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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Unde round
<br />Pole Bases
<br />Li ht Standards
<br />Pool FountainsSS
<br />monumentSins
<br />Lile Safe /Low Volta
<br />Fire Alarm / Dam rS
<br />Communications Cable
<br />Bu ild i
<br />Under Slab / Floor
<br />Bondin / Groundin / UFER
<br />To uern
<br />Sub-Panels
<br />Air Conditioners
<br />Roof To ut menlE
<br />Factor Wired Unit
<br />Walls Conduit
<br />hWallsRo
<br />Ceili S Hard & Soffit Rou h
<br />hCeilinST-Bar Ro
<br />It/eter Release
<br />Rou h
<br />Service Meter
<br />FINAL
<br />Notes Remarks Etc.
<br />()lYllllR Ilt ll-l)Ult l)lil.C/\R/\l-lO\I hclchy af6.rn ud.r Fnalry or prrjlr, rhol I rm qcml)l tmm rhc G,nr6cloF. Licc,s. trs l.or rhc rolo*in8 rcE$n (S.c 7o]l 5Busi.cs !d Prolcssi.n Codc): Any Ciry or Counry wni.h rcquncs n Fmir to con(d.r, ahd, imrrote. dcmrrh o, rclair ony
<br />rrtuclurc. prktrro ns isum., rko rcguncs rh. EpIliconl f(tr rtrch pcmit ro rik i sisrd \tatcmnr th,r rt o, shc h lienqd pu,sa
<br />lo
<br />'hc rnrvhnff ol rhc Conrracror's Lic.n*d Llw rch,prcr 9_ Comcming sith Sccrion ?000 oi Divnion I orrhc Busmcs*nd
<br />Pmfcssions Codc)or ih.r th o, she is cxcmpr rhcrct'roor and fic basis for lhc llcF.d.icmptim Any viotarion oI S(rhn 70:I 5 hyanv
<br />{plicaor for a p.mir sutj(ts rh. applicanl ro r.ivitp.nahyornor morclton nvc hundr.d doltar (S5m)
<br />-1,
<br />ns o{ncr of thc proFfly. o! my enpl.J,es wirn wagc\ ei rhcn sh .on1ltnslrion. wi do rrr sort sftt thc (Mm r\ noti.tcnncd.ro,Icredforelc(Se7044.Busin\san{rpmfcsshnic(nc:ThcconracrorsLi.ctrscbwdocsnoroppryhrnn{nqof
<br />rh. pmpcny who hoilds or i,qmBihcun. alxi sth diEs ssh wu him\ctfo,hcr*tforrhnruEhti,n,r,".n"n.,,,pr"r..,.
<br />providcdrh such intmkmnk m ,ol inrcndcd or o0tnrt lor q,c It tb,c!s, th. hxi ins or nqnormd n ht wirhrn .nc i.ror conpl.r tm. dE Owncr aui d willhovc lh. burdcn ot pbviis rhsl lr or shc did mr hitdoriryn;vc 0r pmJtn) tor r. purlr,F or
<br />_l-rsowcrofrheflorcrty.an.xclusivclyc.nrrrinswilhti..ns.dconrradorclo..ijructllEproj..!lsdc?0]4_Dusbcs
<br />rfrl Pn,fc$bn Codc lhe Conrracrof s Lic.nsc LN docs .or apptr r. an owncr ot proFrry sho t rita. "r i,rlrrn""r rrr.o..nnd sho .onrrachfm suchroirrswir,ra crfiDcxnln tj.cnkd phum olhcConrrftn i Liccn$ bw)
<br />-l
<br />u crcnr|, undcr Sd
<br />woRxr'{s, c:oMPFrisaTroN
<br />I'TCLAIATION
<br />I h.eby o,Tirn under penalty oI p*rury orc oflh. rouosins detmriln.
<br />I hlvc 0,rl will nuintlin a Ccnirrc,te of Consd ro Scti- tnsuf for worker, omp.nernrn. rs pmvidcd r(r b, S(lion ]7fi) or rh.
<br />Lihor tu.. for thc pcnolfrft. .rrh€ qolt lor rhich rhc tEon is tslcd
<br />I hrvc nnn willftinrain sork.rJ comlr.Ndioh i'Nlrrn.c hy Ssriotr 1700.frh. Lr$or C.dc.l{n rhc pc.,inhtuc of
<br />^%(
<br />-1.€diry
<br />rhat in rh. Frnnmne or rhr wor[ thr Rhich rhis pcirnii k isstred, I sha nor c.rpl.y any lj.non in.ny,n.n.cr\' 0s k' tB.oft suhict lo lh. *orhcrr s,np.nsartrtr taws or Crribrni!. rn! r8rcc lh if I should ttcom subjcct ro ttEeorkcn' .ompcns.r io. pmvisbns of S{rion t?(n ot rhc ljhJr Codc. I sho[, lodhwirh compl, B irl rr,,,* pn,"i.in,...
<br />C: l{ilui. h Kuc sortcr .omp.Dsiri{ni .ohrr8c i\ nhtr{ut. dd shall subl.rr rn .ry)loFr ro nn n,l Il.nalris and
<br />ns n,n, d!rugcs as provilcd f(tr rhcop ro o.c hutrdrcd rhousand d(rj!n (Sl(X,.{Xx)r. i'r addil'uwff;
<br />pprionr,D<
<br />IECI.AAA']ON
<br />I h.fthy!firnund.r Fnaltyoflcrjury rhd I am liccn$d lndcr Frcvisio. ofChlpls 9(commncina uilh Serion 7fi)o) or Dilision _lof lhc Busincs lnd Pmfc$iorxCdc. {t nyticcnsc h ir tu n,.c ond cllccr
<br />ds (I f c**^,, f 5
<br />C()NSTI{ICTIoN I fNntN(; A(iEN(V
<br />I hcEt y aaiirnr und.r rEnalry of Dcrjury rhar rhsc G , .oosrtocrion t *lin8 ,gctuy tor rh. lcrroirskd lscc 109?, Civ C.)
<br />nrurc ol lhc sorl fi, which rhis Fiinir is
<br />APP! ICANTDFCI ARATION
<br />I lrrhy trfm udcr pcnnhyofprr!ryonc oath. rothwin8 dc.tdariois:
<br />Dcmltion Pcrmits.Asb.norNolificotion Fcd(ll RcSul,lions(Tittc40. pn6)
<br />-Rcqui6d
<br />Lctter ol Notifi.ali.,n
<br />-l
<br />ccnitirhd rhc lcdcral rc8Ubrn,n\ EgudirS s\h.{osrctrk)vjtarc nor lPpticabtcro rhjs nlolccr
<br />-l
<br />ccnrry rhet I nNc r.ad rhis lrdicnrionaM {
<br />ordiDrtrrr\ anJ Sfutc Iiws rLring ro buitdr!
<br />ahovc f,di(nBt pnif'tn,fo, inspcdionru
<br />Appllutrt o. A,l.nr Shml ure F
<br />nemlre name tprint: F rl
<br />Dn n comd I sBNroL\,rll,lyrithatlC[] rndCndnryft rcrmenriuvcs or rhr cirv md c.unrvilo ..rcr uil,n dE
<br />ffi-y44tr
<br />Translormers
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