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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underoround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm i Dampers
<br />Communications Cable
<br />Under Slab / Floor
<br />Bondino / Groundinq / UFER
<br />Translormers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Bough
<br />Service Meter
<br />FTNAL L-/4 / 2o?4 .-/1 m)
<br />Notes, Rerfidrks, Etc
<br />OWNTiN AU!LDER DI'LCARATION
<br />I hcr..$t ltnrn und.. Fmlly or Frj!ry rhlr I m .x.n{,t lmnr ltc Conlrrlor' l,iuq t'* lor rtr folh*irB Bsn (Se.?oll.J.
<br />Bosin.$ rd Pmfc$ion Cd.): Any Cily or Counry *hi.h rc{uiEr ! Fnn kr onnM. !lra, i,q,ro!t, &mlist or E".n uy
<br />rh.@, Fi.tr ro ils irsusN. rl$ E{uirc{ rh. lpnlidi lM \rh Frn ro fikt rSEn nlkBfll lh.t ho. slE i.lie.{d pt)lM' '
<br />io rh. rovirioN .r E ContR rol r LE.nEd t * (Ctup'.r 9. Commtuiix wi'h sdri'n 7un ol Division I ol llE BuiiEss ud
<br />Pmr.sions Codc) or rh.r h. or dE ir cr.q, rtEr.trod 1rl rtE h.\it ntr rlE.lkB.J.rc.iqrion AnyvioLriod.f kirn?01,.5 by uy rrpplturfor aFmi rubFrrrtE lpplicmr ro r.ivilIE lryorfl,|mErh& ftr h!.d'.n doll,r(t5(l))
<br />l. rr oraE of rlE rreFny, ( oy.'rolJqr w h w!3s 8 rlEir ri..!f,{En!.lbn. *ill &, d. Hrt {n dE jfu ir d
<br />i,rait d d offd.d ld sl (St .?o4r, BuriE$ rnl t\nf6rbB CqL: TIE Colldd ! tm t s &B ml .pply lo u ow ol
<br />rlE F,IErjr wlb tliBr d in+.oB 0Ea .rn *b d(q st qfi hllell or hadf m rhruah lxr d lE om.4k Fi
<br />FoviLd lhtl trh iqmtcd!EdirdndqolEsl(,!h Il lnkE, rh. hildinS r urFoErE r n $B *il6 *,q
<br />of @rplri[ ttI O'rE Builk will hE llE hnL ol FoEE 0a L ot rrE dn d hlt5 d !i!.DE ilE FqEry for tlE F Fcof
<br />-1,
<br />6 owF of rlr Folry. m .rclusiEl, .onL1ulr rnn Uu{n .oddo6 k, ft.slM r,E FDir1 (Sa. 7O4,r- BsiEs
<br />snd EotsiD Co&: Tt Conkdor'r La.nr trw d6 br rprrly ro M osE of FlFn, whd hoildr d impmEs iIEN..
<br />and *tD o'rEl! am rrh,ioFcr3 wirh. C.dd!firr lt.Mn p!.id ro 'rr Co rrld! Lis< Uw).
<br />I m .x.mpr ud.r serio.
<br />lraSEl8l3aMf!$dr0!
<br />DIS.AXAIIN
<br />I tschy {nirnond$ F6rhrortdjuryom ofrh. blk'wlll3 d.yhraln,nr
<br />I h[c ud uill roinrlitr u Cln ilicarc ol Cui*nr k, s.ll.ln$r litr *orkcB Con{rn\dii)n- n nhlidcd for by ssrion ]70o of rh.
<br />lrtn Codc. for thc ltcrforromc ul rhc uort as ehrh rhc Frhr n isu.d
<br />Ccwi::.lls,?r'trr. .. r '.tr.n.,..tr , n,ltih.
<br />lhvcrndwrllmai.rairsnrlcr(.otr,trtr\ari,n,i'Mrrc,r\r.quft(lhySr.rr(.17(xr.lrh.1",Ix,(ixlc.lnrrh.rlfornrtu.or
<br />n A\u.J ltly * '1.'\'.,r
<br />"rdC at
<br />l)ic oL-P L<tC< /
<br />WARNING: FriluE ro E@ *nlar !:rnVE.si.n !1*rrSc n lnL*ful rrn ddl subFt m cntrby.r lo si6in l FEni6 rd
<br />.ivi, limr up ro oft hunn t! lhousn dolllr (!1(I),{rID. ih glri, ro rrE co{ ol contEtr{lior {irtug.! 8 Fovildl ror rlr
<br />s&rhn 1076 ol rh. lrr Cnd. 'nr.d ri ddE'l ldr - -
<br />-,,tILrQ I)u)| ^*,b@I rca{sE c(rlYrf,aL-run
<br />DEIIJSAIU!
<br />I lbErj, drrm u.&r FMty of F+ry $rr t m tmr.d ui&r t,Dirior ol Chrprd 9 lomBins slt Sribn 70OJ 6r Oiviri,6 l
<br />of lh. BuriNr3 !d PEtusaoB Cul., .d h, la.K t r tull LN !n.iYar
<br />3
<br />-
<br />nl /<
<br />lllplirsnr or 1t.nt SiEtuluF
<br />>r l^Pr lre€ I
<br />fu r'-ocLt' 'v
<br />{,-<
<br />d-"I tErcby lmrm ud.r p.n tyoap.rjorylhrl rls. n r.r'.{Mir. t linS r8.ry tor llE lEfomr. drrlE rtt for qhth I
<br />h .d {sc. 1097, ci!. c )
<br />AfILIIANI.IECIJBAITO!
<br />I My ltrmun&r p.nolly of Friury orc of lhc n,lh*inr dccls.rionr:
<br />D.mlirionPcrmirs AstrnosN.rifi.lt,.F.d.[lR.guh'n.,(Iitlc.q).P.ntr
<br />Rcquir.n kttc, of Norif&rbn
<br />lllcfiifyrhDr r hc Ldcrd rguhr trtr\ rcgdd rt a\ht(n\ rcnr)vil (c Bn rnnlicahlc k, rhn pn,rrr
<br />r .d'fy rh.r I h.K Eod rht ltllt.rion u,n nsrc rhd itt lhrw rnk'lmr kn n .rm.d. I .sr ro en{ y *nh !u cir, r,!d counry
<br />(d,Er$.d srarc b*s EhrrE ro h{iliD3 co.(ntlio( arl h.Ehy rurhtrr. EF.{drivc! tr{rhi! City r.d G,unryro...6 uFn rtE
<br />lhr inri)rd pmFdy fm i.!
<br />I
<br />Buildinq
<br />Meter Release
<br />-l
<br />cuify rn.t in rlE rrrlormd or'h. woil t shihthnJ'.rm' t (tu.d,I rh.ll mt clrgloy.n, Fbn in tny nsEr
<br />e &ih b.oft flbF o rrE mltnr srFMhn Lrr or(ilifodn, r'n .3d rhd if I .rDuB lr.or subFl lo llr
<br />*olt6' onyxrsr6n pnvBions or Sdbn 1700 .l tlE t tu Cod.- t {rU, lnihrarh n,tply *nh 'bc Pmvirbns..
<br />knd.r's Addrc\(
<br />-
<br />t o\4 v4)<,/
<br />Rpv OB 07 ?011
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