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ELECTRICAL-INSPECTOR RECORD
<br />ID/SIG.COMMENTSAPPROVALSDATE
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<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 Rouoh)
<br />Meter Release
<br />Rouqh
<br />Service Meter I
<br />FINAL -t/ tt /tt
<br />Notes, Remarks, Etc.a
<br />OWNER !UTrl)F-N DELCAR TION
<br />I h6.t, .ft@ u.d.r Fdy of FJury lhi I o qatrpl 6Do tl€ Codddt Lc.g lry fot llE folb*ina ren (SE 7Dl I 5
<br />B6'nd sd Prof6ion Co<h): Any any or Cody Ehich r.$,c . Fni ro o'!nrud. .nc. itrprDve d@li! or r+t a,
<br />nndu.. Fs to !! isllfte &6 r.{rrn6 tlt epli.d fd uh FEn lo nE . isn d rr6ld lhr lt o. dE i !.€Ed Fr$r
<br />ro lh. FDritioB ot rlE Cdl,Elc t LEn!.d lrs ((t4(a 9. ColM*iry *'ilh Sdbn ,m0 ol tlYnno ! oath' hxiE 'dPlnf<oN Co&) n th,lE mtlt a qnF rlE.6om r li tGi3 for llt.lLs.n ast{rifl Ary violrio. ofsclbn 70ll tbto,
<br />.{plic.d aor. pdnn sudr! lh. .ppli.d ro r civil Fuhy otml mc lh& fir.lsr*.d &11,6 (lJ@)
<br />L B o$G of llr FoFty. or my mphlE wnh *rsa s lh.t $L onFsdbn, rill d. Ewst.d dE itucln i mr
<br />ridrLrt or otrdcd for slc (56.7(}1,1, ButUB ed ProfBbB Co&r TIE Codndd . l-kqe L.w {bd nor eplr lo e ow of
<br />!h. F.pdr, who hri[& d irlFrE thdF( !d who d.6 sh KiI hi@lf o. h*lf or lh^,ush hir .t hc ow 6nplo!6.
<br />prcvidcd thr! 3uch imFlrqEn e 6r idaxLd dofir.d tor sL lr.lb$d. rlr t{ildils o. iqrovald i! sld rihnr G )d
<br />;rodlpLtiol\ tlE O,rd Bu l6 wiU h!v. {E hnd, oaFviB tnd h. q lhc drd Nt trild or inplDv. $. FrFlv for ll* pdpor oa
<br />-1.
<br />sowndofth.Fopary, m dclEiv.ly.ontrxlng wnh licqs.d codralm lo.onjru( tu Fjal (56 7044. B$ilE
<br />.,'d hokir Codc: Th. Conlt.dor't Licd. Lrw &6 6r arpl, to & ovnd otFop<r y *ho t uild! or inprov6 th6@r
<br />rnd *h. odd3 lor uh pNF! *nh . ( 6dMm1s) li.dE d p@u.d b rlE ( odndor'r Li.@ l,w)
<br />lm.'ddu.tdsdM .B.APC lDrlh.lE)a
<br />Irrr. otr.E
<br />\\ oll{rRs' cof, tlltllsarlol\
<br />DECIASATI9!
<br />I hdcb, lilim ui.t r pddly of Frury .m of lh. follo$i.s &(lenioE
<br />-l
<br />hr\. d*illmindn.Cdtifrx.of ( olEdto S.lf-lEE for *vk.r @nlt'.uno.. s t,o\illd for b! Sd6. ]Tmolrll
<br />L,trr Codqjor rh. FIollffiG ol th. x lur lh(h rlE Fmh 6 isu.d
<br />L4*/. "* *r, .**," *,n.,! c.np.N.hon 'Nu,mc. s rcqun.d b, s.dion l7o0 oarh. l,b.r codc. rot rrE Flomm. or
<br />rh. wort aor which thi! pcrnal i! ieql My workd comFsdion i6u4. ceir dd poli., numb< e.
<br />"-ta)1. y't\.of 'Tp la t^l? 5 I
<br />-!
<br />.arit thn in lhc pqfolrlu. olllE *'ort t( *hi.h ihir FEn i' isu.d. I Jdl mr dpL) .nt Fen i. ey lffi
<br />$ s b beom $qd b llE *std onpdErbn Lr: of Cditmia i,!d .ec rh.l if I {buld b.$m $t*tr lo dr
<br />*nlt6 6rq6iio. FDririoB of Sdrii. l?m ot dE lrbor Co<le l JulL fonhq'nh cohPly r nh rho- Foritiod
<br />6+. i 6Lsful, dl ih,il ot.tr d dnpbtq to 6ini l FE|E.nd
<br />'o.. d,n46 s For'(H foi rlE
<br />l'7 ci
<br />I hrcby amrm undo t)3dty oa psj!ry lhd I m li.flrd (.o'n m. 'ns
<br />sirh sdi.n ?0o0) or Divin)n :!
<br />of th.Auir6 d Pmf*ii)B (ird., a,n my lkN it 6lullaor.. drlcaTcl
<br />€t7-t-
<br />'-/
<br />iN taraos.sdr ,or 0E Fr(xfuG of rlr *!it iir $hkh rhir Fni .I h6*ry ilrm s& FEliy of F)u.y rh. rlE. ir .
<br />isuG, (S< 1097. cir c)
<br />L.ndd r Add6.-
<br />lttucANf.DEcuSallo!
<br />Ihddltdlmo 16 rErsh y of pdjury on. of th. lolhtrins dclsalion!:
<br />I)lnolnion Pmns-Arh6lo! Notifi cdn,n r.ddal R.8!l.rion! ( rill..l0. Pan6)
<br />-R.qui.d
<br />Lar6 of !,lolif.rin
<br />-l
<br />.aify ttd tl: &d r.xlldia i*.diDg .tdB lgDr.l e ful 4datbk to lhi' Foi<l
<br />-l .diry rh! I h-r o.l rhi plirin .i rrc dlr dE {oE i!6m,rbn a 66 I tSEtoo mplt *nh rll Cny6.d Counry
<br />odi,ur6 rnd srar. t^! Elr,rr ro rqr.ddit6 of thB cit
<br />.trn. nE edd p.oFrt fm
<br />Appliorl or,\3sl Slr l
<br />'J;t;;,\""
<br />DYIM
<br />*u., ",.o Ll5 i.5 tr.r- t '7I '7 <) (r^ ,,n,,-
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