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APPROVALS DATE I COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />lvleter Release
<br />Rouqh
<br />Service Meter / /. -F|NAL /u// r//"/ P 7'q/z-1a
<br />Notes, Remarks, Etc
<br />OWNER BU!LDER OEI,CARATION
<br />I hrr.hy ,tun undo I.Mlry .i t rtury lh.l I m crcmfl liom rhe Cunk&roF' Licns. Lrw tbr rlf, lnllo*ing (dsn (Se 7011.5
<br />Bun..ss ,nJ Prdl.sson Cqjc) Any Cny or Counry shth rcqutr \ N lrtnnr lo con(ru.l. alrs. inDrov.. Jcnblish o, rtait Jny
<br />sldclurc, ,rxtr to ils issulncc. also 'c+ins rh. ,ntlrlir hn such lcnnir lo lile ! qsmd (,r.mhr rh.r lr or sM ir li4ns'j flFuint
<br />h dr pnrv(onr of rh. C nt..lrtr s t-Mns,l Lr* (Chlnrcr 9. Commnc'n! qfh Scuri]n ?{DO ot fJivtnm .r of rtr Busims and
<br />PnncssNns C,klc) or rhlr tr or:lr s .i.hpr rh.rcli n &d rhc hark Lr lhc alb8c't ekmnrioh Anyvn rrio.ofScdion?0.115hrrn,
<br />anpl(,nr lnr rtl.m sul,jck lh. amlic.nr ro rcivilpcnallyol nornxkrhin hv. hn t dJollars($t(f)).
<br />l. as owmr oi rhc pfl,pcny. ur hy .mploy..s w(h wr8.s .s lhct s* conrEns,rion. wiu do ttr work 8n tlE srmtr b not
<br />inrm]c! or ottcr.d fix qh (Se.7x-4, Busircs .nd Pmlc$ion\ C,rlc: Thc Conr,dors Lf,cne tl* dmr mt aprly b .n owncr ot
<br />rhc ptupcny wh) bu ds or Bv,ruKs IlfFD. aJrl who Jms \uch k)* b'm{11 or hcscll o! rhmush hn or h.r owh cnI'byccs.
<br />tmvdc'.Irhar .h mpovmnhm , hrcnlcd orot aGl for s{k lL ro*.Kr, rh. hoildint or in{hNcnr n$1,enhinoncFd
<br />ol coq,lctn[ thc OwE Builq sill hrk rh. bud.n oi FUvin! rhd tE or rhc iil t, huill or n!6w rh. lNIEly for rlE I,{rInE uf
<br />-t.
<br />rs owncr oI rh. ptuI'.ny, ,m crclus rvcly .onrruclnrs *rlh l.rnf'l .ontr('6 ro co.{dct lh. F,j.rr (se 7044, 8urfts
<br />.il Pn'ldsM Codc: Thc ConrEcltr's Lir.ns. Law JMr nor{Ply t,) eorncr olpopedy who i,uililr Dr imPruves rhcrcon,
<br />lnd *ho conr,a( tor {uch pruFch wnh ! o)ntmclo(O lncrsJ purud b rhc Conr,.ntr\ LEcnse La*)
<br />I dNc\cm0r un,lcr Sc.rk'n
<br />lll}a6[Sl-calllExlarloN
<br />I2EOASTIIIIB
<br />I h.'c$y rfi trtu rn'tcr F_nnlry ot Frjury ncorlhcri,ll,,wm!lc(ln'aron\:
<br />I have ar will mnrad , C.rlrlarlc of Conscnt lo Sclllnsurc Ii{ *orrcr' cohPcn<lrhn, .s tNvidcd lnr 6y Smrnr l70O .t rhc
<br />lihtr C,rlc, t)r rhc Frfinmir. ol rhc wort( ntr Phah lh. lsm s ssuc'l
<br />-l
<br />ha\r atul w,ll nrarnrain workcs comFnsrri{,n insurr(c. rs rqu rc'l hy S(i Dn l?lD ol rh. l-aho. CloJ., ntr rhc Pcrti'rmrh-.c of
<br />rlr work lorulr(h rlri\ lrrn rs isueJ. Myeorkc^ conrp.trsarr rn<urMcc.ri.r ul pli.ynuhlEric:
<br />IYARNING F lue h s...ur. Bltrkcr( com!.ns,rtr)n (.vrB!. '\ utrldwtuL. ifti nEll \uhirr rL.mpk,ycr ro.rihln Pc llFs.n'l
<br />.!'l I'rr\ un 1., !'hu rcJ rl rrJll ,lnlrr\ '11,Y]flxr'r) rhc .on ol comp€osrrrcn, Jmgcs $ proviic,l tu rhc
<br />sceii toT6dl rhc Lrhrr int{cd anJ rnormy'1 lirr
<br />DECIdBAI&!
<br />I h.rby aflnn u6d.r p.trrllyot p.rjurylhalI !m lienql u.,lcr lnovlrbn orch,rt.r9 (osmn.ins wirh Scddn 7ftxj) ofDivni l
<br />ol rhc Busire$ ,n l P!,L$tunr Cdr., .rr my hcnsc N D tuI ture .Rl cll(r.
<br />t2 (otytoT
<br />SNSIAICIIQN.tEIDIIC.ACINCI
<br />Ihcilhyrlltrrrnlcrt-..n.lryolp(rjrr]rhlrrhscrr.onnru.r0nkiJnsrlcncylqrhcpcrl'mrnrcofrh.wolkktrwhrhrlnspcrnnrk
<br />isrncd (S.c 1097, Civ. C.).
<br />L.*l€rs Nim
<br />-
<br />Lc ers Aldrcs
<br />-
<br />-l
<br />cd,tirhd rh.l.Jcnlrcguhrklns rcr{ jrna ashcdo\ rcmovrl rr. norrl'If,lhk to lhtr pl)j.!1.
<br />I ccnnyrhll I hJvc ftaJrhr lppliuri,,n nl {ir rhxrrl[xh)ktr'l,i rnrrN({,.1r I tr!r.c r, (otr,t,ly q hrllCrrr_rtr(l(otrDry
<br />ordm.nccs rtul Str(. Laws rlllling b $u'Uing L.n. m, h.icbv.urh.rizc rcnrcscntlrilc! ol rfi t Cny r.d
<br />ah)vc mn.o'rJ !turny tur urf.clNr tlAt'l,ln{nl trr \lcnl Sipnxltr I 1
<br />;YEt
<br />ELECTRICAL.INSPECTOR RECORD
<br />DeL:-
<br />Poliuy Nunt r:-Erp@sr
<br />-
<br />-I6nrfy
<br />th.l in lhc perl'orroncc oI rhc wotk tu wh'ch rhir Fmir is rsuql. I sh{ll mr eqilo, -y n"*n. uny.onni,
<br />ar 6 to h€q,m \objcr ro lhe wortdJ snl).ns.rio. Lws ot C.litom4 Irl +ft rhar ifl srsrkl tEom sbjccr l. rL
<br />workcs compcnrsrbn povilonr ol Setrn 1700 of lhc L.hor Codc.I null ndhwirhomply vrth thos Povirions
<br />AIELICAIIDICI.A}AIION
<br />I lEErly allim und$ ,.naxy ot Frrury orc ot lhc t'ollowine ,iekrar irnr:
<br />Dcndin,n Pcrnin-Ashdor Ndriti.rrion Fcdcral RcSulllons ilillc,lO, Pd6)
<br />_Rcquicd L.rrcr.f ltu ndsn
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