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ELECTRICAL-INSPECTOH RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DER DELCAITATION
<br />I hcrcby arfirm un.lcr Fnalry.r,'.rjury lh l m.nnrr rr.m rh. ContdoF l,iccnsc hw for rhc followin* rctrsn (sc.ro3l5
<br />Bulincss ,M Porcsio Codc) Atry City or Counry whth rcqutcs 0 ,cmir b co.{d.r. alrd. inl,ov.. dcfrnnh or rcIlan any
<br />srru.ture. priorro irs hsuarcc. ako rcquics rtc ,pplicanr fu \uchp.rnirh filc r siCmd cmnt lhal hcor shc h li.cn€d Nrudnr
<br />b th. porisi s or lhc Conlrodols Liccnscd ttrw (ChBDlcr 9. Com!rcncina wnh sccrion'7(xxl or Ditkion I oflhc Blsiness and
<br />D oE$bns Codc) or rh{r hcor*h. is.kml)l rhcrct om,nd rrE bn\h rorrhcalLBcdcxcmtlion Anyliolalionoasc.rirtrr0rl5bydny
<br />stplic,nrlbrur.anirsut'jc.hth..pplicanllon.ivil,)cn0llyolnolnmrcrhanlivchun&cddollar(S50o).
<br />41t.,, n*n", nr,t p-rny. or mycfrplorcet qirh wrrc\ rs rhcn n,h.onrcns.rnn. will& Ihc sork nrd rht {turm r mr
<br />inrendcil or ollcrcd tu srlc {S1r.7(l14. Busincss ffd Pr ofcssion\ Cod. Thc Conlrucl,r's l.iccn{ hw &.s nol trPtly lo !n owmt .f
<br />ihc popcdy qho builds or iry)rorcs !h.r@n. nl w)x, docs su.h work hnnsclf.r hcnclfor rhrougt his or hcr o*n cnrlryces
<br />lrovidcd rhar such imptuvdnina m nor ir d:dcn or oftcrcd fin slc. It ho*crc. rhc b itiling oi iqnovcnEnl h bld wilhh onc rtr
<br />of complctk n. rhc O*ncr Builds will hlw ttu taldcn or pn,vils thar hr or sh. did nor build or inForc lhc pmFny Lr rlt ruqr$ .r
<br />'11. J\ owncr ,,r rhc nn,n ny. rnr .r lu{wly cnffr n8 wilh liccnscd cotrr,s.t,s ro .on{tu! rh pmr.r lSN. ?0+4. Du\incs
<br />rtrd PmfL\shn Codc: The Conlrrclff. Li.cnsc l-aw do.\ nor apply ro mowrct oinroFrty 'ho build\ or inptuv.s rhcrsn.
<br />a.J *ho.onr.!chror\u.hImjc.**nh!Co mclor(9liccnscd l)usuanr ro rhe Conrracktr r Li..n{ bs)
<br />_llnrcxcnrpr u.dcrsccrion .B &
<br />9L'ate 1.v- /f
<br />DEI;LIMI&Ii
<br />I hcrcby lltrm Dndcr pcndryorldrjury.N.rrhc r.llowin! dc.ldarion\l
<br />-lhovc
<br />dwilln inruin0C.rriftrsr.olCon\cnrrosclilNU'.ldworkd{.omFnsation.aspmvidcdf{tr6yscdn:lTtD.lrhc
<br />Lahn Cdlc. rur thc !(lfonMn.c oi lhc wort for which rhc r.fl ni h n\!cd
<br />_lhrrc and $illmainrrin wo*.^ cdnrr.n\.rn,n Numn.c. as rcquircdbySlrlion:l7lx)olrhctjhorCod..ibrihcpcrlonunccnl'
<br />rh! *..k torwhichrhi\ pcmir i\ isudl. Mrworkdd c. rtr.trsrtion irsurancc.0ricr MdFnicynu th.r dc:
<br />Canicr:-
<br />Poli.y Nunrhcr:-Exntes
<br />l.cniry rh.r in rhc rcrlbrmincc ofrhc ro,k nx wnich rhn lcrmir h i\soL{. I \hall nor ctrlltlo! {tr} Dcroo i'r lny 'nrnrcr$ lo nccoE sub,cd ro rhc *o,ic^ conPc sarn,. ks\orcal b,nir, lnd aSac rh{ ilI should hcq,m {rhF.l k,ll'c
<br />workcG' onncnsorion nrovi\ions of Sern,n .1700 of lh. Llhtr Cdl.. I rhrll. loniwir h mnrlly wilh rhos t iovisiois
<br />WARNING Frilurc h $cnrc $orkcri conrFnsrli{in.ovcnac i\ unhwll| ntul shrll srhiNr rn cnrpl.ycr rn d'niMl Ftu[a\ rnd
<br />cnil finc\uIr'orchu rcrl lhou$nd lolhn (slN-({D). in trdJirn t, rhc.on ol cotrDcnririon. da'n43.\ rs lrviJcd lir rhc
<br />SNrion:1016 olrhc lilnr Codc inr.r.( Md rtroi,.v r fe\
<br />7- /-/ nooo-n,
<br />01 rtu lnrincs!rtrd PmlcslnnrCodc. rDJ nN licctrsc i\ in fuillaRrardcllccr
<br />q)NIIAII;IIAN]INDINC-dCET.CI
<br />I turchy rfftnr riJcr F nlr!.lrcrpryrhnrthcrcta consiruction lcfrlin8 agen.t f rh. rflnntun.c oi rM trork fitr shich dtis l.ilnir i!
<br />isslcd lscc. llr7, Civ C )t trdcls N ncr
<br />-a.tfucANfDEcLAS Il9ll
<br />I hcEby aJrm undr p.nahy of p.rjury onc oirhc rolbwinS dccltr0rions:
<br />Demlirion Pcrmih-Asbcsros Norificarion Fcdcral Rcslhiions (l irlc 40. Prn6l
<br />-Rcquncd
<br />Lcrrcr of Norifrcdri,.
<br />l.o iltrlrxr rhd fr,l.rrl 'dgtrl&otr! rc!rdltrF r!h.so\rctrrtrJlflc 0olinfli.i6le n, rhi\ |]n)l.cr
<br />I.diryrhrr I hdvc i.lld this q'tlicdion flxlsloldhirrhc $ovc itrformrri{nr i\r.ncd lrglerocoflrplywirhlllCiryrndcounry
<br />ordimm$ rM srarc lnws El.rins ro buildins conntuciin. od ncrchyaurktriz. irr.(ntarivcs oirhh Cilyand Coonry l. cnrn trlb. rh
<br />rtr)v. nrrri,nrd nn)t{n! ln n\|[.rntr turt!
<br />Appli(lnl or Agenl SiSnalro
<br />o aa4{rk C
<br />*,.v?-7r
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Slandards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundino / UFER q\L"t\(g./444tl)
<br />Translormers
<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 & Sollit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />Ivleter Release 9l \ r+\ r4 ,<t4(l c)
<br />Rough
<br />Service lvleter 1\\,t\ \s .,<l-aqfi,
<br />FINAL 1\z.r 1(g /,(t{n
<br />Notes, Remarks, Etc
<br />t,iccnsc Clos:_Liccnsc Numbe!
<br />-
<br />l}ll€: Conlmclo.
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