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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 />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm i Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondino / Groundinq / UFER ;e'zo ).V,$L\
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rough)\
<br />lvleter Release 6-lE-Zt y-u-110)
<br />v
<br />Rough N
<br />Service lvleter L-z-zt V,liI{"I
<br />fl.lllfiruFINAL6-!l-7/
<br />Notes, Remarks, Etc.U
<br />owNrrR BUtl,D!:R lrtll,c"rxrtTloN
<br />I h.rcby arfrn, und.r p.ialry of p.rJury (hri I dtr.r.n,rt ftun rh. Co,kroN Li.M bw tor E followiry Fietr (S..?031.5
<br />Busincs ard Prolassnrn C.dc): Any Ciry or Cdnry *hrch rcqlt$ 3 pqmir h @nslru.1" .lls, impr.rc. dcmlish or rcpatr y
<br />srru.rurc, rior lo ns nsu0rc.. .ho Equrs rh. |lpl.sr lu su.h Fmu b nk . si8rcd srd.aEnt rhd lE o. $. 6 I'c.'Le! pusani
<br />b th. Frvisiois .f rlI C.nk&ro1s l-iccnsd lrv (Chafler 9. Cohh. ing *hh Sectio. T(xx) oI Divishn I ol rh. B$h.$ rnd
<br />Ptuf.siom CuL) or rlDr tt or rlt i. erdhpr rhcrtf.ofl rnd rlr bllil lDr dE rIeB.{ .r.tuption. Any vbLrbnofS.clbD 7011.5 byd}
<br />npplicnmrordp.nnnsubjebrh..ppli.dnrtoaciy,lp.Mhyormrmr.thanlrv.hundEndollo^($5m).
<br />-1,
<br />as o*Rr of rh. pnrl,.nr. .' y.'nrlo),ccs wnh wagcs !i rhcn snh !,nFnsdion, *illd. rh. *nk iid rlt !turm t mr
<br />iDr.nlal or oll.r.d f( sL (S&.7D1-1. Buri*$ rnd PtuIcssiois Cod. Th. Contrdor'r l-a.n€ k! &Es nor rpply ro !tr owEr of
<br />th. pDpeny vlD hoildr or iqroE! ihrE4 rrd vlx, de. sxh m.k him.lf or ltrs.lt ur rhmrrh hn or h* orn .npk le!,
<br />p,orided
<br />'har
<br />such impnv.mnh c na intdcd r o,rcEn Ior slc It ho*.wr dE brildin3 or itrpnr*rd n dd *ithin ot ,E
<br />ofcorplcri,q E ()wEr BuilLr uill UE rh. brn'ln of pmviry rhd h. or slE did d bui! or iryruE ll. p$pdy ,oi th. purF* of
<br />_1,,\owneronhe poFny. neiclusir.lyconricl'n! *trh I'ccn$d.odrat,\k).on$ucr rh. proFcr (Sr.7lll.1. Bulms
<br />a kndir Codc 'l hr Ci,ntrcror'3 l-'c.trs. l-as J,f,\ nor rmly b an owDs of proptny wh. huilds or impo!.s rhcrsn.
<br />rnd who .ohhck ntr surh p(,r.crs wnh r G,mBct(s) liccn*d pu^u&r r) rh. O,nbrckr's Li.M t2w)
<br />_l r€rnrpr uxrer Ssrio
<br />]!!8TE8S:.qAM[ISTAIqN
<br />DECIABAIIQN
<br />I h.r.b, tflirm ondcr p.n Iy oI pdjury onc ol rh. lirllo*ine dccLr.rioB:
<br />-l
<br />hav. otd wjll nBinlli, . Ctnri.at. ofcoN.nr ro S.lf-ltrsuE for sorkda dmp.Mio". ar pDvi!.d fo, ny S.ctiotr 1700 of th.
<br />l2tu Codc, Ior rhc ,'dfdr'lsc oI rh. worl fta vln.h rh. ,.rflir B iss$d.
<br />I hak aM will nnnt0n work.6' .onwnsrtron msurstr... a! Equir.d lry Sdrion ,7m of rhc Ljhor Cod., for rlE FramEr. o,
<br />rll voi* for wlich rhi! I.rn L isud. My *dkds oryrdion iNursc mi.dl policy numb.r @
<br />Policy Nrmb.r:_Erpn s:
<br />I ccnify rhrr in rhc p.'forn!rc. oI rlr wo lor *hi.h $n p$hjr ir k!cd, I shdl m. .n{)lry My per$r h uy mnEr
<br />e e ro b.com $bjcd ro rhc mdch conp..s.rion hwx or C.rrromi:. and l3Ec lhd if I should t c.r lubj4l to tlE
<br />$u aJ one.nslrD.pNlrioNofSenon 3700ofrh. kbor Cod..I slrll, fdh*nh llnplypift lhos povirioN.
<br />WAININC: Frnurc i. *.6. *orl.^ cdnp..sdio. s!.tu8. is uhl.will, .nd sh8ll subicr an .nplo,?r ro dimiBl FMhi5 &d
<br />Livil lin.s u! ro otr.l'un&.d rhousd dollaG (5100,(,r), in addirbn ro rh. coi of.on(ErBrrion. d.nqa.s s Dsvid.{ tor rlr
<br />SstioD 3076 oarhc lrtDr Codc, imcFi rnd ariorrc,i lirs
<br />UqENED.COMEAqAB
<br />ODIIdf,AIION
<br />I t6by dffun u*Lr p.Mhy of trrjury (hrr Ln [ans] unds D.lvilion of Chaprd I (ollwNin8 wnh Sat.n 7000) of DivnFn 3
<br />oI rhc BL\incss rnd Pmr.sirns Cod.. ui ny lic.rE k in aull fo@ d .lfcd.
<br />Cl,*,-LiEns. Nlhb{l
<br />CONSARUCTION LENDING A{.;ENCY
<br />I heEby rl6rm und.r Fnahy of pcrjury rhd rhcE is r con(Mlon bndin8 ag.xy ror rhe
<br />'l.rIdhmc
<br />or th. *or* lbr phich rht pcmn k
<br />is5!.d (S.c. 1097,Cir. C.).
<br />APPI-ICANT DECI"ARATION
<br />I hs$y l6im undcr n Dah y of lcqury onc ol rh. follvmA &Tlddh.r:
<br />Dcmtirion Pcrndh-Ash.nos NoLficetbn F.dcrel R.8ulations Gnk.t0. Pd6)
<br />-RcqurcJ
<br />btrcr of |]lniicdio.
<br />I cdily rhar rhc ladcril rc8uiaii.n. eted,n3 sb.s!{ armval& mr appltabl. b rht pmjcct
<br />-l
<br />cdrry tlBI I lDw r$d rlus amlrcariotr urr salc rlDlhc utrvc irlormrion n corur I asr ro conply rnt B[ Cny ad County
<br />ordh.nccs .rd Srarc hrs rcLrir3 16 t{,ldin8 cotr@.iioc ,n h.rcby rurbrnc rcF.stutivcs of rhir Cny .rd County t. .do upon thc
<br />abvc 'Errion.d pmp.ny Ir insp..rion pu.Fei
<br />Apl,li..rnr o, tsmr sirrurun.
<br />IIIIIIIII
<br />ELECTRICAL-INSPECTOR RECORD
<br />Bev. 08-07-2015
<br />Lnds r Add'r$
<br />Drr.
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