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APPROVALS DATE ID/SIG.COMMENTS OWNET BUUDER DIiI'ARATION
<br />I lEEb, rrfn, oBLr p.Elry ot p.+ry tlu I u .knll ttrm rb. Cbft(6 Li.tM bp for tlE fouowi'rt Erfi (S<.70r1.t
<br />Buirs .rd PrnfEi,i C.d.tr An, Ct, tr Cddy rhth Equi6 . Fni h drrEr .nd. trpr.E &mlah n ,rF, u,
<br />itu,In,ohs mtM. rl$ Equc tlE.flrli-sr ld ulr pdi bnl.rBEdn.mr dilEqS.ili:!s, Fru.d
<br />ro tlr Fovtiou of dr CoDlrErrt t-i..n!n b* (Ctur(., 9. C6'ftai.8 wirh Serion 7ux) oI Divnior I or $r BulEs .nd
<br />PrDr.sbE Co.t) ( rh.t E 6 rlE !.&'t{.0'at6or d rL 6.s fr, th. dh.d.rn+m Alyvblrinofs<iE7oll56yuy
<br />.p?licnx fo' r Ftrn tubFB rlr rp?lic.d ro eciyilFEnyord mE thrn lrv.landrld doll6ltrl),.
<br />-l-
<br />s frF nf tlE F Fny. n mr.rpblr6 *ih *.ts s llEn nk 6.+dui]i. qill& riE xrr.n rrMRtnr
<br />icrlal d dlrcJ Ic EL (S-.ru,l. a6E!! rlt PrDt saoB (qL, TIE Con'xidi lirn. br dE d +ply ro o off ol
<br />&. ImFny *l! erkrr r itrIr6 rhds! !d wt, dG ri s,lt nimrlr or ll#lr or tuou8l hr d h.r oen.nlplo]cr.
<br />Fori.d Lld ut rr.DW& E r'r id.i.t d dotLrld fq {t U. h.rG. dE hiBioa d,4mErn it hb vil!! * F.
<br />ot cdrpkia 0! owB Aljll.. *il llE ,l h,nl., or Ffr4 lh. rE d tr dn M hriu d ,!F!E th. Fldy lf tlE F,td. of
<br />-1.
<br />. o*E of rlt Fofdy. d.rtlir.ly .o'Br!! rih lr.Eai .oens b .(fu tlE Fird lsd. 7o+,1, 8Mg
<br />.rn Eo&s!'Cixl. Tlr. Co ct,'! Lr.trE L:s.h{ d rfi,|, to owE otFoFny*ho hd i! or fp,ot! ri.t@r
<br />ud *ho conr,acrr aor :.ch Fi,Ids *iri r CodBr,,(O li€Md poB@ ro rlE cotu.dolr LixMc k*)
<br />-l
<br />d.r.r+ ud.r S.rru-. B &lC.foithnt..bn
<br />llllEflEs.:glull;6arrad
<br />DECI.AIAIII,D
<br />I h.Eby aflr undcr lrBhy oI ncrju.y orc of rlr hll,*ry dcclairiod:
<br />_l ME in *'I rnrrd. CdrLr. o, (.l,ed ro S.lfINE fir Hrt6 onFdDG a FoviLd ld tt Sd-n !7m oldr
<br />Lahr C.d.. Lr rlE F lon4. in rh. *oll n{ *hth rlr Foii b ilsu.d
<br />_l tur rrl r,,l tudd q!lt?6'6n+rMrh. BurE.. i -!n hy Sarir l7@ ol rh t-lxn Co&, for rh FnnIIE of
<br />thc *orl (,llwhtlui Frm n '\{xd My rort(i m Nutru clmr !n Doky nun*E !.
<br />-l
<br />c.nit $, n 0r rEfomu. or rh. *.'t a(h th! Fmi s uir.d. I ndl d.r{1,} uy FrF, r uy lBE
<br />$ ro b...n. suhtd h rh. u,.Idr cotrFnstion s ofcrl'romi. iid r3E rh{
<br />'r
<br />I 'h.rld b.<orE &bl€r b rh.
<br />wo.t.! llntFnerren pmrn@B of Sdetr l?(x) of rtr L,!or CuL.l dEll. fdfi*dh onlolr virh rho* pmvlkB.
<br />W,\kNING, ltrilur. ro Ecoc !o.1.^' $r{Ensr hn c.v.ft8. r unhvful, dil rh.ll slbFr M .r{,krrr ro om'nal Fuh.s oJ
<br />civil ,irtr qr h oE hurdrcd rll,usd doll (1100.rlE coi of conllMlon, J.ny., . nrovd.tl fq rlr
<br />".,.' .-\ l \\\l?.., a
<br />DECIAEAItrXI
<br />I h.Eb, .frm lndd p.Mlrt or p.rjury rtur I !n lien&l u.ds suvBon or Orp'd e (.ofl'Ix[-_-'ina enh Sdior 70(10) or Dndon l
<br />or th. Aui:[ d ttrfdid CdL. rn hv lt.n. a h lull for !d.fid
<br />(: to 1se5+
<br />U\rr 'Lt)
<br />t U\,1t
<br />l9lsr8!.ll]rxtlEdlac-A{iE8cr
<br />I h.Eby alTrm !na- Fuhy .r Frilry rhn rhd. i r @nrtuiln kdin, .a.ry for rlE Ffnljll.E .I rh. *rl lor *tah rhir psnil ir
<br />it$al ( s6. 109?. civ c ).
<br />AISJSANI.IECIdEAIQB
<br />t }Ert'y lnimr urd.r l*n.lr, of lrrilry om .t itE foltr*ir! d..ludioNl
<br />D.nll,rion PqnnlArllrN NdfrdD! !.n d R.ruhiry Orl llll. P{6)
<br />-RcqlRd
<br />td., D, Niifrc.li,,n
<br />_l dd, od rE Lddrl EluhrnB rtrdin! shrE EBn.l E d +dirbL ro drn FsF.
<br />_l .drty du I ME Erd ttu rt lrdhn .n d. rlu rh. tloE infonuion it .6.d I {r lo otrpl, wri rll Cly ud CMr,
<br />ddift6 rn slr. Lrqr rlina ro hrrLli.8 codrdia .!d h.drt dlrrM qllddlG "Y Ci y nn C@nly l. nrs LrFr dr
<br />abo\. 'EnrDrri pn'r'.ny ,(tr mip.
<br />cl\r''\r."
<br />P.m'lrm nrm. 'prtnr':
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Lioht Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding i Grounding / UFER
<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 & Soff it Bouoh
<br />Ceilings (T-Bar Rough)
<br />lvleter Release
<br />Rouqh
<br />Service Meter I n\
<br />6-\t-zo YrU ,\l I
<br />Notes, Remarks Etc.
<br />ELECTRICAL.INSPECTOR RECORD
<br />Rev. 08 07-2015
<br />Dit.-
<br />Transf ormers
<br />FINAL
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