nd$l}ovi{ionof Chrprcr9(.onnncncr! wilhSstionTUX]).1 l)ilisionS
<br />of rhc Buriic\\nnd Prof.s\n)n\ Codc, aixl.ry lic.n{ i\ in frllf cc ud.tfccr
<br />/J /t?L/t7
<br />Dr,.: 4* zl't 2J
<br />I lErch, !{ltm undcr rcMltyofpcrjulylhal I
<br />issucd {Ss 1097. Civ C ).
<br />APPLICANT DI1CLANATION
<br />I hmby afm undcr petr.lly of perjury orc oflnc followinS delar ions:
<br />Dcmlilion P.roirs-Asb. os Nolif(alioo Fcd.6l R.gulitio.r (Til,. 40. P,n6)
<br />Rcquir.d lIllcr ol Noiification
<br />- l.eniry,,lhrrrhc led., sl (sulxrion( (gadrs a\brror !cm\,1arc ior lnnlhrbL h, rhs pdjer
<br />ll$nrMhd I hr\e Erd rhr! rpplkddn tuld {ar. rhd th. rho$ i.tumibn Li.o'Bl.I ag@ ro.onply*irhrll Cilyand Courry
<br />oRl'.s\r/.nJ st,rc tjui Flor'ne ro hu'Hing c.niru.rbn. rd h.Ehydurhorir rca,ce.rrliws ofthi Cily lnd Counlylo.ntcr upotr the:;H^:;:::"::VW *," /-;.u /F
<br />,"-"o*.fn,,, y'r' 'a /1/((a/'ml.'
<br />Site-Work
<br />Communicalions Cable
<br />lvleter Release
<br />k a constructbn lcndin8 a8crcy nx th. perr'ornuncc ofrhc wo.k for whth rhi\ Fnnil i\
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