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t ELECTRICAL.INSPECTOB RECORD
<br />APPROVALS DATE tD/@"COMMENTS OWNER BUILDER DEL('ARATION
<br />I hcreby rffirm u.d.r r.nDhy ol t riry Ihor I n cxcmpr ircm ihc Conrrlon Liens ltrw nn rnc ftnl,wine rc.sn IS!3r0.115
<br />Businc$ nnd Pr.lcssion Codc): Any Ciry or Counr) whicn requns a lrrmir rd conllru.r. ,hd. inDrov.. &mlist or qroir lnlr
<br />srrudurc. Friorro irs hsuarce. lko rcqlnc\ rne ,pplicanr lor \!ch ,Ermir ro fiL a \igmd {rr.mnr lhd lr or shc h liccnsed Nsl.
<br />ro rh. t .visn,ns olrhc Conkrdols Lic.trscd tnq (CMprcr 9. Connncncirs *ilh Scction TiOO ol Divi\n).I ol rlE Busitrcs and
<br />PmfcssioN Codc ) or lh.r h.or sh. iscxcnrfl Ihcrcflonr md lhc bffis lorth. lllescdddmprion Any violtrionofScdion 70lll.5 hyany
<br />{Dlicant for o Il.nnit suhj(ls rhc lprlicrnr b a civ il lrnalry of nor nhd rhnn fivc hundrcd dollm (rSsu)).
<br />I. .s o*mr of rhc FrctEny. or my cmDlolas wilh wlScs us lhcn sb conq*nsdn'i. *ill dt rh( wrrt .id rh. nGlw i\ n,
<br />inrcnh or oficE{ 16r solc ( 56 7(}11. Busincs and lliorc*ionr C.dc Th. conr.crol s Lient Lls doc\ nor appl! r. {n owncr of
<br />rlE nNpdy qb builds or iqrorcs rh.rmn, llxl who docs itch $.,l [nnscll or hcr*lf or lhrough his or her osn cn loy.cs.
<br />provid.d thar su.h nnrtuwnrnts $e ml htcftlei .. oltacl fo, e! lt ho*clu, rtr buiklins .r hPlNmd t eld $irhin oR y.rr
<br />ofc.rylc'hn, rlrc Owner Blitbr willhrv. rhr hrdcn .r roving thd lt or shc dt nor build or improlc rhc pmFiy ro. r puqrscof
<br />l. No*ncroirhcF,!cny. ancr.lrsir.ly.otrh .hr8 Rilh licc scd cotrrNl,'F t, cotrntu.i r)rlr)i&11Scc 7044,llu{nc\\
<br />d PrulcssiDCi)dc ThcConrrncttr \ l-iccn\.1-r{ (1,,c\ norrpplyti r o*n.r of Prorcn y $ho huildi or in,PRxtr rhcr..tr.
<br />rid *ho .onrrrr fG $ch fnilcch Lvirha Conti.ro(r) li.cnscd ln6uonr ro rhc Contrctn \ Lt.it Latr)
<br />I Jmck'n.r undcr S(h.tr . A. & P.C lor thn rcJ."n
<br />Dsrc: Orne.:
<br />woRxERl' conlPEnia^ rx)N
<br />DES.A"BAIIO!
<br />I lErcby rffirtuutrdcr FnJhy.rp.9uryom uilhc rollo$in8 d.cltudn!N:
<br />-!
<br />hf,rc !trd $illmrinrtri', trCdnili.nrc.fC.nscrrrr Scll ltrnrc for workcr' .ompcn\dn,n, as rov .d li)rb) S(lion l7(Xrolrh.
<br />lisitr Codc,,o hc p.rtunnrtr.cofrhcuort lorNhi.hthc N nir is hnrcd
<br />F htrvc rrl will nriftir workcs compcnsrrion insunrncc. .\ rcquircd hy sr.r n]7fi).rrhctjhorc'odc.rorrhcpcrrornwtr.or
<br />thc work f(trwhi.hrhis pcrm,l is isucrl. Mywo.kcs conrl^-trsrrion insuraNd crnicr d P.ll.y trtrtr$.r arc
<br />fu>l\rt t, T"*t
<br />odc \006
<br />IccnillIhorinrhcD.rfonu..otrltaorkftrshi.hthtp.nniri\ir{i.i.Ishrllnoirn,tnoyn,I)lisrrirtnyDmncr
<br />err\k)tr..r{rbjccrk,rhcsorkcri.onlP-trsinnrl!\rolCrliinnir.xndi€to.rhdnl\h'(l(,hc(.nE\ubFcrroihr
<br />N.rkc's.onll,ctrs nrUrvi\ion\olS.cri, .l7lx)olih.L,lxrO..lshrlltudhw[hconrflyBiihrhoscpNisnnN
<br />llARNlN(; Fnihrc ro {curc sorkcF corpcnuri covcmgc i\ rn l. nid rlrll suh..l atr cmplorcr h 6i rinrl |fi.hti.rkl
<br />.ivrl ftr\ up k,.nc hundrc(l lho!\rDd {lol1l (tl(r).(rx)r. ir rJ,lir 't2 dlrrogd\ 1\ pnviJcd tur lhc
<br />Yi:.IHlt"- l;;
<br />I h.rchy !it'nundcr peMlrrofocrjury rh,r I rf, lion$d und.r ttutirion ofChaplqI (qnnnE'rins *irh sccriru TOoOr oiDivi\ion:l
<br />or lhc Busircssnel Pn .ssionsCoric. el my liccns. n in tullro$!d.lLcr
<br />c-tb /oao?t3
<br />,^" ?:21:!{x &
<br />I hcrh, !0id undfi p.n,lry or Frjury thd lhcrc is. consl diotr lcndirs oscmy for !tu p$lorn.mc of rlrc work forqhi.hrhh l*mir n
<br />tsucd (Scc.1097. Civ. C.)
<br />lxndcis Addrcss:
<br />-
<br />Afrtlct![IrEg.AaAr]ltN
<br />I IEL$y rrmn uMcr pcnrlry of perrury orc orlhc loUouins dccl@rion\:
<br />Dcnolirn,n Pcrfrns Aslrsos Noliicrtion Ftdcrrl RCEUhliotrs (lillc,l0. Prn6)
<br />R.qut d llrr..of Noifimlhn
<br />-l
<br />ccnifyrhlr thc fencElrcpln(ion\ Rg0rdinS,ib.slos onolalarc not {'rlicrtlc lo rht ptr+c'.
<br />l c. 'fy rhr I hrlr RrJ rhr .rmhc. ion and {arc r h rhc lhovc i.li).inari{,i i1 .(ml. l agrc lo omPly wirh rll Ciry ind Condy
<br />.r'l'nJn..\r 'lsr rlrq\rrLr'n!hhu'ldrn/hn{ructntra{hcrchveultn'vc'rn'c*nrortrr\.rrhFC vlndC^unrvhcnrfl uFrrrr
<br />ffi,;::#":szfu Aa rh. ?-"?,P
<br />,"-u* *.",o*,,,4-ett.i8 Casl 4cS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht 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 / Floor
<br />Bondinq / Groundino / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rough Tl'u/i$6'\(Y
<br />7
<br />FINAL (tolotltS lVata E1e;ilt*
<br />Notes Remarks Etc.
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<br />Service ltrleter
<br />tf,nd.l( Nam
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