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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OIVNER AUILDER DEI,CANATION
<br />I hcrcby rl6rn under Fnalr, ()r Frjury th,r I m cxcnfl nbn lhc ConkmbN- Liccnr l-&w for thc lollowin8 reNrn (Scc.7oll.5
<br />aurncss .M Pmrc$bn Cod.): Any Cny or Counry shrh rcqun.1 . Fmn lo cnnrrucl. allg. nnprclc. &mlhh or Elat a.y
<br />nocluE, lrhr kr ils hsu.mc. ako rcquircs rh. trpplic,Dt for suchFirrit Io lilc! \isncd dsrcBnr rharhorsh. is li.cnscd pu6uNr
<br />ro rh. Eovhions orrhc contd.roir Liccnscd hw (Ch,fl.r 9. C.nrmncii8 wilh Sccrion 7(x)O of Dilkion I oi rh. Brsiic* ,nd
<br />hofc$ionsCodc) orlhlr trorshe ii ercnfl licrclionandlhc Msi\ l'or lhc al[Ecd cicnrprion Anyriolarionorsc.rionT0]l.5hyany
<br />,mli.ant ror ! !.nnit srbjftrs rh. nprli. rto!civilrcn,hyornor'nor.rhMiv.hu.drcddollus(S500).
<br />-l-
<br />!s owrcr oI lhc pmpcny. o. nr, cmpk,yccs sirh saScs 6 I lrcir {rlc umNtr\rr idr. sill d. rhc wmk und th. sltrtutc i\ rol
<br />nnrndcd oro,lc'cdf{trn'lc(SL{70,14.BusiicsmdPDf.\sn,isC{xl.ThrCoikr.ttr\Licctr\cLawdoccnorlpllyromosncrof
<br />rhc pnpcny qho ioilds o! irpmrc\ ltEFn. ond who drcs sEh trlrr hnnscllor her{llor rhrousi hG orhcroNn.ntloyt.s,
<br />pn,vid.d rhar such inln,kmn* m nor i'{.nd.d ollbred lbr \rh ll ho$dcr, rh. hdikl ing or inlm*$rnr k okl qirhin. c }crr
<br />ofcorulcrion. rhe O*ner Aui[cr *ill hnr rhc tralcn .f tmving ihd hr or \hc dil fr, htriH or n pmw rhc pmFny for rh- pu(n$ of
<br />I.downcrofrhctR,rny.a.x.hrsivclyconhx.rhSwi(hli.cn{rd.ofta.ronr,.onNnrcrrfuImrat(sec?o!{.Bu\inc.\
<br />Md Pmfc$io Codc rhcContn'clois l-icensc lnwdocs not opflyio rnowncrolpropcnysho l,lildsor i'ntn)v.\ ihcron,
<br />rnd uho .onrB(rs lnr \och pmFch *irh a cuntmcro(\) ltci\cd tnrornr k,rh. (.ontn roir Lf,..sc La{)
<br />uaatr[BElaurENsllloN
<br />DT.CLIITAI,&N
<br />I h$cbyrffi nund.rr.nrlry.f p.rjuryotrcofIhcfolk,w,ll8d.chark,ns
<br />-l
<br />hntc a will minhin a Ccnificrrc of Consctrr ro Scll lnsurc f.! uorkcr' conpcnsrnrn. a\ rrcvidcdrorhtsccrionlTfi)oltM
<br />t hor Codc. for ihc palormncc olthc wod fo! which rhc pcmrn ic nsucd
<br />{r hxv. rnd \illnrrinriln sor[.^ confcn\rrion i$ur]mc. r\ rrqun.d bt Sdr bn 17fi) .f rhc Ltrbor Cbdc. for thc pcrl'onurcc ol
<br />/bb'{hnbthn ncrmn n n\ucd Mv sorlc^' rd'nmnlduil AaThf< f q,*".J ')c,c/
<br />OT EA 72 ?cl
<br />(r."n'ty rnn'
<br />'n
<br />rr," 1",tn,-rc olrhc trnrr tn, trhich rhis pcrmil n nsu.n- I \hall nor cnrlo, !.y p.sun in.ny nmnc!'u ,\'u tn.um.dbF r h, rhc w.*nc ,^'nFcnql',n h$( ur Crl'r.m'r, Jrd 4Rc rhr rl I (hould hc.om.uhF.r r, rtr
<br />workc6 L\rnp.ns,ion pmricionsofScdion 3lU).lthl btnr Cod..I shrll.lonhqith compl, sith thosc povnbns
<br />WARNING: hil$c lo *curc rorkcr( conrpcnsdion mvcmsc is utrhwtul \ubt cr rn c'npk,ycr t, LrnnnrlFmric\ rtrd
<br />.ivil fincs uD ro orc htrfldrcd rhou\nnd dollan ($l(D.UXJ). in nsriion, drdrs.s as ptulidcd r(r rh.
<br />Y--!1)illY
<br />I hqcbyrlli,alundcr lf,tr{tyol p.rjury Ihat ! am liccnsd Drovision olChlrrs 9{comnrncnu *irh sc.rion 70tx)) olDivision l
<br />'"g')-t)Io li..i\c n ni lDll nr..id.Jltc.r ta0
<br />I."" Tfi///<
<br />r!\rrd (scc l(l{)7. civ c )
<br />I
<br />AITLIqANLDECI.AAd.IIQN
<br />I lr($y oIinn u.dfi p.iahy.lpcrJUry.nc olrhc folloEi.B dalararion\:
<br />Dc.rnirn)n P.ii irs asb.{os Norinc{ion F.d.rrlRcBuh!n'n\ (Tirlc ll1). Prn6),
<br />R.qurcd I cncrol N.rli.didr
<br />I ccdllirhat rhc rcdcr.lrc8uhionr rcsrdin8 0shcstorrcm\rl c nor lP0licabl. b rht pmjftr
<br />**:lrl rhrr I hrvc r$(l rhl\ rmlicrrid,
<br />xh vc Drnri0r Dn)])crry lor
<br />ADplicnnr or ,\gcnl Signatu
<br />\-t( t 1 {chu lfr
<br />.u nnD wirh illCirj xnJ Cnunry
<br />,h^. t,&r. ou vro. .rtaftr rhc
<br />;","21a&
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab i Floor
<br />Bonding / Groundino / UFER
<br />Transformers
<br />Torqueing
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />[/eter Release
<br />Rough
<br />Service [t/]eter
<br />FINAL 1o\s\rs c1*6)
<br />Notes, Remarks, Etc \,
<br />Sub-Panels
<br />lrm.\rtr,J,u J..S..rnr lJ ril'( r,tr thA r.r\f,
<br />Dxrr
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