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ELECTRICAL-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underoround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Siqns (monument)
<br />Life Safety /Low Vollage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditroners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />Itrleter Release
<br />Rough
<br />Service Meter
<br />FINAL 4/1/)fl lltlD,!
<br />Notes, Remarks, Etc
<br />OWNI]R Bt'ILDTR DI]LCARATION
<br />I hcrcty aflnr undq pullry f Frjrr, rh r I m.rcmfl ntnr rhc Q)nlractoF Licens liw iot rh. {olk,wins rcasn (scc 70.11 5
<br />Bu\in.\s nnd Pn'!.\\i.tr Cdc) ny Cit! or County *hich rcquircs ! Frnir k, coniru.r, drcr. nnprovc, dcmlish or Enan otry
<br />sflcrurc. prhr ro irs nsuoncc. oho rcquncs rh. aprltanr n, \!ch pcrnir t, liL a si8kd sllcmnr lhll hc or shc n liccNrl puruanl
<br />ro thc po!i\n,n\ ofrhc C.ntn r.r's Liccnrd tjw (Ch!pt.r 9. Comn*rcin8 wili Scclhn 7000 of Divi\ion:l orrht Busnrcss lnd
<br />Prorc$n,nsCodcrorlhrrh.orsh.ncxcaDlrh.rcnonlndihchr\isturhclllcscdcrcnphn.Aryvk,hrhnolScdio.T0lr5byony
<br />aptl,crtrr rbr 0p.nnil sublLrk lhc uptlicrnr lo !cirilpcnalryotnor nrrc rhr. fivd hundrcd d.lldn ($50o)
<br />-1.
<br />trs o*tur of rhc Fntrdt. or ny cmplolt s w[h waBc\ {s rh.n sob conrpcn\d i,'n, *ill do rh. w.d ,rld rh. stu:iE t ml
<br />inrctulLt or off.rcd tor slc ( S€ 1044, Busirc$ ond Prolcsn,ns Cdc Thc 6nta.rr's l-i.cns. ljv &Es iot ltrtly ro !n o*ncr of
<br />the pmlcny wlN toilds or in{'orcr rhcEr, rl uh, dds \kh M* himscll or hcsclf or l hmugh hi\ ot bct osn cmpk,yc.\.
<br />ptuvidcd rhar such innoRmnts m rcr inrod or ofcrcd nn slc la h,@kr, rh. hildin8 .i nqft{mnr is sld wirhin onc
<br />'t{otcoq,lcri,n, rhc o\rno Buiu.r sillh.h rh. hrd.n.fprcvin8 rhat hc or shc dd mr hoild or inqftr. rhc potEny f(t lhc purPos of
<br />l. r\ owncr oi rhc fiorcny. rnr cxclu\iu ly .ontading *irh lircnsl\] cotrrrct)^ b c.n$fld t]r proj.rr ( S( 7(}l.1- llu5im\\
<br />,ftI Pn,lt$iiG,Jc: lhc ConrNktr sLi.cns. Lru docs mranolyh 0nowncr ofrn)l. yqh. buildsor nnftnrlcs rhcrcon.
<br />.trd sho conrachfor slch pmicl\ *nh u Cnniruck,nI liccn\d pu$xnnr r, rhr Contrlcntr s l.i.cn{c lirr
<br />I m .rcq,t undd Sedion
<br />I hri.by dfinn un']cr tctrfiyol pcrjuryorc.lrhc
<br />ITICLI.BJIIAN
<br />_l hsvc nnd willtuimain, Ccnificar. ofconscnl ro s.lf.lNurc for *orkcrr ompcnslrion, ai Ervidcd for byS.crion 1700ofrhc
<br />tihor Codc. lor rhc pcrlorroncc .i rhc *ork fn *hi.h ihc p.rmir ii issucd
<br />I hd\r nnd s ill 'hrinlrin vorkcra comp.nsrl ion insuruncc. r\ rcquired hy Sdr i(n ]7m ol rhc tltlr Co.lc. lb! thc perttrron.'c of
<br />rhr wort litrwhihrhh Fnnir is issucd My w.rkcrs co rpcnelion in\urrm. .atrtmil Flicy numtEr dc
<br />_lccnilyrhrr in rhc pcrfonrBnc.ofrlr $o'k fd *hn_hrhi\,nflnil i\ ts'cd.l shJllnorcmpby rny p.n.n inanytnmncr
<br />v, ds ro h..om \uhi.r t' rhc sorkcr c.nrp.r\Jri.n hss oiCrlitarnir. rnd dsm rhd if I {nuld lEcom sut'jccr b rh.
<br />e.rkc(..mr(nsdionpa)vi\n'nsolSccri(r:l7()oolrhcLtrtryGxlt.lshrlltunhwnhcornnlywithrhos!ro!nn,n\
<br />wA|ININ(;: I'rilurc ro {.urc sorkcr\ confrt\Jion ovcrxgo i\ uthsrul, r d \hrll suh]..1 rri cnr|loy.r k, (tni' l t^-tJri.\ nid
<br />.ivil fims up kr onc hundrL{ rhour.M dollds (S!(x)-u)O)- in trddiri,,n k,i(,n. drnr8cs !\ prcvidcd l,r rh.
<br />Sr.rirnr:1076ofrhc lnhtr Cotlc. tr cton! di
<br />I hcrcl'y!flirmu crpcnallyof Itrjrry
<br />I,,(jl,Af,AI&N
<br />uMcr o.elisi of Chlnrc! I (conm{n. ins wirh Sern). TUIO) of Dili\ion l
<br />,n rlr Iltr\,'.$ rn l)',nr$,r!(i,n.Rl ry liccn\c i\ in iullturrc lrl cllt.r
<br />QNEISIJT:IIIINIENDIXCAGDNCI
<br />IhcrhyuillrmunderFnulryorr.rjuryrh,trhdcnn.onst crt n htrdin8 sscncy fin rhc Friornldc of rhc sort lor which thn IEmi n
<br />hsucd(sN l(r)7. civ. c.)
<br />AIILIIANII]ECI.ASAII$i
<br />l,urhydrfinnu .rNi,llyol!.rjryomoirhen,lhtrinsdcclnrdi(,nt
<br />tlc'nulirn,n Pcrmns Asbc{os Norificrlion fcdcr{l Rc[ul!rion1 ('l irlc .{r. Pd6)
<br />Rcquird lrtrcr of NorifcJlion
<br />l..niiyrhrrthr lcd!fllrcgulxri,rnr tugrti',9 J\u{f\rcin)rxl r nrrrmlicihlc n)lhis nrrjtcr
<br />n i\.otu{r l,!ro ro conply wirh lllCirysnd A,nnry
<br />ls { t')
<br />:^":;l;);e-
<br />APPROVALS
<br />trnd.''\ Addm(
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