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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Lioht 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 / Grounding i UFER
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />Meter Release
<br />Rouqh ?lt r,lt>.fltarCD
<br />Service Meter
<br />FINAL l-?7-zo i'rr,r* to>
<br />Notes, Remarks, Etc
<br />OWNER BUILDIiR DELCARATX)N
<br />I h.r.hy aflirm undcr |xnllly ol r.rjxry rhrr I .fl crcnllt lronr lhc C.nkr.tr^ Lkcnrc lrw l'or ihc followirlS E!\nr (Sc.1l.llt
<br />Busincs\ ani Profesion C.dc): Any Cily or Counry *hih r.quncs I Pcnnil lo connru.l. drcr. improvc. d.mohh oi rcPIir trnv
<br />nru.fure. pr;rkr ik is$trrcc. rho reqxir.s rh. rP,rli.rnr ntr sKh lEnnir h filt. n8trcd slalcnrnr lhli nCor sh. is liccnrd pdflrnr
<br />u lhc Fmvhiotrs of rhc Conrr.ror\ Li.cn*d t s (Charrcr 9. Comntn.inS wirh Scciin ?(xD ol Divhi{,n .1 or rh' Bn(ims 'nd
<br />Profc\\ionrCode).r rhar h.or shc is cxcnrpl rh.retion $J rhc hnrn lo hc olL8cdexc nri,n Atryvt'liri.nnlserbn70.ll.5hvnnv
<br />L]L
<br />rhenml]cny 'ho huikl\ or infmEs rksD. snd wtx' dms ruch slrk himsclfor hcrclf or rhnruSh his or h.r o*n cry)loyc.s
<br />polid.d rhar such in{'orcmdh m mi ini.idct or.fcrcd ror {h ll t*,q.tu. tlE ttrilding or in'{mhm ns!sihin"RFxr
<br />ol sr0krirn. rlE Owncr Buil:Icr uill h v. rh. i{dctr ol l,olirg lhal hc or \hc did fr, build or imprcvc [E t'trFny fot rnc IrrIIM of
<br />l. iso*ncroflhc p'o|*ny.,ncrclusnelyconlr{.lins triri lic.nscd conradoF ro .on{tucr rh€ pn,jccr (S(. 7{!4. B \ir*
<br />und t|r(,tds\in Cod.: Th. Conlrrlu\ l-i.cn{ l-uw docs nor apFlylo at osntr orproPcrty *ho huilds or inprovcs lhcrcon.
<br />,trd sho conlmcts for such !oj.{h *irhrConlE todr) lienscd pu^ud h rhc (-.nlrxroir t-i..n{ tjw)
<br />l.nnrrcn.r tr 'l.r \.ari.n
<br />^.6 /V'ja
<br />I hcrchtnlftmundcr t noliyoll].rj!
<br />Sozrl z/1 1."5 'f
<br />DI.CIAXAI]ON
<br />r, onc ofrhc tulk,sirA d.clnn(i0n\
<br />-l
<br />h0ve and {iU @inrain a ccnificarc ot Contm i. sclr.lnrur. lor wolkcr' .on\mkrion 0r Fmvid.d lor bv SEtion :1700 oa llE
<br />tibor Codc. lor rhe I)crfff'l1mc olthc $olt t r *hich rhc p.rmir k irsucd
<br />Ihrv.andsillmlir oinso crs comp.nsarion nxurarce. u\ rcquiEl h, S(ltun.1700.frhc t,bor G)d. tor lhe pcrformftc of
<br />rh. work for rhichlhh pernir i! ksucd Myworkcis comFnqrion in\urarcc cdier ud Flicynumb.!&e:
<br />Corier-
<br />It
<br />lr tLt
<br />uorkcrs.onrpctrsriionpovnion\orsLrh!tr3r0oolllEl- orC{xl..l \h.ll.li,nhwirh.otrDly *ifirh)a Pmvnbn\
<br />lvlRlilNG l:xilurc n, {.u.
<br />.ir I lnrc\ uf k, onr huddrcd
<br />so*cr\, c.n,Irnsii{r,.o\rrns. A rtrlx*lnl. rnd (uhjcd in c'nrkrycr tu ainriorl l.mlriG nnd
<br />I conrcn\arbn, dn'M8cs !\ provided fttr rh.rh.nqn,l dolh^ rSlm.(XX)r. n ddiri{nr ro (h!
<br />Sc.ri, 1076or rhr l.rtxtrC.("r a 6irob .g-//-/-/i 5'4
<br />DECI,A8AI.ION
<br />I h.Ehy intr,n undcr p.nrhyolperjury rhar I m liansn undcr llrl,nisi,notCnaPtcr 9 (@mEting wilh Ssri6.70oo) orr'ivhi'n 3
<br />ol rhe Bu\iftcs and Polsions Codc. dd my li..nrc k in tull f.rcc ard efrc.r'
<br />CONSTRI]CTION t FNNIN(; ACT'N(]Y
<br />I herchy rlfiim undcr Fnrlryol Pellry lhrr ihcrc iv coiifl.ri,tr Lndin8 rgcm, fd rh- l).r lannancc oarhc trork lirr shi'h rhir Fmnr s
<br />i\\ucd (Sr( 1097.(iv C )
<br />lrn{l.i\ Nrmc:
<br />-
<br />t ndfi s Addrss:
<br />-
<br />AIPLICANLDEIIA8AI1ON
<br />I hrhylmm unds nenrlry oapcrrury onc ollhc lolloring d(kdrioi\l
<br />D.mlirion Pcrmil!-Asbc\lo\ Norin.{ion F.dcrrl RcSulrrion\ {Tnk 41). P.n6)
<br />-Acquted
<br />l.(d or Norilicalion
<br />ifyrhd rhc lcdcralrsdlDri(trs r.S dira .shc(o1 rcnn'!rl rrc ornmli.ahlc lo rni\ !n,Fr
<br />rlLlt rhrr lhrvc r. rhartt)l r.rri !tr(l(arr rhrrrh.rhrr trrl,tr 0lr i\rnrcrr Ir!'cco..nrnly*irhnll(ir!rtrdCouniv
<br />.\ rtr(lSrdc l,,sstol:[in3 ro hnild horzc qrc\cf r.r'vc( of rh^ Ciiy rnd Crunry ro cnrcr uFr rtr
<br />tr1"itr. nu , r(l f,oturl l,n trtr L , 7-'/ /7,\tpli$tri or Aaonl Siannl 1U 2_
<br />of.d
<br />-9
<br />4 ia .fr,r-a/,L
<br />COMMENTS
<br />Translormers
<br />ntr r p.rnrir subr.ch lhc amlica n, a dvil n.mlry oi nor mrcrhrn filc hundrcddnllurr(S50O)
<br />Licctr\c Cls$
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