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ELECTRICAL.INSPECTOR BECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER OUt!,DElr DOLCARATION
<br />I hcrctyullt u crpcn0lly{)lpcUuryrhlrLhcicmpllronrrhcConrrucr.r'I-i.cnrctiwrorlhcfollowingrc0hn(Sel03l5
<br />Burin.s\ rdl l}ofcssn,n Gnlc) Atr, Ciry oi C.lnry which rcqltc\ a l.mir '. .onstd.r. rll.r. inrtrovc. dcnnlish nr rclan ony
<br />$flcrurc. rritrh ih irsu,Nc, oko rquircsihc rrtlli.anr ror suc[ Itn lo nh, sigmd s.lcnrtrr thil tror shc ir liccn\cd pldlnl
<br />t, rhe pmvnions ofrfu Conllrcror's Liccnsed t,u (Cnaplq 9. c]ommncins wirh Se.rion 7000 of Di!tn,.I or rh. Busincs Md
<br />Pofcssio.s Codc) or rhnrhc.r rtr is.xcnrfl thocroo aid rh.6a\ir fd rhc allclcd .x.frprion. ny viohlnlnolScclion 7lr.ll5by0ny
<br />appliu tu a pcrnil subjNlsrh. appliclnl ro acililpennxrolnot nrrc rhln rivc hundrcd dollm (S50o)
<br />-1,
<br />os owrcrofrnc pmpcnt, or mycnrllores wirh waScs.s rh.t slcconrrcnsdion. will do rhe work and rlE {er@ i$
<br />n c(lcd or.ficrcd lor slc (Sec 7o,r,a. Busimssand Prolcssions (rode: ThcConlrucror's t.iccnsct,*doe\norapplyro.notrftror
<br />rh. notEny wh. boildsor nnpows ihcmn. rl wk) dd\ {ch wrt hinsclr.r hcr{l! or lhrouAh his or h.r own cnll,'yccs.
<br />pn,vidcd lilr such in{roenEnh sc un inrendcd or orfcEn lar $h lt hosevcr, rlI Srildin8 or impovcn. r is $ld *irtun onc }car
<br />ofcomoldi4 rlE own.r Buith *ill h.!c rlf, burdcn.rpo\ilrg rhlr hc or sh. dal mr t ild or iml,oE lhc poFl, tu lh. puqD$ of
<br />-l
<br />am.iunr|i undcr s.ctn,
<br />]llJxtr!!5_!!JNt!!sr-lt!2!Irlill,/t&trlllN
<br />I hcrcby nflnm urdcr lcnrhyofIl.rjuy.nc olrh! tullowinr dc.l{didN
<br />I harc od *ill roinrsin a Cenificlrc oi C.ns ro Selt lnsuE ior sukcF mnr.nsarion. pmvid.di,b,s..rk,n1700ofrlr
<br />l,ltnr Codc. rbr rhc p.rfoflunce oI rhc *ork for which lhc !.rnrir is issucd.
<br />I hrtc,nd willmdnrrh qorkfis- .otrrlxtrsrrn, insuhrkc. s rcqoi, cd by So.rnr 37U) of rhc bbor C.tlc. for rhe l].rtumurcc ol
<br />rh. work fd whichrhh pcnnir is issEn M! work.(- $mp.nsrr i(,n insurrtur caricr 0Jt lnlicy nunrbcr Nl
<br />-l
<br />ccnify rhd in rhc ltrroflrtstrcc ol rh. trork fo wlrich rhn l.rinir h i\sucd. I \hrll nor cnlpby rn, pcr$n in any nmnncr
<br />s, t'hcdnm suhFd ro lN *orkcri ro nrcD srr i( nr hwsolCrlitunrin,ond rsNerhrlilI \houl(lti..onu suhj..rn,rhr(o*.s c.nrp(n\ilion pori\ions ol SNin,n .1700 ol llE Latnr Codc.lsh.ll. rh'1hs,irh conrply *irh rlDc rmvi\i(trN
<br />IVARNIN(;: Irxil$c r) {.!r. sorkr^ .o rpctrtrrtri .o!.'r8c r\ urk{hi. tr d \l,rll {rh loycr I. aimirrl pcmhis ond
<br />drnucs as pnvi .d lor lhc.ivil ,nrcs trt' k) dtrc lrtr.drcd rh.usr iollrnlsl(x).Ux)), in rddiridr t) rhc.os ol
<br />S..rl.tr l{rr 01rln.Irritr( 'iI n .rt'{ xl]d
<br />*,.,,-7|/cl( t{
<br />IJITTIEILrcNI&!!]OI!I)E(l ARA'I'IoN
<br />I hrrbt fir. rndcr Fnslry ofFrjrry rhar I sn li.!.$d undcr lnovision ol'Chrpr.r 9 (om,mocins snh sc.rk,n 7000) olDivisiob:1
<br />or rhc Busircs\ aod PmttssionsCodc, and mylicn\c is in fullfoar ud catNl
<br />C-t ","*,, n ,"1t'L37ltt
<br />CONEAIJqUTNIDNDINIj.&{jENII
<br />I htrcbt nrtrm und.r lln.ht of p.rjury
<br />'iat
<br />lh.E is a .one crhn L.ding 08.rc! for th. FrfornEmc of lh. uxk for Btict lhi\ rEmir is
<br />issucd Ise. iro97. civ c.)
<br />AITLI(AII.DEI;LIEAIIIIN
<br />I tErctry af,inn undcr Nnahyorpcrjury oR ot lhc rollowing d.cl&trrions
<br />octulnion Pcrniis Arhc os Noriti.dion Fcd€rul RcBUlnrion{ frnt$. Pan6r
<br />-RcquiEd
<br />trtrr ot NoliaMlirn
<br />-lccnilyrh0t
<br />thc ltdcr.l rc3ulul bn\ rcErrdins asb.stos rcnn,r.l irc n.r ,|lic{hlc ro lhh Fjccr
<br />I..' .1) rl' I 1,,.\.'.' i rL,i. -t fl'. i.,.,,,i i.r "',,r'l'.'tr i r ., .r,. 1 r!'.^r,.,,n'rl) {r\ J l r i\.url (-. trr\
<br />.nlrn kc\ r rlSrrrd Ln*si(.llri ! hhtr'ldrd!.o {nrrrtr i rorhorrc rctrcscnrdnG orrhir Cnynnd Counlyro ctrltr uB1n tlr
<br />rholc nrrnri,n(d Frpcny n]r in
<br />inDli(!nr or ,\acnl siEn.
<br />l(rcr -)licrc ^,.-7lx\lltr
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Lighl Standards
<br />as, Pool, Fountains
<br />$igns (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondin g/Grounding/UFER
<br />Transformers
<br />Torqueing
<br />a /b7//*-"nn-a-/n
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />lvleter Release
<br />Rough
<br />Service Meter
<br />FINAL 7/m/rt 6,uon /ltrz-
<br />Notes, Remarks, Etc
<br />Sub-Panels
<br />-1.
<br />$ owncr of rhc ,mncn y, nmcxclusilcly.o.ridirrg Birh licctr{d.onr.crosro co.nrucr rlE pmicr (S€ 704.,1, Bd\i',c'\
<br />rnd Ptr'fcisi,n Coddr Itc Conrractr's t-iccnse l-rw des ml ryply ro an owncr oftropcny who build! or itpovcs thcrcon,
<br />ond wh. contncrs for such nrej.rrs wnh a G)ntmdorls) li.ctr{d FUnu r b rhc Conrrach s Liccnsc li* )
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