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ID/SIG,COMMENTSAPPROVALSDATE
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Lioht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Translormers
<br />Torqueino I /-1"ttr?Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouqh)
<br />Meter Release
<br />G-^.<L "-/,(1 lo),0a1fiitRouoh vIService lvleter
<br />FINAL
<br />Notes, Remarks, Etc 7
<br />(r\!NuR llu!LD[R DUI-C]\RA',l l()N
<br />I hcEby .ilird r.df ,.nalry ol pcrj!ry rhd I m cxcmpr lmm rh. O)nrBclo^ Li.c.sc tiw in lhc rolbwin8 lcaqrn (s" 70ll's
<br />Bu\incss ind Prolcssion ctdc) Atry Cily or Cor ry which rcquiN a Frnir ro .lnntocr. alr.r. inr[ovc- ttcrmlish or NItn trny
<br />stu.rurc,rriotroilsissuaftc.alsorcqrnc\rlraDllicanriorslchtcnnirlolilcosiencd$crE.rrhaltrorslEirliccnlcd|Urnnnl
<br />rorhcptr,lii,onsofhcConrscrofsLiccn*dljw(Chrprcr9.Comhcn.ingwilhSccrt,nTuDofDivisionlofrh'Br\inc*nnd
<br />Prnassnr.sCodc) orrhsr hcorshc hexcnDr rhcrcrro rundlhc hasn lorrhc.llcgcd crcmprn,n Anvviolurt'nofscdiunT0:ll5bv'nv
<br />,mli.rnr r'oi 0 Pcmil sxhj.cls rhc !0Plica k, !civil Fnulryoln.r rmr. th.! fivc hxndred dollln (S50,
<br />lll, s owtrs or rhc Fs,rxny. or nry cn$ r!De\ wtrh q 08c1 0s rh.t slc om|tn{ltrn will do r,E worl ord rhc (BluE i\ ni
<br />inidrkn or ofcr.d rrt $k ( Ss 7(]14. Bnsi,rs a.d ttofcsio.t codc l hc o, ncroi s I iccn{ hw docs nor nmlv r' 3n n(rr or
<br />rhc!tuFny *ho hoildror nryovcs th.E,n..d who dms skh w)* htriclror hcrcllor lhrcxeh hk or hcr own cmlloles'
<br />pm'a"a rrrar sucrr inrmrcm.h e nor inlcndLri d olTctoid ro. sk ll l$wcv$ thc hiHine ot itr{'mEmd n $U wthtu onc Fu
<br />;r.onucrhn. rtE Ownfi Bu lcr will haE rh( l{ftlctr oi Proin8 lhd he or sh. d nor build or irurort rhc I'toFnv for lhe purFs or
<br />l. as owncr ol rhc pmpcny, s'n c(lu\ivcly.onr|cl ilrg *iri lic. s.d co rucb6k,..n(rucl llE ltr'i'1(SN ?(E4 Bu{i"u*
<br />ad PDrssbnCodc:1h: Co ra.ror's Liccnsc t,!$ docs mr a!'llv ro an.*ncr olJ'rcpcnv *h(' builds or ifrlrovcs rhctcon'
<br />drd wlr contr( ror such proFcrs wirh i c.ntmcrod n li.cn*d Fnruml lo rh. conlt.dols Li.cn$ kw).
<br />I rf,crcrrr r tr Sc.ri
<br />"",.,f
<br />J qL7-letf
<br />lrl:lllailuQN
<br />I lIrchy !rl nn u dc' t,cinlry.l i).riurt o . ol llt tull riDS tl.clnrnri, \
<br />I rhtr G r.,,, rhc l].rl.nrx .c rr rhc \.rk,nr \hi.h rh. Nitrrir n n{r,t
<br />ih. \y.rk tu $ hi.h rhr\ rIrnil i\ i$md My $otk.rr contn. n\rrnr ${tr xn.c rr t rcr rftl Po!i.r- iu l{r r''
<br />Poll.yNun$cr
<br />-
<br />Z ccnirrrh, hlhc lcrtormnc.ortlE qork iot whichrhh Pcirnir h G cn.I shall od cnll)lov0trvleson in onvnanncr
<br />'v, s h tB.om sbjecr b rh. wottss cd'nP.nsriotr lsws ol Crlitudin. and lgrcc lh ifl should bcoit subisl k''h'
<br />lorkcs compcnslrion Fovisions ofScdi(,.:lTlDollhc tjhor Codc l shall. lbnhsirh conplv qnh rho{ ptuvisions'
<br />WARNING: Faihrc ro scurc sorkcn compensarn,n .ovcfl8e is trrhwtul. and shnll \ubj..t trr cnrploFr lo d'niMt Ftr'hics mn
<br />c \i ftr\ rn ro .D. hnndrcJ rN)u\rfJ n. l]^ 1\](x).lXX)) ir t'l(lirirnl rhc co( of..'nI[tr{rri.n- JrnrrCcs rs Ir.!id.d lnr llr
<br />Sccrion 1076 ol rh- &hr Codc. int.tcsr and atrormy s fccsll-\Lq8
<br />I hcNby lftinn undd o.nrllyofFrjury rhar I rm lieo\cn xnd.r !6vnion ofCh,
<br />or rhc Busircssand Pmr.ssi NConc. s.d 'nylNnsc is in tulln,cc,nd cf,cur
<br />pr(, (mnntuking \ilh Sccri('n ?m0) ol Divni,n I
<br />QNSINCITONIIIDING.AAEIiCI
<br />I hcrcby llrtn utrdcr tf,.rlryolneiury rlrrc h ! q,n{ndhn L:nnins ascnrv ror rn. Pcr,ormr'c oirhc Nork tu r'[ich rhi\ p'nnil n
<br />irsucd (Sc.. 1097. Civ C ).
<br />APPI ICANT NECLAIAT(TN
<br />I horby lnim udcr penalryofpcrjury.n. oflhc {ollo*ing d.{ld,riotrs:
<br />D.mdlirion Pcmils A.b.sos Nolificrlion F.d*rl RcSul{ions(firlc 'lo. Pan6)
<br />Rcquncd Lcuer or Norifi c.lio.
<br />l.c iryrrr lhcledcr!lftsullriotrstcaadint dsh.nosrcmovalarc nornPllic$lc t, rhi\!roitt
<br />4"n',,rlr{ l halc rc rhisapplicrri{,i rtul sldclh.l rhcuh'rr nironn|liof hcotr.d l aere h conrdv wirh ill Cirv dnd Courv
<br />onlrmo.c\ nt Srrl.ln*! kldhS lo hn
<br />rtxrc *nrtr,rd f roDcnt i(tr \l,cdi,n,
<br />and hcrcbrNrhorizc rcprcs.rarivcs oarht Cny nnd Counry ro cntcr ulbn
<br />Apdi.snl or ,1rrnt Sirnalu (l'ennilco nnnr lp.int):0A JInron
<br />*,lJrlL2lI
<br />ELECTRICAL-INSPECTOR RECORD
<br />t -'l
<br />.,WtUq/
<br />Lic€nsc ClNsr-Liccnsc Numh.rr
<br />-.-Drle (-onlmcror
<br />knd.r' Ad,lrcq
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