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ELECTRICAL-INSPECTOR RECOBD
<br />APPBOVALS DATE COMMENTS OWNEII BUTLDER DELCARATION
<br />I rE.rby .mrm uftbl FBlty of Frllry thal I m ct mnl iiDd rb. Cod6.tn rr.r trr itr rlx rdhwil3 rc.$n (S.c 70.!l 5
<br />Busifts &l P'ofcsii,n Cod.) Any C y or Counry whth ErtuiEr r F rn lo o.r^rr, !hs, irq'mh, &mlish {r Ep.n my
<br />rtuduE, rnr t, s issu.rf,.. 0!o n1ui8 llE rpf lad for rkh rffn ro nk . siSmd n,rcmtrr
<br />'hd
<br />lE or rlE i! li.$sn n{sg
<br />lo rh. pn,v^bnr of rtE (tr.iak, r La.ncn LB lchll)lcr 9, Comtrxrnr *nh Sclid 7On ot Darnbn I ut rtE Blsitrs Md
<br />PDr.s.ilns Cod.) or thd lE or sh. 6 .r.r,g rhocnom .nd llt hdr r.r rl. nhscd .r.qii,. A.y vfLrionorse'br 701I 5 bysy
<br />.pplicr for ! p.nnir subl€(rsrlr l,tli.a ro..ivillcBlryolhr frElhu 6r. hudEd dolles (S5(I))
<br />l-.1 owrcr.fllE l,l,Fny- r my c,.ploFei wirh *sI.\ s\ rh.n $b Nmp.nr.lbn. *ill do rlE *rr* rd rh. rdm i. rr
<br />inroJdi o, o!I6.d ror iL (Se.7O!4. Burirci! ud Pfl,L$ionr cliL Th. C. t-ltx\ Ltcn* Uw d€. nor q,Pl, to e owE of
<br />ih. FFn, *lr, trildi or iiFmB rlENtr .rrl wln dB uh {o* hirelf or h.Mlf or r}NUIh fiir or lEr o*n.t 0lo}t.s,
<br />Fi,vdcd rhrr such nrrE,EBri E 'br incd.d d ofr.rd fd rL lt rbw.E ttE ttrildnU or iqmErnl is sld uihin om )t,
<br />of.onrfLri{ !t! ovE. Aurra eill IEE rlE htrdc. of In,sn! rhd lE or slE dil rlI tlill or i,troE 0r Forlly rff lrE FrF! or
<br />L a\owErofrh! DK,rcny. .m crlu\iElt ro rd inA $nh lr..*d co.t.d,m ro cotr{Ml lhc ptr,F..'l ( Ss ?Ol,t. au\iEs
<br />!flj lh,i:\snn c(d. Thc crnr&1ol r La..rc lrw de. mr lpply b an o*n.r ot pr,lxdy wh, huld. or inp(n$ rh.Rrn.
<br />ond wh) ('trrBrr fr \Eh rrnjc(r sirh a Conrtub(\ r 1..6d tuhu.r lo rlE Conlrdols La.ncu$)
<br />_! !ncxcmrl und.r S6iion
<br />.t}ll8trEllg!&t8ENrdrll!
<br />DEClaSArllrX
<br />I hcrchy alfin. undcr p.nohyofpcrruryor ofrh. ft)Uoqint J.thr.ri'nrl
<br />I hlvc a,n *ill nrint.h r CcnifErrc of CoNnr t, s.r.l.suE for *orlsl omlEN.li,n, .r F,vihJ f.n by lsrhn 17u) sf ltt
<br />lrrn clt , rd llE Frfmft of
<br />'h.
<br />w* for *hth rh. ldrn is iliEd
<br />_l i!\r lnd wilt nEinrur worlcN conp.nsrbn insurE.. {. rcqriEd b, Ser n,. l7U) or lh. lihor Cod.- for llt Isl'orllEN of
<br />Ihr { rr lttr qhEh thN Fmur s ho.d Mv r.'k6 eEnerDn r.\uMc !o.r {rl F,lry trumlq e. Tzeh.toti",q hc. Caw< . ,
<br />""r'rr t
<br />_l (nitr rh in rlr FrfornEr. or rh. *orl for *hrh llrs IErn l i\ i\rhti. I \bll tur or?lry t.r rErmn rn tny mnftr
<br />$.th bcconr rubr{t torh. uo.t$ cnqrnsrtn Leroac.lilom4 rl rgm
<br />'h,l
<br />if l ilFuld h..or stl,Fll hrh.
<br />*olt.T mnr{nurion F,vtion\ ol Srdir,n.17tl0 or rtl lihr Cdrc,I \tBll, f(nhwnh..mlly *[h lbc pnvisi,nr
<br />It,\k\li\C l.rrlur. xi utrrc ".rlrh (otrIrnnixr .d.,rlc A trnl.'trxn ;h!ll runr.r rn cnl|rbr$ t, dinlidr Fnl'iB..d
<br />cirrl 6nc! W ro or nnidEd rhoxsd doudr (!ltD,(m)
<br />fii[t,
<br />i'n.rr! rtrJ rnorfrv \ kr\
<br />.rppri.rnl: (
<br />ull;Nu)-lau8 ljl)8lE(]d&!rg!
<br />I h.nhy olrtm unLr FGBlry of IEiDry rhur I am lian{d udcr pfl)vabn orChqr6 elNMErrtrt snt Scdnn 70OO) orDivFEn l
<br />ol rhc Busift$ ud PmrcsirN Celc, ud my li.n. n in nrll for !n cffd'
<br />LZo t
<br />,1,iF c-r*r...6(
<br />CoNiTNU('TtOfi LTAINING AGENC'V
<br />I hcFhy ltltn rnl6 FEhy or Frrfy th.r rtEr. !i ! d,n(ruclbn ldinssscBy tor llf FfolrrErc olrlE w,l ntr *htnlhn Fmn is
<br />n!!.n (s*r 1097. cir c )
<br />ATIIIIANLDECIJSAIIgB
<br />I ho!a', atrm ulldq p.nrh y of pcrrlry onc of rh. folhwinB d.rLr{.nr:
<br />Ixfl,lirion Pfimj8-Arh.sro. l{otifrrlhn F.nfll Rqlblions (Tilk 4l), Pd6)
<br />R.rruirc'j l.116 or l\* ir.dih
<br />ty
<br />_l .cn iry rhd
<br />'h.
<br />(.drhl E8uhrioB rcg{dh8 .rt shs Em)vll !E nor utlicoblc (, rhi rm}tr
<br />.l rdilyrhni I hrE rcrd rhn spplicrt i,'n ul {rhn.'nl(trnBrir ^ !urc!r I iBtu! h, cln'dy * [ rll ('rynrl (-((nv
<br />ddmrft6 ard srlrc rjws EUrr{ r. bui
<br />ah,v. mnrokd p^'p.ny |nr in(F.rFn
<br />\.nrJr^c\ of rhF C ! dd C,'udrv k,.N.r uF$ rtk
<br />l pt,li.-n .. lsrnl SiEolnFL
<br />P.mne mnr (nrtnlr:rL a{: bqbr
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Bu ilding
<br />Under Slab / Floor
<br />Bondino / Groundino / UFEB
<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 & Soflit Rouoh
<br />Ceilinqs (T-Bar Rouqh)
<br />Meter Release
<br />Rouqh
<br />Service lvleter I
<br />FINAL V/il*t t rvffilt )
<br />Notes, Remarks, Etc. /'
<br />-$
<br />ID/SIG.
<br />Site-Work
<br />Lk.tr-
<br />L.nkr'. AddB..
<br />-
<br />{Ta-R/*/
<br />I
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