|
ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE
<br />Site-Work oUnderound
<br />Li ht Standards
<br />S S Pool Fountains
<br />ID/SIG.COMMENTS O'\,!N Ei BU ILD':R DEI-CARA'I-ION
<br />! hmby .finu u d p.Mky ol p.rju.y lhol t an dcnpr fsn rh. Contraclos LiceB. l-6\ ln lhe fr'lhtritrB l91mn (5<.7011 .5
<br />Busins and Prol6io! Codc): An, cny o. Counly qiich rcquil6 a ponir ro .onstud. ah6. nnprorc. dc,nolilh or €pat M,
<br />srrucruc, riorro ir. Gstrec€..lso r.qutB the npplira lor sud Fmn ro fi|. a si8tr.d slalflol thal h. or she i li.mkd puNmt
<br />ro rh. FovisioN of rnc co racrois Licen!.d t:w (chsprc 9, conrm.ncins sirh sdion 7ux) of on isbn 1 of lhe Busi.cs and
<br />Pof6ions Cod.)orrh.r hcorshc is €xonfl rhcr.fo and rlE basis for lh. alks.i cronprion n,\iol.rionofs&len701l5br;y
<br />applic l fora pqmil subjtclhc alplicahr ro a.i!ilp.nallyofnot morclhan fivehtrndr.ddollas{1500)
<br />l. s o\vncroarhcEop<.ry. or dycmployc wnh $ags as rh€ir elcompqsari.n, *illdo nE$o* utl llE slnidue h nd _
<br />inlddql or oilcrcd foi :al. {Sc.7044, BNins and Frctdsions C.d.r ', i. ( ont.dois I icosc Lsw do6 .ol aml, Io an o( na ol '
<br />lhc lxlr.ny $ho btrildror imrovd rhdbn tnd \lho do6 $(h solt himscllor hs*lr or lhiodUh his or her o\rn enrpltD.6.
<br />provid.d rhd su.h impro\'aD.ils E. ml hl6&d .r oII6.d lor sL. l[ lbtraa. dE hildilts or inltIovcrcnl is snd rvirhin .n. ,@ t
<br />olconplaion. rhcolxn6 Blitla vill ha\c Eto.&noaprori.sthallEorsh.dnlnolbuildoriDprovcrhcOnpqiylitrllEprrpos.or
<br />l.6o\.doath. propcny. dexclusiv.ly.onrmctin8 $ith lic.nscd conrrflclosto cofrtud rh. prcjd (s(. ?Or.1, hlrns
<br />and Alnsrion Cod.: : h. co.lr..lois L,iccnsc l,aw do6.ot apply lo.n.snd olpror.ny $ho builds or i'nl,ro\6 rhscon,
<br />and who co ncrs ior such !ojc$\LIh. conta.Lo(s) li.6scd Du6u.trt $rhe ( onr.dois Licd* La\ )
<br />I arncxempr trnder S<xon- .Ir & r( tulhis'€ns.
<br />l)ol. o*nerl
<br />vaRxE&IcarlfENla-lto!
<br />DICIAIAUAN
<br />I ls.hy amnn undcr p€n.ltyofpdjuryoncofllE follorinr declamlions
<br />I halc dd rvill'nsiflain a Colilicare ofconsmr to S.lf-lmur€ aor qork6'co'np. arnrn.s pmvid.dforbySdiotrr'70ooflh.
<br />t*bor Code. tor lnt Ddlomancc oflh. *ork lor *t(h th. p6nn b isucd
<br />lha!...dwill'n.inrainwork.rscompeNdioniBuranc.,sBqut.nbys(liotr1700otlltl..l{'c.dc,forrlEFfonnanc.ol
<br />rh. $ork aor which thn pmnit is issued My worl6 comFMlio. imrr arc. carie. ad F,lt, nu,nbd tuc
<br />Ex ealT
<br />Poli.rNn'rbdr '
<br />-.-l cdiryrhnr in rhc pcrlorman coflhe wort lor Nhich lhis ps'nil is is$4d. I shall not onPloy anr_ peson in any 'nann$s s ro ll. o,ne sbj(l ro lhc soAsl co,npmsation la* olcaliloEio, aid rlr rh0t ia ! should ii$o,n. s,6j{( l. lhc
<br />wol{ds comD€osatnnrsorisn,nsorSerionlT00olrlrlrb.r(idclslrll.lonhsithco'nplr$irnrho*Pmrhions..
<br />W RNINC: [ailurc ro Burc Norkos compmslion covrssc i. nnh$nn, ind shall sul,jNl a', onplottr lo dnrin.l lwlliB ed
<br />civil fincs up to ofl. hundled rhoNafld dollars ($l00.0CvJ). in addir mst or cmr4Nri? d!i'.Ees 3s p,orid.d aor thcu'l''inrs6r flnd 6rrom.y r 16
<br />ZLY L ,Yr /ZL
<br />DECIdI{IIA!
<br />I h6.ty lrrm unds p€oahy ol pdjury rhal I an li6Ed ond.r provbion ol Ch.pt6 9 (con Bncins Nnh Sdion 7000) o{ Dn ision l
<br />oa rh. BBin6sd PmlBsiotuCodc, od oylictu. i! ir lullforc.ttrd€rslI .oD(.,."./--
<br />tz1+7tua,*, - 0/ta,/zr>io - "-,.*"X
<br />COIiIaUCUON.IINDIIG.ACIM:I
<br />I ncby .mm und( Falty of p.rjury thal lh6c b a conntudi('f, lddiiB .8ocy for lh. p6romdcc of rh. wolk aor shi(n lhis PEttrn is
<br />tsual (se 1097, civ. c ).
<br />l,c!dd s Name:
<br />a-e8!,r(arluDctltalla!
<br />I hottya,l'dnuido pc.al', of t lury on. oith. lolloNinB d6laraliohs
<br />D€molilion lmrik-tuhctor Norifi.arion Feddal R.aulatiom 1l ille 40. I'ano)
<br />t<turcd L.llcr of Norifi .arn,.
<br />ily rhar rh. fcddal rclularions Egdding sbBlos reno\ al tu c nol .pl,liMblc to lhis p ojccl
<br />lw",irrrhdln.v.rcadihis6nplicnlioaudsralelhar$cal\^cinfdnr.rn$isconNl lall.!l(, cfn,t'ly \ irI nll( ir\ afl (irtrrly
<br />ordmdcd md Srit.tnrsr€hlrnrlo l-{
<br />'Utr's
<br />(onqrufl tr4. ,'^,,:i::::"::7.::xru44
<br />Perrricnrme(prl ): L 'PeLaal E
<br />oarhi! cirt rnd cornry ro €nt6 upor tlE
<br />,,,"'' O/'f/'C4'
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Building
<br />[J nder Slab / Floor 7 2, l(1 _t/4<fu$
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Faclory Wired Unit
<br />Walls (Conduit)tilv//th?
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />lvleter Release
<br />Rough
<br />Service n/eter
<br />FINAL -2t o J)es rJoCf)
<br />Notes, Remarks, Etc
<br />--a
<br />Pole Bases
<br />Communications Cable
<br />L..ddt Ad.lrs:
<br />NnnryrceBdldn6
<br />/Aw?,
<br />l
<br />I
|