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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG-COMMENTS OWNER BT'It-DER DELCARAl'ION
<br />I hcrch) rflnn lndcr pcnahy of p.rjury rhm l m cxcnrr tom rhc Conl,ocror' l-icn\c ti* lor rhc following rclson (SN ?0.11 5
<br />Iluri,e\\ r.d Pror€rsn C.{cl Any Cily or clrnly trhirh rcquncs fl Frnri o .onstDcl. .hcr. iryrcvc, d.tu,li\h or tlrn 4
<br />vrucrun, rior to irs irsu cc, aho r.qundrhc rptli.anr tor uch tEr.nn r. n[ r sismd n .Enr lhar rEDi shc h licctr*d Puruanl
<br />b rh. pbvisnnr orrtE ao.tr.ctors l,iccnscd ljs (Clupler 9. Cohntn.hg sirh Scdion 7U)0.I Di{i\i.n 3.rrhc Busirlc$ aod
<br />PofcssionsCodc)orthortEor\hc i!.r.mpr lhrrcridm Md th. bnsis for rlEallcscdcxcmprion Anyviol,rionofSccrionT0:rl5bysny
<br />anplicanr lurFmit \!bj&t rhc appli.ant b rcivilpctrd[yo, nol morcrhsn nv. hundrcddoll0is (S5mr.
<br />l.,s osn r ol rhc prcF,ny, or mycnrphlss *iih strlc\ nc rh.n enc .oDrP.ns.tion. willd. rh. *o.k dd rhc {Muc i\ rDt
<br />i.rc cd oroficrcd for ek (Sft 704J. Bxsimss Md PmfcskrN Codcr'l1c Codrrror's Li..n$ tiw docs tror rplly l{, {n oqmr of
<br />dE ImFry who toild! o, inpmws rh.m.. a.d wlr d(s $ch woa hantlror h.r{lror rhn)uBh his or h.r o*n cmtloycc..
<br />triovidcd thrr n'ch i lrcv.nEnrsm mr inrcndcd or offc,.J ltr*rL.ll, howcvcl rlt huiuing or ir{mhmm h$U wilhinr'nc For
<br />or..'{,brn,rh.ONn.rBuildswilllmvcrhchurdcnolpmirylhrrhcorshcdidnorhtrildorinpnrclhcF)p.nyrorrh.pu'|nscor
<br />LrsowncroirhcnoDcrly.!.rcrchsivelyconkacrin!wirhliccsddcoticttr(b.on{flicrrtunn,j..rlScc704-1.tlui0cs
<br />rnd Pnfs\ion Codc: Thc Contrcrtr's Liccnrc lnw io.s tr.r r|]pLy h rn owmr of |x)lrrry who builds or nnPn,vc\ Ihc'cotr.
<br />n d sho ..Drn rsirnrchpn,Jc((trirhr(i)nrrrcn ) i.c \c Dtrr{rnlrorh. O,ntrcttr \ I-icctr\c l-n$)
<br />t2ErlJ&\l!!lr
<br />I hcrcb! ilfirn undcr rcf ilry.incrjury oic otrlt,4
<br />-l
<br />hevc and *ill nuinrai. , Ccdir.ar. of consm lo sclllnsurc for *ortcrs .omp.ns,ion. .s pmvijcd rbr hy Ssrn,n l7m or rhc
<br />tnhor Corlc. for lhc Erfomnce ol rh. kt* for whi.h rh. !,cmnt i{ issucd.
<br />-l
<br />hivc ond s ill minrain worke^ .omFn*,rion insurum., .s rcquird hy Sccln,n .17( or rhc bbor Code. lor rhc pcrrormmc ol
<br />rhc Bortaorwnichrhh pcrnir ir issu{n. Myworkcn conlcnsalion insur0Ne cari.r drl poli.y nunl'cr nc:
<br />-l
<br />c.nily rhni i'r rhcFrf.nmn.col rhc $ork ilI shichrhi\ pcflnlr i\ i\\ugt.l slirll nol cmPloy uny l.noi i'r rtrynrtrmt
<br />r, tr{ h b.d,rtr {bjcd lo rh. wortcr( .onpcn\d n,n h*r or calirdnfl, ttrd a!r.c lhtrr il I fi,! ld hi.onr {'hjcct lo rhc
<br />*o&cs..n{cnsorir ,,mvhionsofScciion.l?O0olrhcl-rhrC(xl..l\hrll.lon[sirh.{mPlysirhrh.sPori\ion\
<br />WARNINC: lirilurc lo srtrrc work * .ompcn$tiotr.o cmpk,Fr r0 .ririnrl Pmlli.\ itrd
<br />rion. dflnugcs rs frovidcd b. thc.nil linc\ tr|] ro on. hundrcd rlhhrrl d.t. in !9e)1i th.
<br />:::1/W;
<br />I hcmby trflim undci lEn0llyofpcrJurylnal I m liensd under,rbvirion orChq,tcr 9 (omnr..i.s wirh Sc.lhtr 70m) olDivirion.l
<br />ol rhe Blrinc$!.d Porcasions Codc, and my liccns is in tu ll tb,ft lnd cflicr.
<br />CQX$IaUCIIQNIIIIIINC.ACENCI
<br />I hcrch,xrlt udcr,.nrryolFrjurrrharihscisacon\rru.rioikndii8recN,lnlhcPcrionmnccorrhc$.rkaor$hichlhnFrn,iris
<br />hrucd(S(.1097. Cir C )tl.dcisNanE:-
<br />AIIUCAILDICLAAAIII}N
<br />I tftby aflim utrder pcnalry of F.jury om of lh. folloving delaralionsl
<br />Dcmlirio. Permit!.Ashcsros Norificorion F.ncral R.guldions (Tnh 40- Pan6)
<br />-Rcquncd
<br />l.ltcr of Noliarari.n
<br />-l
<br />c.ni,rrhrr thc rittcrrl r*ul.rio.s rcEardin3 !\h.no\ r.nmral rr nor Upli.ihh n, rhn p'oJ..r
<br />l(aify rlu I h.vcrc&lrIis " ncomcr I rsrN k,cotrf], wirlr !llCiry rnd (i'unry
<br />o'ditun.c\ rdd S[rc I iN\ rc[i tunr.scnliNcs ufrh^ cnv rnrl cou
<br />rh'vc nrnridrd pmp.ny n,1 b
<br />Underground
<br />Pole Bases
<br />Lioht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Bondino / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilinos (T-Bar Rouqh)
<br />lvleter Release
<br />Rouqh
<br />Service It/eler
<br />FINAL 3-9 - /9 J/e{at or-vz )
<br />Notes, Remarks, Etc.
<br />Site-Work
<br />Under Slab / Floor
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