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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNEII BUILDER DEI,CABATION
<br />I h.icby affirn u.d.. p.odlrt or p.rjury rh I u cr.dpr 6on
<br />'hc
<br />Contr0clou Licnsc Lar I'or rhe li)llorins rcNr (S€ 70l l 5
<br />Busincs nnd Pmfcsion Codc) Any Cn, or Counry which requtcs r Fnnir lo condtucr. alrcr. i(pn,v.. dc hlid' or rc,',t my
<br />srocrlrc. !ri'r to irs issu!rce. al$ rcqlnesrhe applicanr lbr $chtcrnrirb fld, \igncd sr0rcnrd rhd tror she ir li.cnEn pumani
<br />to lhc pmvniotrs of ltf, Co.tnclor's Lic€nscd t!* (Chirlcr 9. Comtrncins wirh Seclio. 70fl1 Dt DilGido I Dl rh. susincss a.d
<br />PDfc$n,ns Codc) or thar hc.r shc h crcq)r rhcrcturnrand rh€ Usk f{r rhc dL8dl cxc'ntrion Atryviol0lion.iSccri ?031.5bylny
<br />oDplicant roi rp.mir suhjecrcrhc apllic r lo adlilr.nnhyornol morcrh livchu rcd dollis (Ssdjl.
<br />l. as ownc, ol rhc pmFny, o ny cmploy.cs wirh wdgcs as thcn tub comp.Ds,rnrn. eill do lhc !o,k lnd rlrc srdrlE h mr
<br />idc'rd ot n,Lr.d ror slc (SN.?04,4. Businc$ lod Pmicsiotrs Codcr Thc Conrrn.rois l.icc.sc tjs &,cs nor apply h trtr owftror
<br />th. Dtufdy wh| boildsor inprcEs !tER)n. rnd who rlNs such f,rl* himselro. hcrellor rhrough hi\ or tur own cn{k,yccs.
<br />providcdrhrt su.h nnpmEmnhNmrinrc .d orolTmdhr{le.lt bwewr th. h{ildirE or inlmvcNd t$ld wirhi"unc r
<br />of.omptrion.rtrOsnerBlildcrwillhlwrh.t{rdcnotrmvingrhdhcor\h.dil'r hiu or inDtuvc th. pnrFny lor ilE purllc of
<br />-l-
<br />a!osncrollhc pn,pcny. amcxclu\ivclyconrrrrin8 wirh li.en\rd rotrtrcktrs k) .oiifl.r rh. |n'|\r (Scc rOU. Bu)iri.$
<br />rtrdPlo,csybtrCodc:ThcContrnrofsLiccnscLtrwd.csn.rnm]yN{nosNrolDrotrcrly$hohuild\orirnprrc\rhcroo,
<br />and ,ho $nlmcrslbr$rchpn,J.c(wir[aConrrucro(nliccnsrJpursuanrk)rh.Qrnr..ror'sLiccnscl-B).
<br />I a cx. rt, uid$ Sc.rnrn , B. & PC inr rhh rc6o.
<br />Drre: ORr..:
<br />ry( rnKFes' c'()t\,1 PEIt.saTlotl
<br />DIiELAIAIITN
<br />I heicby imfln!.d$ Fnalryolpcrjxryonc olrhr lolk,*ing decld.rnr.s:
<br />I havc rrilwill nrinrain trC.nific cofC.hsc h,S.ll l'furc f.r workcs co,ntEnsarion.0s nrovidcdlorbySccri,'!]?moflh.
<br />Lahi C.dr. f(trrhcl.rfornnnrcofrh. sork rorshi.hrh. p.rnir k issucd.
<br />-lhovcandwilimuinhin*'orken
<br />crmpcN n,n insurince. a\ rcquirql hy sc.r im l?0o of rl[ Ljhor cbdc. ld thc Nr hnMncc ol
<br />rhc wor[ aq whichrhh pcnnir is i\skd ltly sorkcfi conlxnern in\rrd'rc.d $akl policy trutrfi.r rrc
<br />-l
<br />ccnify lhar in lhc pc.ntrmncc olrhc *orl I{, *hich lhis p€r.i! is i\su.d. I sh,U tor cnPloy ruy l,crlnr ir rtry nnn rcr
<br />so dsb bcor* {hj(l lo rhc wirrcn .oDp.tr$ti{ r hwe orcrlif{mi0. nulrrrcc r[nl ifl sh,uld hccoff, sulic.i h d]c
<br />Borkds ..nrFnsdnrn lnvisions of Scclim lT0O ol rhc hn Cl'dc. l shrll. lnn hsirh co lnly s irlr rh*c p vi\nN..
<br />WARNIN(;: Frilurc h scurc workcr\ conrFnrnrii,n cokrgc is utrh{lul, rnd nrll \rhl..r .'r.nDk,ycr k).ri'nirxln ultus and
<br />.i!il linc\ trn ro onc hutulr.d rhousrnd dollnr (llfl).{Xx)). in rddirn$ n' rhc c.{ ol cotrrtctr\rri.tr. ,[tru'gc\ ]s nn,! cd for rh.
<br />sc.ri{,r.1074'olrh.l-rhnGxlc. inrcrc{ niJ nn.rf,y \ rco\3t3 lv
<br />I hcEby 0lfiflnundcr pcnallyofrcrjurylhul I liccnsdunderpmvnn,noiChlrrd9l.o mf,ming $irI s.cl inr Tfix)) oI l)ilision .]
<br />of rhc Busirkss0trd Prclcssions Codc, oln my liccnsc is in tulll'ore onn cfl'ccr
<br />r -tOI rcn- Ctr\. - t |c $
<br />Ds,. 3^23-lb <.^'-,,,, x
<br />sB7 866
<br />I hcrchyuon unds D(nlllyofpcrju,y ll lhsci\!.on{Bcrion
<br />issucd (Sc.. 1097. Ci C ).
<br />!n!.dcr fttrrhc$ nrn.icc oltu $ork ii,r uhi.h rhn pcrmi n
<br />ATIUCAILDEILAIAIIAN
<br />I h.Rby amm uMcr ,.oally of pertury om ol rhc rbllosinS d(larur ions:
<br />O.mlnion Pcrnirs A3hBr6s N.rifi.rrion Fedcidl Rcguhiions {T,11.40. Pd6)
<br />Rcqun d Iliidrof Norii.ariod
<br />lccdifyr) r rhc lcdcrrl r.grltrii{'rs '.trrdi',g rslr{o{cDn,vrlr'. ror rt)J,licrhc h drh |x!.cr
<br />l.cnifyrh lhrvcrcadIhnlFllkrrn'na {d. rh.r rhc rh\c itrlonu ion h .oftcl l asre k' co ,fly wirh rlL Cny rltr1 Counry
<br />o.diMtrccs,tul srd.ljws Elarins '. buihnr! corrru.rior ell hcnb,iuthtrn. rcnrcsnr ncs ol lhis Cily nfrl Coutrlt kr e .r uFn rh.
<br />rhli\! no ii !,rnl|cn\hrn\r{JXrrfr
<br /> nnllcinr or \!cnl sirnarur ^," 3- Z3-/L
<br />Doo.\lI'rmrilc€ nanr I Dri nl ):/(4,,.t/o rutvt
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Solfit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />Meter Release
<br />Bough
<br />I
<br />FINAL q/r//r ,
<br />Notes, Remarks, Etc 7t -/-
<br />Sub-Panels
<br />Service [t/eter ,Mq
<br />I
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