|
ELECTRICAL-INSPECTOR RECORD
<br />I hcrcby ofltm lnder neialry (,f pcrju.y rhir I .r cxcnll'l lronr lhc Contmdom Liccns Li* for rh. folk'wirg tnv,n (s.c.7011.5
<br />Bxrin.s ad Pror.srion Cod.)r Ant ciry or Coumt which rcqutcs tr pcrnrit ro conrrtucr. alrci inlfovc. &mlish or rluir any
<br />strudurc, Irirr b ns nsu0Nc, .ko r.iuiEs lte {'plicanl fo! such Irrdii ro tilc u shnd sarcmd rhar hc or shc h licenscd ll6n,nr
<br />tu rh. pmvhions ordr conrmclols Liccnsed L{p (Chiprer 9. Conmencin! *irh Sdri.n 7fix) or Division I oi lhc Busincs an&
<br />PofcsionsCodc)orrhath€orshchcicdprrhtrcft,dr.drh.bnsirr.rrhc,llc8cdcxcm,tli,n.AnyliolarionofsccrionT0.ll5by.ny
<br />aptlicd.r f.rs pcnnir rubjcch 'h. lppliclln roacivilpcmllyofnor mrcrh.n lirc hundrcddolld\($500)
<br />I.,sowncrofthcnroFny.ornrycmllorrssirhwr-qcsasrhcirsrcc.dpcns,iion.willdorhcwo Bln thc sldl!rc is n.i
<br />inrcnicd orofiercd for srh ISE 1X4, a!ri@s\ Md Prordssio.s cdc Th. Conr[lot \ LiccnE llw dd: nor lPply ro dnowncr ot
<br />rhc DturEdy sho trurlds or inrnvcs rh@)n. rnd wlx, d,B stch wo& hnns.lfor hcrslfor rhouAh ht or het ovn cmPl.)ccs.
<br />poeid.d rhrr such inrlr.wnt m mt inrddcd or ottrcd for eh. lt ho*evc( rh. bxildinS or iryrowmnt is $U wirhin om )tr
<br />ot corylcr ion. rlE Ow.cr Buius *ill hnk rh. bo.dd of l]rrvibg thd tr o. shc dil mr build or in{ot lhe rm[rny ror itr purl[s ol
<br />WARNINC: Frilurc h scrrc work r( .on!*n$rn'n . r*+c
<br />ciril llncs !p r,, onc hundrcit rhouratrd dolhr\ (Sl(x).U)o). nr
<br />b'.L7. t6
<br />(Ir\'NFR xI n DrR l|I..I (,^R^ IIi)N
<br />wful. arl shlll \dbiii m dntloler to rin nal rEmhts and
<br />ro rhc.o orcurpcn$ n,n. d0roBcs.s provilcd lor rh.
<br />l)lt( t,.\R \rr()j\
<br />d 9 (.oDnEncin8 wilh S$rbn 7ffX, olDivisn r l
<br />)g Y ti'/
<br />rltr p..forirn.. olrhc \.rk nr*[i.h lhi\ I).i,nir is
<br />vxLrrc nor xf!li.ihL l,, rhn pror.cr
<br />vcilfonndi.nisc.rc.' l.Braroconr/ysnhrllCir!andc.ufuy
<br />aurh(trizc rcprc* rrri\t\ olrhirCilyoi(nudyt,cnrruB)nrh.
<br />I.uso$rcrofthclropcny.rmcxclurivclyconrrnctinSeirhlic.n\.d.ont.rosro.trsrrudlhcpmrcdlscc7()4r.Buri,tc)s
<br />aBl tk,fcsi,n C.rlc ThcContr.kr'sLiccnscLrwdoesmr.DDlylosnown.rofpn,Dcnyahobtrild{otinTrovc\ihcreon.
<br />a wh{ contrrcls l'or \uch pn'jrk wiih n Coitactln n li.0scJ pDruilll n) rhc Conrrlcroi\ l-i.{nr trw)
<br />I arexcmfl utrdcr Sslt)
<br />lroaK[aLc!.lM$Nsarll,tli
<br />DECLA.E{IION
<br />I hcrchy uin"runder r.mhyotl)crjuryom olrhe &,uowios dc.ld,ri{ \
<br />-l
<br />hlve !d will minllin a Ccnificarc or Conrni ro S.lr- lnsum ror work.tr ompcnsBrion, 6 rh,vidcd lot by Scclion 3?00 oI lhc
<br />tihor Conc. for thc l).rforrome ol thc *ork aor shich rhc pcrnir ir issucd
<br />_lhatcand *illmainrdin sorkc^ .o D.nsarion nNkrtr.c. as rcquncd byScdion:l'7lx)orrhc Lnboi cod., for lhc pcriornEnce of
<br />rhc {ort a{tr wiich rhn pernir ir irsu.d Myworkua tu'ry.nerion i.surcftr crricr and Flicy nun$.r tc:
<br />I.cnil'-vrhdirrhcpcrlonmn.corihuwo tur*hirhrhi\|t,nrir is rnrd.I shrllnor cnDloy rnyPL^on inrny N nrr
<br />q) r\ t, hc.onf, ltrhF.r rJ rh. r1trkcr .omNtrsirion l0ws olCrlilhrnir. ind lgN rhrr if I :h)uld bcNnc suh]ccl lo rlr
<br />workcr\ con,!.i\rrn,nIovhfiisofSc.rio.]7U)olrhchhorCodc.llhrll.fonh*iih.ordytrirhrh.-_F)vhions
<br />I hctubyafllnhxMcr Fnallyof pcrjurylh,l I !'n
<br />ol rhc ausinclsakl Pntlc$i()ns Codc,0nd my/ rs U >1
<br />.L1.t6 &
<br />I hcrcby rmulndcr p.nrlryorpcrjLry rhlr rh.rc n r.omru.riotr lcnd
<br />ATTIIgANLIIESAAAIION
<br />I lrnhy amm und$ p.trrlly olpcrjuryonc ollhc lnlk,winr dcchrarn,n\
<br />Dcmolirion I'cro,irs Ashc{os Norlll.dioo r.dcrnl R.!uhions (Tirlc 40. Prn6r
<br />R.qonL\i t..(ri ol Norili.rlion
<br />lccnnyrhil rhc,cncrrlrcEULrnnNrqrni',gr\bt
<br />l.cnifyrhal lhrvercndthisrptlicrli{,nnl\lrrcrhar
<br />udi'rtrccr tr sfurc l-rN\ rclftftlo huiliir! conJn(
<br />rlxr. m.nri,,nd pmlfny fir i'Btc.r
<br />APPROVALS DATE ID/SIG.
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Volta
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Torqueino
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Solfit Rouqh
<br />Ceilinqs (T-Bar Rouqh)
<br />It/eter Release
<br />Rouoh
<br />Service Meter
<br />FINAL <lot )Cd lo,
<br />Notes, Remarks, Etc I I
<br />[tI
<br />q\-.,rrr^-./ '
<br />^,,,6t-z-l't€
<br />COMMENTS
<br />Transformers
<br />Air Conditioners
<br />issucd (Scc. .309?. Civ. C.)
<br />t ndr'r Nxn.
<br />-
<br />Appllcani or ?lgerl SiBndluE:.-.<_
<br />Pemire namc,rrinr, -\\
<br />I
<br />tt
<br />I
|