|
APPROVALS DATE ID/SIG.COMMENTS OWNf-R BUILDEi DEI]CARATION
<br />I hd.tt .rrm un<lcr Firy of Frjut lh, I - aapl 6m lh. Con .16- Li!@ ts ror l,E folloetE laJn lS< 7011 ,
<br />ltu'nB ind Prcfdhn (o&l Any Ciy or Cdiy rn.h r.qun6 . Fri ro oldrucl. th6. imFove &.mlirh or lE.i 6y
<br />3rNdu.. Fior ro ils iNuc, .b. r.qr6 in qdkd for ru.h Fnn t6 6E. sgi.n srn6Ml lhd lt or tlE it lica.d Pullld
<br />ro rhc FolirioN olllE Conrlrhrs Licc.ed L6w {(hrpld 9. Comndcins *ilh Salion 7000 oaDiviion I ollh. BBi.4 md
<br />Profdrbnr Cod.) or th.r h. or ih. it crcmpr rha.{tom 6d ih. b6n fo. th. ,ll.g.d crmFion. Any tnndior ol S<li.n 701 I J br D,
<br />mplici for ! r,6hn rubj(b rh. .rDliclr lo !civilFuhyotnol mErho fiv. hu,rtt d doll,m (1t00)
<br />Z, r n"m otr* prnlElr. "' m' onph)G $dh {.16 6 rlEt sL mqFdnn, sll(t) rtE *st rn tlE rrrrm 6 d
<br />i orroJ *o,Io.d f- -r {sd 7o{, Bd6 &d EnrsilB Co<k: Trt( odr- 'tLtcL!*&6ml+plr"rooorEof
<br />tlt FFiy n h6 hilll c rsoE llEm !d *rr &E sh rrnl hiMlf or hq*lf o, lllDuen hn d lE osn .!lplolt6,
<br />Fovid.d rfi.l iucfi imForE1Et & mt i ai.l n olEql tur sL lt, lbw.€. rlE hilditB or lrtrxeEr i sld tihh m
<br />'aofsmrkrion. rlE O*rd sdldd *iI h.E $. hdn otForr{ lhn h. or $. dil Nl hriH or inForc lh. FrEi, 6r tlE p,p.& ol
<br />t
<br />L s o*ffi oath. F.Fly, m.tcluiv.ly cotlrsiinr [nh ltan d colntdE b coldrud rlE pmF tsc 704r. BtBud
<br />.,n F$t6in Co&: Th. C6 sr.r'3 LicN L.s {kE mt .r'9l} lo m o$nd 6aFopdly slF b{!kl, o, inpror6 rh6or
<br />,nd {ho @fldr ld sh F.!j.<r vnt. Colrt ro(tl lrd!.d FlN[n lo tlE (tnrdd'3 Lid t.*)
<br />I m.rdpr u.J6 Sdr,n
<br />D,b o l:P L-Zo o"*.(
<br />DECIjAAIIO!
<br />I hd.bt rmm !nd.r Fuly ot p6Jurl oE oarh. LlhstrE d<lr.rioE:
<br />I h&. !i *illrid.h. catifrtI. of coen lo s.llleE fd *si6 orpo!.n'! ! Ftit d lot bt sclih 1700 oillE
<br />Lrm Codq tc rhc Ffotu. of E mrt 6r *nih lh. pain ar isEd
<br />I h!v. .nd *ill mrintar woil6 conpner{n iBUr.(., 6 ..qutql by sdr Nn lTcn .a rh. l:h.r (i'd.. fo' thc Faoffi. of
<br />rh. $orlt for *hich lht rcm't t isrql. My worlsr' ..nF6r.tirn iBu6n c cmd ar{ Flicy numb6 rc:
<br />I cd'lr rhr i.lh. Ff.l'ffic otllt uorr hr shth rhr Fmn is su.d. l slull bl.tplot 4y F$n in uyi.ljfr
<br />e Br. b.tom. $bj.rl lo lh. trlrlfi comFMion Lwr ot Cdiaomi( .rd .gE rhd if I shoud baoe rubi<l rorE
<br />sortd'comFBalionprcvsnBofsfrtionl?o0oflh.l!bo.Cod..l!hdl,Ldh*nn.lnPly*ilhrhosrrcviioN
<br />wARNl,l(; Faitur. !o sr. $rrt6' comrEN.ix,i cov6l8c n ubwf!|. Md lll rubjccl u 6pl.F lo dimiMl pq{n6 Dd
<br />ctrrl lin6 ur ro ok huiEl rh)ulsn doll6 (llln.fir). m .ddir rh. .or of corFsri.a d.EgB s Fold.d for rh.
<br />Sdrpn 1076 ofdr t ior C.dc nra.r &d.rdE,
<br />o.,,. Ol-OZ -ZO tor^r
<br />DICIA8AEq!
<br />I hn.try rrm unds p<rhrolFjuryihd I n licosl und6 provisEn 6f( h!pl6 9 (.oftmdcin8 w(h sario.7000) ofDivi!'oo l
<br />of rhc BBins Md ltolaioB Co&. ed my licre n h full foc &d cfidl
<br />coNs rtatrcTloN LEIInING acFN( v
<br />I hdrby ittm und6 Flrlty or pcjury lhd lhd it . o,uDcrbi !.diis .8try fo, lh. Ffolrm. of llE srt hr s'lth thi! Fna .
<br />isu.d (Sa 109?, Ci!. C Ilr ro-rNc
<br />AITI,ICATLPDCIJAAIIA!
<br />I h66rlilm uid,i,.nal'y ofFjury on oflh. follo*in8 d(Lr6tioc:
<br />ttoolinn Pdtil3-Arb6rG Norificlio. F.ddl R.soL' k'N (Til!. 40. Pdl6)
<br />Rdt!iid lrrrs.rtJorifriEn
<br />I car'E $, rlE l&.1 EglldioE Esrdi.s Bldlor rd1\.1 r. mr .pPlrlbL lo lhn Foir
<br />I cdrfy rhd ! hrErddrhE.prl(lrFnEii.krhd!h.!hv.irh'tution i! coE4r I tgE lo 6oply wilh !0 Cny and Cou ,
<br />o..l rncd Md sr.r. Lrs! ELrrrs ro burldor c.dtud/i ud h6.!yaulhori4 eF6.itilivd oflhi! Cily d Couf,ly to nlE uFn llt
<br />ab.v. 'Eno.dt DroDdy Iff EperEn nurDo6 / /
<br />n.,-"-*-,.*.- * L,--L-- -,, A/ o'L'? L)
<br />Pdxi6c(pdno: Aqiolla Bo/*Pa)
<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 />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equapment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />Meter Release
<br />Rouqh
<br />Service Meter A.
<br />FINAL L-w->.0 )1)fr-1i.\
<br />Notes, Remarks, Etc
<br />ELECTRICAL.INSPECTOR RECORD
|