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APPROVALS DATE ID/SIG.COMMENTS OWNEn BUILDEf, DEI,CAn T(rN
<br />I hd*t .lrm uidd Frn, of FjEy $r I i darpl fioE 1L (o t .1@' Lke Lv for lL follo{le la]tr {Sc ?0]L5
<br />t,l!i,6 .,!d PmfsilD Cod.): AIy Cny or Coudy \hi.h rqu6 . Fi! 16 6tud. .na. irp.otq daelat or tr?., oy
<br />!r.ucrw. Fnrlo ill i!3l]id..bo rlqui6 E ip9l.d for sh Fmn b 6j.. riSrEd fl.ml thdh.o,CEili.d.d F!'d
<br />ro tlE p.lrirbE oa tlE Co'xr..td r Lidr.d t * (Ch.c(6 9, Coffii,& *in SEli,n 7000 of Divnio! I of lh BGi!6 lld
<br />PDfdbe Co{,.)nrh.r h.6rl'. a aap( thddon !d Et n for r& nk!.d asqion Alty litldionofsdbD 70ll tbroy
<br />.!?licet lor r Finn sbjd th. .rpli.a lo r civil Frhy ol ml m..lhc fiv. hsn&al doua (ltoo)
<br />-1,
<br />B oqc ofth. Frpaty. r ol @dot6 wirh v.36 6 ln.n &L.ooFMion, wiu &,llE usl &d lrE ttt lc i! mr
<br />idord.d o. ofr@d hr ulc (sia 7044, SuitB ud Pr.fdioE Cod.: Ttc Co'n6.id't Li..M Lrw <h6 rut.rply lo d owd of
<br />rhc Fspsiy utr hil& s i,!.ov6 t]Eo'!. !d whd dE uh wI hinrclf or h.*lf or ltmuth hir or lE om mplo,6,
<br />provid.n rhd !!ch imF$sr.dr E ml hrdrLd orolH 6r sL ll ho*dq, th. hriniig o. inF.nGd ir old witnh onc )@
<br />ofod0Lrior rh. ()qns &ildd *dl h!\r dE hrd6 of Foviry rhr tt o. !h. did ml hild or m!.!E lh. FoFly lor lh. F,Fr of
<br />-
<br />I. s otr'6 of tlr FoFiy, m o.lBil.lt codr1 in8 *nh li.s!.d.ofr-l6lo @rdrcl lL I(,j.tl lsc 701,1,866
<br />!d P!o6.m (od. Th.ConlncId3LtGL.*dEml.pglylod0*,6ofFoFr_*h.t ild! oi inFor6llE@(
<br />.nd *b .anr8! fM sn Fols wnh. Co mon.,li.E d Fniln ro rh.cdftdi lilE l^J
<br />, m.rad ur&Scrb! .B &PC tulhuletr
<br />D.t.: Oi.d:
<br />laSSEALgrU$rSAnA!
<br />IESJAAIION
<br />I h@b, rmm undd p.n lty of pqjury oE of tlE lollou'in3 &.lt tioB:
<br />-l
<br />l[v. antl vill mimain r Cdrifical. of Co6dr to S.ll-l6ur. for Nrk6. con1!.nrllbn. s pNviddl for by Selion 1700 oalh.
<br />t hlr ( d( tu rhc p€taMc. of th. sorl lor wni.h rh. pc6ir ir iso.d
<br />_l h,i. rnd *ill m.iorti. wollsi .onFrul1ion iBlrffi., s rcqon.d b, SdFn .r?0o of th. l,tE co&, au llE Ff({fuc. of
<br />fr vhi(h rhi! Fnit L isEl My Dvtdr' sn{Edi,n i6UM. csir ttd !oli, nuhba e
<br />C .as O/n
<br />-ErpiB
<br />-l
<br />cdify rh.r in G. Ffotl1e. of tlE sorl for *hkh thn rdnn t isc4 I Cull ol dpkyo, F$. in My meF
<br />$ a b h(!m lubjar ro rh. E*6' @6Fdb. h*. ol( .I'lomi{ $d lsE lhd it I rlDuH b(or $U<1 b rlE
<br />tr$rLd' cooFld ion FovitioE of Sdion l7o0 ol rh. l,ho. ( odq I JEIL fonh$nh @nply sirh lhos prtfiri'N
<br />w^ltNlN(i ljrilur€ ro suc wo.k6'cofrlnrlirtrr. cordr.
<br />civil fin.s u, to oru hundr.d lhoMd dolld (1100,0{D). in
<br />orpkrrd kJ sininrl Funks d
<br />nrn. d&nr*6 6 provid.d ror th.
<br />lrhtr( od.. ior66r MdlnrEy'r fc
<br />x..
<br />IICIa8AIIO!
<br />I hdrt'y lIIm u'xis FrXy of Frur: Or I m licqE d u,iq Fovi.ir,. of CtTrE 9(offiir{ $nh S<ri.n 70OO) of Dn'iion !
<br />of llE R!i!l6 irl PDlsirB Co&. !d ty laGE u n iru foc rd.Itdl
<br />96?q7_{
<br />zol 1 Psbryy DrA SvtryyS)"
<br />(otfiB!cuall,li!I)l!clc[!l:}
<br />I hfthy aft $ und6 Fnllty or psjury tha rhd. . ! connruni,. Lndins .gm.y ao. th. lstunMc. of I hc *ork for rnich rhB FDii k
<br />ku.n(S< 10e7. (-f (-).
<br />alllJ(Arr-o8gasallod
<br />I hddy.ffrtrun& Darlty olpaluy ocoft fo[o*in3 &rhrrbN:
<br />Ddmltbn aafinl^rb6lor Norifrlio! F.da.l R.3ubioN {Tnlc a0. Par6)
<br />-RaNiild
<br />ldlc olf+oifi(,n.
<br />Irdifurlb rlE ll{6rl r.xulario.s rclt d'ns & nol arpliciblc ro rhh tx('lal
<br />-
<br />I cgliir rhd I h.u r srj lhn applicdion infomdion t coEd I rSta to comply qnh .U ( ily dd Counr,
<br />ordimR6 Md sr.r. lrtr s EhrqB lo hs.t, rlFEr rcF(grdn 6 of rhir ( ny .nd ( ouily lo dla q{n tlrr'*
<br />\r..u*.,-",rn",,]L Oz /$etl
<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 />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rough A
<br />FINAL )''"t-l\Y\Ul1)
<br />Notes Remarks
<br />ELECTRICAL.INSPECTOR RECORD
<br />Service Meter
<br />Etc.
<br />)t fi
<br />s
<br />I
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