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ELECTHICAL-INSPECTOH RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEI,CARATION
<br />I hcrcby afirm undcr pcnalry of Frjury rhar I rn .rcmrr fon rhc Conrr,.r.s' t-icctrk bw for lh. lollowins rea$n (Sc..?oll 5
<br />Burirc$ lrn Profc$io. Codc): Any Cn, or Cou.ry whhh rcqoncr a Fann ro onnrud, alrci implove. dcnhlnh or rcpnn any
<br />d.rnrc. a/ir ro irr isiu0ftc..lso rcqutcs rtuopplicml lor su.h lrnnl nr lilc r si8ncd sdcmnr rhlr hco. rhI is liccnsd Nnurnr
<br />n, rhc tnvtions of thc Conrrrclols Liccnsed lj* (Chlnrcr 9- Co.,mckine wnh s..lnrn 7000 of Divhion 3 oflhc Busincss aIrJ
<br />Pnrrercion\Codc)orrhtrr h.or\hc is.rcmfl Ihrrcrr.mMd rh. h.1h rd'hc rll.Scd .xcnrprion AnyviolationolSEri,.?03l5byrny
<br />,mlicanl ror a p.nnn subj..rs thc apdic.trr to scivilpcnlllyofnor mrcth.n rivc h!.drrd d.lldr (S50o).
<br />_l- !s owner oa rhc pmFny, or my c'npbyes wirh wr8c\ a\ rhct $L con1N srio.. will do rlE work 'dIhcsrMrucis t,
<br />i.rur,.d or oficr.d ror sL (5(.?(114- Businc$ !.d Pronsiotrs Codc I hc (nnrrudoi! l-iccnsc kw doer nor arply ro atr .qE of
<br />rhc p^,pcny sho hilds or i'qirors rhcd,n. arxl sho doc\ skh wo,I hiE.lf or hfslfor rhbuph his or hc. osn.Dployc$,
<br />pNvdcd rh.r such inf,mrc rnc rm mr inrcndcn .r.rctod nn slc. ll how$q. rh huildiq or irqrtrrnr isoklwirhi", 'cyrJrof.o'nplcrhn. tlr OwRr Bxildcr *ill hrw rh. hurdcn ol |,ovnE fttr h. or shu dil mr huald o, rfmvc rhc nFpcny for rhc purp* of
<br />I a .xc rU undcr SL{lion-. B. & PC lnrlhn rcr$n
<br />D.lc: ()en..:
<br />.u0af,E8s.lout[Nsajl(]N
<br />DEOAAA.IIAN
<br />I hcrchya,firnutuLi pcnnlry.f Frrurrotrc.f rhc lolbwmS'lclrhrionsl
<br />I hrlc d*illnnn Ji',rCcnirlcrrc.rco \c r k, S.lf lnturc tur \0rl.6' conD.r{rli, .n{ Drovidcd,nr hySccri(m l7(Xrotrhc
<br />LrIxtr(od..forlhcpciolnrnccof rhc*orklar*hichrhcpcrarn i\l$ucd
<br />-l havc and will minloin workeB comp€nsalion insunrcc. ss rcquircd 6y S<lion lTtl) or ih. t i,co&,forln ttrlotnEncc or
<br />lhc port aor wnich lnis lcrmil is is$d. My *o,kda mnwnsri,n insuntue cari( &ld,Dlicy.umb.r m:
<br />P.lkyNunh.r Erprcr-:
<br />_lccnilyrtd irrhc pcrfornuncd ofrh.work for lhich rhi\ lcrnrir is h$rd.l shallml cmployrnypcro. inlny manNr
<br />s is b b..onx suhjccr t, rhc workcn ompctrs0lion hws olCilihrnin. rM a3N rnar ill sl&uld t corft iubj..r to rrr
<br />w.rkc.omp.neriotrtmvnioosolScdion3Tl)oollhctilnaonc.lshlll.fonhwirhconDlywirhrho$tr.visir,ns.
<br />WARNINC hibrc ro \ccurc *1trkc^ cohpcnsrn,n cokrrsc i\ unhNrui. nnd \hnll nrhjc.t rrr.mploycr lo onirrl !.'r rirs tr.|
<br />civil ri.cr up to onc hundrcd rholend dol
<br />Selion -1076 ofrhc tit r Codc. inlercsl snd
<br />Xxr). iI rldiriotr ro rtu ()n.l (unrNtrlrrir . drnr8c\ r\ t,'ovidrd ktr rl'c
<br />o"t", - 5/tl\8
<br />ltltll3truaN
<br />I h.eby affi.m u dc. r.ndry ol p.rjury lhal I an: li.c.$d u.d.r !$vision of Chaptcr 9 (urmmMiog wnh SNrdn ?000) ol tlivhion l
<br />ol rhc BusirEs\ aftl Pnfcssionr Cudc. arxl my lkcnsc ir in tull ttrcc dd crrd!
<br />-
<br />4\^ >=b_?orqtl
<br />o"", g:7 r/ 16 De<.o r- 7.- e.< J. r '-
<br />ATfL,ICANI.IIEIJAAAII()N
<br />I tsthylninn!nncr p€nrlryotpdjoryo c.rrhc ft,llowi'rgiLcl,rari.ns:
<br />Dcmolirion PcrnrillAst sos Nolificalton [ed.rulRquhrions (lirlc 40. Pan6)
<br />-ltcqutcd
<br />hrrcr o, Norifi carior
<br />onti. Ns and Strt ljw\ rclrtirglr)ildins c.Nrrucrn,n. nnd hcrcl'yrtrrhoih rrF.\cnr.riv.s orrhk CirytrM Counly ro cnrcr uF,n rhc
<br />rll'lc trrnri(rcd pr.pcny for ir!
<br />,\ppli,ntrl rr {!.nl Sirnalur.5/rr\(
<br />Site-Work
<br />Underground
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab i Floor
<br />Bonding / Grounding IUFERA
<br />Transformers
<br />Torqueing
<br />Sub-Panels 2 tf-Ap tB lr-#o (vt)
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />Rough (-7o-to -Jt €D
<br />Service lvleter
<br />FINAL /."-/?* lU JleJ*,Gy )
<br />Notes, Remarks, Etc
<br />Pole Bases
<br />lvleter Release
<br />-l,.soqrcrorrh!
<br />[oli.ny. rflrcxclusivclyconrrncrins rnh I iccnsed co nrlcroF ro co nd tucr rh. Frccr (s( 7014. Bu$rs
<br />snd Eorcsi,n Codc:'l hc Conta.kr'! Li.cns. Law d..s nor aprly ro M o,ncr olnropcay who t'uilds.r inpmrc\ rhrron.
<br />otrd qho coahcF tu such lrojccls wirh ! Conrmcto(9 li.cnscd pusunr ro rh. ConrnLkr\ I-irc.sc hw)
<br />CANEIBUCUANIENDING-&CEICI
<br />I hcBby.ffinn undcr Fn.hy of r.dury llEl thcrc n a conslrucliotr tndins ascrcr aor rh. pe.Iormrc. olrhc *ork for whichrhh pcrnil n
<br />hsucd (se.,1097. civ. c.)
<br />Lxndc'\ Nsne
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<br />I ccnify lhal th. fcdcrul rcBubrions EBlrding ,shcsros rcnbvol arc nor lpplioblc ro rhk pmitr
<br />-l
<br />enily thar I havc rcod rhk application ud (alc rhlr rlE 0hoE infortuiidn ii c.ffiI. I .8G lo.omplywith 0l!Citylnd Counly
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