|
ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDER DDI-CARATION
<br />I hcrchy aflt r d.r pcn,ky or !.rrury rhr I mr cxcmpi lm,n rhe Coiknciorr Lkctr* b* lbr rh,Ii,llo*ins rclsnr (s.c.7orl5
<br />Busincss nod Pronssion Codc): Atry Ciry or Count, which rcqoncs r t^_nni tu .otrnrucl- allc!. imP(,v., d..ml$h "r rcFrn .tr)
<br />srrucru.c. t.inh ns t\ua(r. rho rerluircs rhc lptli.Mr lor {rh lEnnirb lilc! ri[ncd {ar.nf,trr rhd h.or shc n liccnsed pursmnr
<br />ro rhc provinnr ol rhc Coorractr'r l-i..n*d l,,w (Ch.prcr 9. C.nrnrcrcirE wirh Sccrion ?000.f Dirision 3 olrhc llu\in.ss and
<br />Pda$n,n\C( c)orrh h.orsh.iscxcmpllh.rcironrannrhch1sisiulhcall.g&lcrc'n|totr.Anyvi('lnrionotStrkJn70:lIthyrny
<br />r,'tlicant ror a ncnnit subjcck lhc alplicant lo !cililpenalrroinor hor rhts nrc hutrdrcd dolk I $5m)
<br />-l.isosncroflhcpropeny.{rtrrrc,ntlorlc\wilhsrg.sr\lhcnvncmmpctrsllior.willdorh.wotkd
<br />r1r shrcrurc i\ nor
<br />i' ciird oroficrcd fttr $1. (slr.7044. BusnEss d Prcri$ions Con.:'lhc Coitrcttr r t-i.cn{ L.qdocsnolaPpltt,anosn.ror
<br />rhc Inpcdy wh. hoiltts or in{nrvcs rltoi. rxl sk' d,s su.h rttrk hinscllo. hcrsllorrhR Eh hi\.r hlt own cmploycc\.
<br />pr.vdcd rhlr slch in rorcnrnh m mr inr.nded or ollcrcd f.r sh ll kiulcr. rhc hdildi'r! or nrymvc tm h $h wirhir on. rr
<br />or.ontlcrion. th.owtrd Buil.ils $ill h,vc lhc burdcfl oi proins rlli h. or tu dil ml buiH or imfmw rhc nn,Fny ror thc |[qrcol
<br />l. as ownci ol thd ph!(ny. an cxcbsncly cotrlrrd irS * ith liccnscil c.nkNbs rr strsrud t lE PmFI I Scc 7044, Bustu$
<br />rM hlf*sbn Codc, l hc Conn&tn r l-i..nst l-sw dmi n.r rt)ply to {n o$ ncr ol por. y *ho bxild\ or nnfovc\ rhctsn,.
<br />and who cotrkn B for such prcrrls silh a Conh.ro(9 liccn\cd I)Ur\uMr rorhcc(n r.ctff s Liccnsc li*)
<br />I .mcxcnrt, trndcr Sccrim
<br />Date .. OPner:
<br />woru(r.qs'c-aI\rPFNsarx)N
<br />DICLIBAtrA!
<br />I hcEby affi n utrdcr lEnalryolpcrjury.ic olrhc nnhwirg dclrtdionsl
<br />I h.vcrtrrl willnuirllin! Ccnificrrc olCon\cm b sdlf lnsud lin sorkcr'.onlncn\rri{nr. ar pmvidcd for hyScclion.]?(x)otrhc
<br />titxr Codc. ro,rhctdlonmn colihc r6rk lor whicn lhe !.rnn n n\u.d
<br />I hrrc rnd wnlnriintiin $o.kcra comrensarion in\orak..3r fqundbySccrion:lTlxJorthcl,ahnCorJc,forrh.pcr{ornnnceoi
<br />rhc work n whirhthis pci,nir ir i\$ql Mtworkds .onDcnsari,nr irrsuHrcc cotricraliFnicy nrnihcr d:
<br />(,'3 /zrt /zo t 1
<br />-l
<br />ccnily rh,r in rhc FrIortun.c.llhc vork fttr uhi.h thn t)c.nir i{ issucd. I \hrll ror cmfloy.try p.rstr in rny hani(
<br />$,\robc.onrsubj.crtolhcwolkcrlcorn|Fnsllt'nls$ofC,lit{triir,trnd,8rccrhriflshouldbc.omsubjccrbrh.
<br />*orkc$ conlp.nsarion prolisiotrsotSsrion 3?fir otihc ljhor Codt.l \hrll, ronheirh mmPly eirh rhos F)visi{,'t
<br />WARNING: Failur ro murc workcm'comrcnsoliofl oEmAc ii unlssfol. dod shrll sxhi.t! 0n cmtlorcr lo ciminrl lrMlra\.nd
<br />rN'l lincl np k, onc hundrcd rhousand d.ll.n (Sl09.rll)). in addirn,n ro rhc co .icomDcnsrion. dlnugcs rs Provid.d for rhc
<br />sclrnn 1u?6oLlhc Lit r Cndc. mrcrcn rnd dhney'. res
<br />",,,1113/ze1g ^*e), Brerr b,/00?
<br />UCIISEDIAII8ACIOB
<br />DECLAAA.IION
<br />I hcEb, atfinn !ndcr lcnaxy 6r Frjury rhd I am liensd undcr pmvhiotr oaChr/d 9 r.o'n.rming Pirh Seclion 7Om) ofDivkion l
<br />of thc tsusiDcsond Poressn,nr Codc.,nd mr liccnsc is in rnllfollt drd c{lccr.
<br />1rCI27LlAuzotr ..",LwESr T- PalEdl
<br />(I(TNSTRUCTIoN LENDIN(; ACTN(]Y
<br />Ihcruhylfln undcr trMhy olllrjury rhlt Ihclc n tr ca'n{rudnnr bndiis rgcky l.r rhc p.r,hlnurcc otrhc sork ftr whi.h rhn l,cnnn h
<br />i\\u.(lism lotT ( ir C i
<br /> ITLICANLDICIABAII!]N
<br />I hod,y aliinn u ndcr Fnalry orrcrlury om orrhc followih8 d(lar.tions:
<br />Dcnblitioi Pcirnits^sbc(os Nolilicltion FedcEl RcBUIai ions (Tnt 40. Prn6)
<br />-Rcqnncd
<br />Lllcr ol Norifi .alion
<br />Ic(n'f) rhrr rhc lcddrltugulxri"rs r.!n rnllr\h({.\rcnn^tnrr.norx|nh.rhl.r,rhN[oi!:.r
<br />I c.nnyrhxr I h.trc rctrdIhis iptrlirllion ontj n crhrllhcahrvcinartetrio.is.qEcliIr8.elocom/ywnh,llCiiy.ndCoutrry
<br />'{d'nrrccr,'rr srr. trwr rlJrtrS rytur ld,ns ca\trud 6n. o hcrch, tullxtrirc r.prc{cnr0rivcs ofrhnCirymdCornryioc.r.rupondE
<br />i:j:n::rY%@. *,,4t712,"tr
<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 />Bonding / Groundinq / UFER
<br />Translormers
<br />Torqueinq
<br />Sub-Panels
<br />Air Condrtioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Solfit Rouqh
<br />Ceilings (T-Bar Rough)
<br />ltleter Release
<br />Rough
<br />FINAL 4-rt-rB fq4
<br />Notes, Remarks, Etc
<br />Service lVleter
<br />,,,",., i(EAClf /*ffda/& Dr/t- cd. -
<br />-
<br />I
<br />--------T------
|