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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains rcJl6lzlr"r <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 />Ceilings (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rouqh) <br />It4eter Release <br />Rouqh <br />Service Meter <br />ela.t t4 w.,AW <br />Notes, Remarks, Etc. <br />OWNF-R AUILI'ET DEI.CARATION <br />t ha.by .fGD ud€ Frty oaFJEy rh. I m dcq fiDn rh. Conr.cro U.de L& li" rh. folloEs lEn (Sc.toll 5 <br />BBi,l6 Ed Prcrdir! Cod.l: Any Cn, or Codt *'hth rcqu6 . Fni ro odM. .lr. inE o\q dtolih or EFi -y'olE 6c Fi, ro c islffq &o Eq'liE tlE +pli.ot aor ich Fnn lo 6E . .'*.cd nr66i rhd h. or tE i li6.d prMr <br />lo rlE F!!nn6 of dE ConEetd'' Lidt d Llw (ClI''rE 9, (\mffiins wnh Sdi,n 7000 of Dvbhn I of tlE Bu!i6 hd <br />Prcfsi.n. Cod.) d thrr lE or dE ir ddpr thacliDh ed th. b.li3 for rh..ll.scd erorqio. Ary vhlni'notscrion 70ll.t bruy <br />pplic.nr for . FDil $bjEc rlE .prlicur ro . civil p.mlry of nor ooc lho fivc hundr.d doll&! (t500). <br />-1. <br />B o*nd of rh. p.oFrr. or Ey mplotd *irh *rgB s rh.n ark mnFsaioi. silldo rlE $!rt xn llr nnrl@ a ml <br />idqld.d r, ofi6.d fn !t (s< 7oa4. BBiE ud PrctusbN Co& Th. cod..dn ! Lt6e tre dE ml +9ly to e o$c oa <br />llE FDFIy *'ho hillor 4DrErlE4 in lho dcrxn s nimllot lE*ltorihush h. d hd on dlployc- <br />Fol iLd tlE $cn imFllElt6 E Ei ncd.d q ofiEd 6r $t lf. tb*6d, tll hoildiB llFq-Er . -ld wihin .r )a <br />of $re!rD[ rlE O*c &rildd wil lnr tlr h!d6 of FDvuB tl! lE or C. dn d tuild d in+.o1t d. FtFiy tu ln. F,FEol <br />I. sown6ofrhc rroFry, M .r(lNrvcly contridins wnh lics!.{ oik&1oR ro cotrnrud lh. pmjcd (S< 7(x'1, Bdir6 <br />ed h!tuim Codc Thc conln tor'r t,ic.ns. l-aw do6 noi apply kr M oEns of <br />md *b .oelclr for $ch p.q..lr *irh ! ( dntaro(t ltd!.d !uM' ro rh€ <br />sM l)trrl(l\f' (nt,,o\ur lhLrc.f. <br />ll o*Z-cc- <br />l1-tt-!.!B.l.l!.1: <br />I hq.hy !ftm u.dd Fmlry of Frury oE ofrlE follosh3 d€lstlk E <br />-l <br />h!r. nrl w'll @inrain a colifrd. of ( otMr lo s.ll-lNlE Ior er[dr conrp.n!.tion. s Fovid.rl lot by sdlio. ] 7(xl ol lh. <br />Llbor ( o&. hr lh. pqfotu. of rh. sorl for whkh th. pqmit ir isu.n <br />I h.r. lnd *'ill saint'in wo*..t c6np.Mbn iNum... s r.{ut.d by Sdion 1700 of lrE lrbr (..&, tor lh. psfolrre. ol <br />llE wrt fs u'tin lhi! Ff,ir a iqEi Mt wstsr odpaMi,. iffi ffit rn pofi.y numb.r r.: <br />Policr Nunts-Erpn6 <br />-I c.ni& rh.t in lh. pdforunc. of rhc wort hr lhich lt! pno n ir.!.n.lsh.ll ml adoy rry paen in mymffi <br />e ato b.en $bJdto$.e 6'@nFMion h$ofc.liaohi., $d r*dlh if I lbuld b.(om. rut dl lothc <br />@rt6' omFMrio. ForloE .ls..r ion 1?00 oarh. t bm co&. I iEll. l(,lh*nh onplt *hh rt6s Foviliod.. <br />I {bFr e dr{LF <br />'o <br />ainlEl Furb.,id <br />$'l 1Ug up ro oE hund.d rhblgi LInh^ (lloo,firo,n4 drrus6 6 FoYd.d 6r rh. <br />sd-n ro7; "r 'rL <br />Lt4 cod- nd< !n d <br />-* Sf t f tol ^,,, <br />Z<r-> <br />Drr]"r&uto! <br />I hRby.llirm unds po.ltyofpsjuryIhd I @ lic.B.d unda p.ovilion of('h.pts q(commdcins nirh sc<rion TOCIO) olDivirion I <br />of rhc t\!iB ..d PNfdlioB ( od., svl my lkGe is in tull lor.. ltd .ltd <br />CONSTRUCTION I i:NI}IN(: A(:FN'Y <br />I h@by.mnn u.ds Fnah, of pajury thol th6c ts conslruclhn k diry agocy for fi. pdfonnanct ollh. work tur s'hich lhi Frril ! <br />i$u.!j (S( 10q7. C!r. C.) <br />AIIIJSASI.IIOJAAIIAN <br />I hrlby.trm uB:!d polhy ot Fjury oE ol rh. fouo*lns d.(ll,!tnni: <br />ocf,olniin lrd'nne^lb6tos Norificd bn !-.ddrlR.*ublions ('l illc 40. P&n6) <br />Rcqrned lnr6 of Notificalbn <br />I (dify rhd rh. fddsl rcsullli'G nsd{sg dbd6 @or.l d. nor .ppltlbL ro thB rrcFl <br />-l <br />cqrrfr rh.r I lE\. rad ih6 rttl(dirn .to* inLl i)n . corcr I @r ro omdy $nh i[ Cn] .rd Coud, <br />ordlud Dd sr!r.l^: dr'C h hri lE.b &rls& G!.eInn6 of rhn ( nr'rd <br />!bo\. ftetnEd Frpd! lor r6p€lh <br />(> <br />a V_Ter rit(n,n,rr|In'r): <br />t, <br />O'ro '7 ( <-> <br />J <br />'f,Fi*"* <br />II <br />FINAL <br />=,,"r* <br />fT