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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNER BUTLDER DDLCANATION
<br />I h.r.by rlfiin und.r ncnalry oi !.rjnry lhar I sfl cic rpt fmnr lhc Conlncro6 Li&n* hw lor thc foln'wir8 rcnsr (scc70:rl5
<br />Busircss itrd Prolision Codc): An, Ciry or Cou.r, $hich rcqon.l a ttrn b connrucl. olrcr numlc, &mlnh or rllan iny
<br />srflcrurc. Fiorro irs isino... dsorcquircs lhc +/kn.t lor sx.h p.rmjt ro filcfl risncd iskftnl rhal hcorshc n liccnscd !uF!a!r
<br />io rh. ,lovhions of lhc Conlradois Li.cnEd Llw lchlptcr 9- C. ln.fting wirh Scction ,0OO of Divnion :l orth. Buiin.$ .trd
<br />Pmiesiotrs Codc)or rhat hcorshc heicmpr rhrctrontud rhcbdqk lor'hc rllc8cd cxen{rion Anrli{,hlnrnorSNlionT0ll.5hy!n,
<br />0ppliclnr nn a ncnnir \lbicca rh. ntplic,nt ro a civilpcnoltyofnor n c rhlo fivc hnnd(d d.ll,s ($50o)
<br />l. is osncr ol r[c lmtcny. o, my c f]oycc\ sirh wagc\ r\ rh.n yJk .omtxnsd ion. r'ill do llL *ork M rhcnndurc i nor
<br />inrc cd o. olIcrcd fo' ulc (S( 7011, Ausirc\s and Pmlisions (nnc: l nc Adn'.Ln s l-hcn\c Llw doc\ nor arlly t, Jn .wNr ol
<br />rhc nn)rcny who tnrildsor impmrs rhctutrr, aid sho do\ su.h s1trk himtll orhcnclforihsuthhisorhc!osncmPk,Ic.i.
<br />Ir ovidcd rh"r \uct i'npd cnn* m nor intRlcJ o oll.Et ior srlc lt hoercr. rhc liuiklinS .r irrt mrcnrnl is wrkl ,irhir oN )t'nr
<br />ofconlFlction. lh. otrncr Buikcr sill har rhc hurdcn of pruvi'{ rhrr h. ot \hc dil mt bnitl or ifllrnE rhc pturcny n, rh. N,Ft oI
<br />-1.
<br />usowrcroirhcpmpcnr. atocx.lu\ivclr.ont..ring qirh lictr*d .orttrcr(s t, .o.dtu.r rh. phjccllS( 7{}r4 Bt\incs
<br />ud Pmr6\tu. Codc: Thc Cotrticrol\ Licctrsc Luw docs mr rpply b atr.*ncr.lPrnpcrlywho tuilds or nnpn,vcs rh$con.
<br />.nd who.onrlctslorsEhpnimr\sirh,G'nrtuch(rli..nedfu(unrrorhcConlrucroisl-ic.nscLaw).
<br />lomcrcnrnl undcrS.crn B &PC ktrrhi\r.r{
<br />D e Orn.rl
<br />WOR(ERS -MPEN.A X)N
<br />IIEII.AXAIII}N
<br />I hcrcby !flnmlnder rcndryorFrjuryoN orlh. rolk,wiry dNl.rdions
<br />-l
<br />hovc ond wiu tuinEin a ccrliff,.lc ol Cotrsnl t Sclllnsurc r'or wo.kc .oinlrnsarion,0s trcridcdrorbyscdn r l?mof rhc
<br />tihor C'odc. l'or thc Frlbmancc ofthe qork f(tr whi.h rhc Prrnrir is nsuen
<br />I halc aid{illnlrinrai. w.rkcrs-comDcns!tion insunncc. fl\ rcq!ircd hySc.rn .lT(Xroflhc L.l,or Code. fix rh. Fdninurnc. ol
<br />rhc w.rk r(n whi.h rhis pcmtit is issud M y Norkcn' conrFnsar ion in\lrancc ciftkt dxl Plicy nnnrhq -c:
<br />I ccnilrrhrr ir rhcr.rf nrrcc olrhc e lor whirhrhi\ n nnit is n{rcd. lshallnor cnrtLyanyl}c6on in anynk.ncr
<br />n) sro h.conE ub]cd lo rhc rorkc. Ln'npctrsdhi h$s orcnlironrir. md 4rc hrr ifl sln,uld bccor* subicr lo rh.
<br />sukcs omp.nsrrion pxrvirn,ns.fSccrnrn l?(x)olrh.ljtrr Codc- I shrll. fonhsirh.omtly wnh rln$ prcvni.n!
<br />1IARNING I'rilur k, scurc $orlcri.oarFn\rrnn,.1,vcftsu is r l,$lul. rtrd shilT nrhi.r r c'npl(Dtr ro dnni.al P(ntrIic\ rnl
<br />( nil lnn! d i, !n. hltrtl,.,l r[.tren,l,lolr'\rSl({)). in dddirion ro thc cosr o, mmpcn\orio.. datugcs as Frovidcd fu rhe
<br />Sc.r ,r 1076 oflhc trhr (t\lc. i' .rrn rti LJ-u{4*-r71o^t I
<br />IECIA8AIIgN
<br />I hcab, a[iound$ p.naxyolpcrjuryrhal I Mt liened under lnvnion orChaptd 9 (mmmncin8 wilh Seclion Tunr ofDivkn ]
<br />of thc Busincss.nd PrclcshnsCod., and nrr lic.ns. is inttlllot.. d tlr.tl
<br />Dt>16 2-7
<br />1/- rr^ - rg"
<br />(AXSIBUEIPNIENDIXGIGIiNCI
<br />lh.rcnyrfrmlndcrpdrlryofntu.yrhdrlrrcnrco{n'.ri,nlc ifgrsc.ytrrtNrlonnnNcolrh.sokf(t{hi.hrhtlilnrih
<br />issued (Se.3097. Civ. C.).
<br />Irnicl( Numc:
<br />-
<br />ATTLICANLI'EIIAAAUON
<br />I hott,y ltim undcr pcnalry orr.rju.y om oflhc lollowinS dsllmtions:
<br />Dc.Dlirion Pcirnils-Asbcnos Nolificarion Fed.rul R.sulari{,os arirh 40. Pan6)
<br />Rcquncd bltcr of Norifi elio.
<br />_lcMilrrhrrrhcfcderalrrguhrnrr rcg dirg.\bcsto\ rcmrnlrn for rppli.ihtu k)rhn pr.ic(r
<br />l.cnrfyrhrlhNrrcrdrhherpliclrionmd{trr.rlHrrl,cahnritrf(nrn)nt.onrclIuralo.olI'ly{ilhrll(irtitrdCou0ry
<br />odnun.c\ rtrd srd. hws Nl:iritr8 lo bu ild ing .onnnd nr rni nuhori,. r.rrcsctrtutiv.s olthk Cilyand c(,lnry lo cnrc! urotr tlr
<br />Appli(a orAIonlSignxhrre ,",", ?- tl/ - tz
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm i Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq i Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)lel )
<br />Ceilinqs (Hard & Soflit Rouoh I
<br />Ceilinqs (T-Bar Rouoh)I Y
<br />Ivleter Belease
<br />Rouqh
<br />Service lVeter
<br />FINAL u V (ii, )
<br />Notes, Remarks, Etc.I /V
<br />ID/SIG.
<br />Site-Work
<br />tu,
<br />v.*lrr
<br />I 1',1.. \'1.!c..
<br />rhvc nEnrioncd pmNn! n,r
<br />I
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