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ELECTRICAL.INSPECTOB HECORD
<br />APPROVALS DATE IDiSIG.
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Translormers
<br />Torqueing
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Bough)
<br />Ceilinqs (Hard & Soflil Rouoh
<br />Ceilings (T-Bar Rough)
<br />I\4eter Release
<br />Rough Tltolt(-.(t ?2 v,t
<br />FINAL 7/3o/te ..<tr/ En E
<br />Notes, Remarks, Etc.
<br />I krcby !ffrnr u nder pcnolly oi llcrjlr, lhal I an cxenDt {mnr lfic Conlrucron l-ictn* li{ lor rhc lollosing rea\on (SE ?0ll l .J
<br />Btrsi,es !d Poft$tn Codc) Any Cnt or Coury Nhich rcqoncs d Fnnir ro .{tr{ru.r. alt$, imP.ovc. d.nrlth ot rprn any
<br />rru.rurc.l,i,r ro irs iisu.k., al$ rcquiEs rhcappli.ant ror such lErmir to nba signL{ srolcmnl rhar h€o.shc is li.c.s.d Pudu,nr,
<br />k rhl Eovisnrns orrhc Contkt,\ Licens.d bs (Ch,prcr 9. commcncnrg wirh Sccti T0(x) oi Divisiotr :l ofrhc Busnrcs ind
<br />PofcssionsCodc)orlhiltro!shcisricnrptlhcrcfroflotrdlhchasnforrhcrllescd.rcnqnnn.An,vneiionofserionT0lrthyitr!r
<br />nr f{{rptnnir suhtd\ rlr rnI,l'crirbr.ivilpunalryofnortrrr.rhr fivc htrn,lrcddolhrr(151x))
<br />rrosrcroirhcl)n,pcnJ,.orrycmnloyec{$irh\rscsisrhcirsolcconrt.rslli,,n.willdurhcworkrndrhc(ructucnmr
<br />lcndcd or ofiercd for slc ( Sc.?0,a4- Bu\incs ad Eoicsions Codc Thc Conks.r.i s Lt.n* hw docs nol itdy ro u nsncr ol
<br />rh. pmFny wno bdildi or irqn,E\ rlrM...rd who der rkh w.* hins.lfor hcrslfo! thmuAh hh or h.r o*n cfrploy.cs,
<br />provid.d rhar such imrmrnrds arc nol inrcnded or oftcr.d foi slc lt borcvcr, rtr huitling or in{mE Enr ir skt whhin .nc ytir
<br />ofco'nrlclion. Ihc Owncr Builds qill hlve rhc budcn ol pmving ltsl hc or shc d il nor buil.l ot in{to* rhc Impdy ror rhc ,urlst of
<br />-1.ro*ncrofrhclropcny.rmexclusivclycontEcrin8sirhlicc\.dcontacr,nkJ.uniru.rrhnnlccr(Scc.7l}r,l-Bu.incsdikl Pir,fs\in C.dc Th. Coitacrols Li.c scLrwdocsnorrpflyrodnowncr.fn(,pcnywhoSuitkornnpnrvNrhcrcon.
<br />un sho orrrlcrs l'or \uch pn,rcc( sirh s Co mcttrG) liccn\cd pursur rk)rh.Cir r ktrtLicctrstiw)
<br />I rn,rxrtrrU ! Jcr S..rn)
<br />Y.,.,!k4t& y"".,
<br />DICTZIAAIION
<br />I h.rc6y rillrar!nds pcnalry olFrjtrry onc ofrhc n,lkiqin! dcclanii{rn\:
<br />-l
<br />harc ard will roinhin u Ccnificarc of Conse r(, Selalnslrc nn wo*cr\' .orp.n$rn'i. as Fnvidcd fot bySsrion:1700 otrhe
<br />tibr Codc. for lhc lcrfornrNc oflhc wo* for *hich lhc lnm nissucd
<br />_lhrvc !0d *illmrinlain 8or kcr\' conlllcn\ri id lnsurrnc.. rs r.qutd btS(riot:l7l)().lhc l-i6orCodc. irrhc P&foi,nrmcoi
<br />rh. \orl fur*hichrhn pcnnil is isucd My*orkcri co'npcnBrnrn in\ur f,c.rnicr t ki tni.y Nnrhcr m:
<br />Poliij Numbcr- trn r"
<br />$.-rr,t, ,,* **-,-ne orrhc wo,l tn, whrch rhk pci,nit is hsuc'1. I shall nor cmploy trny pe*on in anynmmr
<br />in Nh hc$m uhJ.d ro rl-c ro,lq. mdn.n.ah"n lo$\,, Cxlil,,mir. rhd rgF rhr ri I .hnuld l$onE.ubJcd ro rhc
<br />Norkr( compcn\rrn,n pruvi\i,,ns ofScrri(,n 17fl)ofrhr Lrhtr (1)dc.lslrnlL turihwirh conrply *irh lho$ Ircri\ion\
<br />1VARNINC l-rilurc lo $cnrc so.kc( .onrp.nsrin,n .okragr i\ ilrwtll. n0d dull subEcr .rr cnrplo)er ro d'niml p.trrhics md
<br />.nil li'rc\ rp n) .rc huRl'rd rh.!\rtril dolrr\ llll[).lxn)). iir (lxnu!d\ a\ n(nnt.d tu' rhr
<br />nt,o{ rDtlrno'noY \ rc.\
<br />ts*a \__
<br />DLrl-L:ll3trlllJl
<br />I hcrcby rmi,nu.dd p.nahyolFrjury rhal I am licc.st undcr nmvision olChaprcr I (6mftikir8 sirh scclion TuxJ) olDivnion 3
<br />or rhc Buinc$ rd ProtcNiods Codc, 0d nry li.c.sc h i6 full rorc ana cITLrl.
<br />CAISIf,IJCIIOXI.I,NDII{CIGENII
<br />I hcEby ufilr under rcnrllyofpcrjuryrhrr rhcrc i\ a con(dcri,n Lndine {.n.y ior thc pcrrbnmncc ofthc wo tur whi.h
<br />'hr Fnnil is
<br />is\ucd (sN. 1097. ci!. c ).
<br />APIUI;ANIDECI/XAIII}!
<br />I hsrt, nnif,D undcr ,'cnalty oI lcrjury om of lhc follo*ins dc.l0rrl ions:
<br />Denlnnion Pc.nirs As bcskn Noiific,r io n Fcd.ral RcSul iotrs (Tirlc 40. Pan6)
<br />-Rcq!tcd
<br />lxrrcr of N.rifi @rh.
<br />lc.n,fythdr rhcf.dcnlrc8nl0tions rc8 dilrg .stEsos rctrnvrl arc nor q,plic lct,rhiltmj..r
<br />ccrtiiyrh(l lltrtclcadrhi\lnrli.rrionr {arcrhnr rhcxhnr I0AreroconrplyNirhallCirtrndCouni,
<br />iNcs and SLnc tiws rclllin8 Io blildi
<br />dttr vc rnrn,rcd pbrcdy ror nr\lLrtiotr
<br />ADpli.!nl or Sol Si*n.krre x'wff
<br />COMMENTS
<br />Sub-Panels
<br />Service [/eter Li.cni( clis(:-Li.cn\. Nu'nh.r
<br />D{1,. ( onlD.lirr
<br />LrrJ{'i AJJ|cs
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