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APPROVALS DATE ID/SIG.COMMENTS OWNER DUII,DEN DELCARATION
<br />I lEEhy d{rrn unlcr FMlry or lErrry rhd I m.k,pl rFo rlr Coddm LatR L* ntr E ftnbwiia urn (56.',r)llJ
<br />Buri6r md Pmr-tio. C.no Ary Cn, or CNdy rhth 'qdB 3 |E,nn ro onrut. clr6. in{lnle &tulirh or EFn &y
<br />itulc. Irin k' irt iliu0e. .lq, rcqune rlE rpplt r lor suct rErnir ro nL a sigmd rr.r.ror rtu h. or rlE ir liffid p!N.d
<br />lo rlE t,ovirionr of rlE Conrrrrdi Lief,$d lrw (Ch.F( 9, c(,mmmi.g vnh S<rhn TOUI ol Divtn. I o, r,E Blrim.t d
<br />Pndcsionr Cod.) or th.r lr d 3lE it q.trpr rlt'.6rn rd rlE tuir for rtE .llltn dar{xhn Ary vL'l{io. otsdirn 7o.11.5 hy t.!
<br />rndk.nr ror! Imir sbiik rh. +tili(..' n,.dvil,EMhyorn m'Elhrn riv. hundEn dnl[r lSa0)
<br />{/,. * ,*,,r,* a'*ny.,{ my.nrhFcr *irh *+cl.. rhc! st o,q{nrrr4 r,udg &GnLl .r ofl.Ed fm qt (Sd 7or.r. BullBr rd Pnr.(hB Cr+ TIE Cdr*rorr l-iv- lr]w ds ml .0ply lo r. ovE of
<br />rtr pn{dy {b trildl or inproE llErd !d wtb d(B trh trl|( himsrr or h.*lf or rhflr8h hrs or nd own .ilPhF$,
<br />pnrilcd rh.' i$h nr{mmd.@ d h'dr&al n olkBl rd {L l(t M. E llild!€ r 4rwld ir sld wahinm }q,ofcrrq*ia EOwF Burllr *iI hE rh. hrd.n.r tmanq rld lE ir rlE dil r, ldu or n,lnlE dE FsFny tur r FrF{.r
<br />l. riowBorrlr l'olf,ny. !mcr.lollcly.odrrr'n8 riih ltcn*d co.trnEk,d,n{ !rlrfn'rdlsd 7O4a.Itu'ims
<br />rd E$ri{\nl coJc Th. (ilnt0cxtr \ I -iccn{ law dr6r nor uppry
<br />'o
<br />ui own.r ol Plo!( y u ho hu ri'is .r inprov.i rhcG,n.
<br />an *tx, $nkd\ lbr \u.h F.}{k r irh 3 O,nln.n'( n li.nkn Irursnr t, rhc ( ontdtr\ l.irne 12*,
<br />.)I
<br />DEC:IIXAII(E
<br />I Hry rmrm u.&r FMly of Fir, oE of tu rolosus &clnlbB
<br />-l
<br />hrrc rd will mhrtin. Ccrifn'c of Conmr h S.lr-lnrE ln rmrtn orpord@ B FofiLd for b, S6rih -u@ of0E
<br />tikr C.d., lr tlE pdl()lrlrN of lll rdt ln rhih rh. Fni a tgEn
<br />_l bE and qill Ni,trin *ortm ohtEnurion inrunE. r EquiEd b, S6rbn 37(D or rlE Llbo, Cod.,ld llE Frfn'N ol
<br />llf, *,* for *tih fiir Fmn ir kid. My hrt6 on!.nstliE iffi tri. id lbli.y o'!5c. e:
<br />Polia Numb.r: t-tDncr:
<br />*r4drt tt r ttr ptta{[N orrh. m* rd *hrh rhk Fmn t ir$.d. I ddl mr.ipbyey Fmn in.ny nUEv{ E h b(<or stF! lo rlr Flt6 $trpcE rnn he! ofcniloni& url.aN rh.r ir I *.!ld b.$ft lub,c.r ro th.
<br />mrl6 eqrn$tio. povnionrofsc.rion 3?molrlE t hnCd..I tdl, fdhwnh.ut , sin orE FDrti6
<br />WARNNC f.ilur. b sm qrLh on{Insri)n flnrra. k unl$r!I. rid ihrl rut'Fr i dr?hFr b oinjMlFEli.s.nd
<br />.iril lin.\ ut n) nm hu'rl'cd rh.ustr doll$ rlll{).lxx)r. trr
<br />sr.itr)n.lo7a "irhc lrtrn(irl.. i ycn rn(lrtorr) \ f!r\
<br />n . ditrllc\ rs pr)vklcd lfl rhc
<br /><,.+4 u!.utstul.qnl&lLrc8t2t(l.l&rllor
<br />I lEFh' rilrDldLr p.uxy orF+r,
<br />'h!,
<br />I m [.rnsl uiJcr thvni,n or chlptd 9 klmmNin8 rilh SNr-,.7OoOr orDi!nFn.]
<br />of rtu liurim$ lnd PFn$i()ns Codc, u! my lrcnq i\ in flll n&r dd clTccr.
<br />c1Nslf,!!:rururlal)alilliENlr
<br />I h.Ehy !ffrm u.dc. Fnrlry ol lxr,try rh. rEn ir r on{Mrbn Hm8 ra.B, 16 'h F,ror,tre o, rlr Frk fq { htn rhir Frnt it
<br />nrxrl rsd 1097 civ cr
<br />l. cl{ Addrcs
<br />-APIIIIANI.IIEIIJEA:IIO!
<br />I lsnry lrm undc. rnalry or p.rlury od of lhl n,lb*ins d.rh,!lh.r
<br />D.mn ion P.rn(sArtEnos Noriric.rion F.n.rl R.3ulnanl (T k.lo, Pan6)
<br />-R.1uncn
<br />L.lLi of N({ifulhn
<br />I .dify lher rlE f.rtr.l ,.8!Lrio.. rcaudin3 0dE{os (mv.l !'. rn lllplt,hL h ihi\ I)oF!
<br />#,,1'xlr rlir I rln. r.r(lrhr rnflork)nx nrk rhr r rlc rnn,m K,. tr.n&1 I *r( h &r
<br />drl Sr.tc lrur Eldh8 tr l'!.ht iurhni/. rcl,.{nrdn.\ ofrhn
<br />/ rtFvc rn'inEd poFnlntr in.
<br />Dpli(.nl or,\gdl Stt0luN
<br />!l'rmrilft nnnr lprinl)l
<br />q,l, P t.I Cny.nd Counly
<br />cir, .,n Counly lo.t s ulonllE
<br />,,,L<1:l {
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Solf it Rough
<br />Ceilings (T-Bar Rouoh)
<br />Meter Release
<br />Rough
<br />Service Meter n
<br />FINAL 1l'vche ,+(SX
<br />Notes, Remarks, Etc.
<br />I
<br />ELECTRICAL-INSPECTOR RECORD
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