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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNEI AUILDER DEII'AR TION
<br />I hdd', !,rm u!d- Frlty ot FJury ltr I n q.rn{!l ioh th. Cofi-t6 l,taEtwfortlEft)lLwrtslan{Sd70!It
<br />UcrtE -d Prcl6i,n Co<b) An) Cny or Count rl'ih ..quic ! rani lo oirru<1 .X6, h!.orq dmlih or qin uy
<br />rl due Firr ro ir. i.!e.. .!o Equn6 rh. 4rlk8r for 3kh Fm, ro fi1. . lCrEd naa6t lha lE o, thc i! licaed pusri!
<br />lo lh. Frvili.ro of$. (.onll.cror! Licot d L.w (Ch.pla 9, Comfti.s wnh Sc.rion 70OO ol lrivnion ] ofthc Blrin.s $d
<br />PDrdiom Cod.) or lhll lt or rh. b .rmpt $acton ed thc b.1n fot rh. .lLl.d ddFior. Any vhhion oascrion ,01 I J ht .n,
<br />.ppli..ir tor . pchir sbjalr rh. @licrd ro . .ivil pdt, of rcl m,. tho nvc hun<H &'lld (1500)
<br />l. B oqe olthc Fopdr), or ny dnpblE rnh s.g6 s En sk onp dio.. siu d, rlr *st .d l)t rndE ! ftr
<br />inod.d n offald ar nL ts< 7(x4. a6ilB od P!o6.aB Co& Th. ConrrrG r Ltc t * {tE mr .rply ro o o$n dfIt r,nFry *hd hitbor EplEllEEtr rn str() &Ersi*!lt huelf or hadf orlhDust hn d lE.trn.nployd,
<br />Fovd.d rhlt rucn inF.\6rdr Ed idaiLdoroEq.d to.sk.l[ lsM. rlE bildiiB inp.o\€d ii$ld *ihs... !d
<br />orcompldion, dEolrE &rLla willhrc Lt hrdn ofFtrtns tl6lEor {'. dn mt hrild or irqr$. fi. FnFry for dE FrFror
<br />L E ow of tlE FoFrr. m d.lair.lt.oMati,ls vnh li(oEcd codE loE kr.lldruct rh. Fold (Sd 7041. B6IB
<br />!d Ptot-in Co<L: Irli Codr.roi! Lic@ t,* d(E mr +l! 16 d o$E o f FoFry s-h6 hild. or iipo\6 rhd@n.
<br />rd *ho .onrrl! frr.uh FlFr snh. Conr.ro(rt lala.d F&Er lo iE Conrxrd r Li6E l.r)
<br />I m.idrn u.d. sd0n
<br />noa5.sBgcalttEllAIlo!
<br />DECIAAAIIO!
<br />I hs.t''v.mm undd FrhyoftEiuryon ottn folhNu8 &rlr i.B
<br />I h.E -d $ill mido r Cdt'fr{c olco6r ro Sdl-lM f ruld 6rpdlairr16 FDliLd to. b, scrior !7m.frlr
<br />lrh{ aode &. rlE Ff.rttec of dE *qt for *ntt rlE Fni i! i$.d
<br />I h!r. lnd *ill m.i.l!i, w.d6 (omp.Ndion i6ufucc. s rcquiEd by Sdion 1700 ofrfi. tltNr (-od.. for lh. Ftonrft. of
<br />lhc worl for which thi Frnir i! isdi. My wor[6 codr.Mion iNtrrm. cuir ud polky f,umhd u.
<br />,*,-, \ '2)) dL,
<br />P.*yN,.b- - \\e 914z1LO ,,*,* 4[ t[\L
<br />I.dtf) lh3l iIlh. Frornu. ofllE $ort ac whih fi't Fnn t eel. I rt llmt dtrpky.ny F$. in Dy,ME
<br />e B to b6om iutid to th. krtd' .onpq6i ion h*! of (-!lilomn. Dd +c rhr if I 3tbuld h..ore !br..l ro lh.
<br />wo*m' conpd ior F.vti.Nofsdion lT00olth.l.hy Co&.l slull, fonhwith omply wnh fio*tmrBioB.
<br />r+ tNlNC Fnlu.
<br />'o
<br />cd. \rld cotrqtldbn (n6.*. s unLtrful, $d rhd bFd M dpLF ro oimin,l FshB ond
<br />.N'l lin6 up ro orc tundr.i rl$urid doll6 (tlm,o(.omFdrion. drrugd a Fovid.n f.r !h.
<br />l2I1l,r!AAI0l ct,p. o 1.,#.-"ing *ni s-ln'n 7o0o).aDnhion II hdty lrfln und6 pa!h, of Flury rhd I m licmr.d utrds prcvl,ion of
<br />or lh. B6ire md Pmf6i.N (id., &t my licN it nr tull fora.nd.l
<br />,** a,] .-"aE
<br />e+b ^-l:*** 96157'.)
<br />",r-,"rqc1o>frlftny1u1*1+[11
<br />CONSTNIICTION LENDINC AGf NCY
<br />I hd$y .tfm u.<ln Fdly or rsru.y lhr llEc i! r onntodio. todiis isfty h, lh. Ffolrwc ofth. $rd tur stth tht F:ni it
<br />hu.d (Sc 1097.Civ. C ).
<br />APPI ICANT I)ECLARA'IION
<br />I hod'y 6mm uf, d6 po.l'y oap€jury oe of rhc follosins &rLrliio :
<br />t).nFhion PdfrnsAlhcror Nolifidnn Fcdsrl R.B!!!hN (Tnb 40. Prn6)
<br />R.quind t!tooltrdf.inn
<br />I .airy lhlr lh.,in rul rcBuLrKB r.3rdnlB Gtrsbr r@\rl e mt qrdrrbL lo thir F.j.<
<br />l.difyrhd I h.r. .ad rha ion and srat.rhd rhc.h!r.$.otr&r I.{1616co'.pl) sihall( (}ind(iu v
<br />f',Itrl ,c.\ i d Srar. Lass'rlI'nIn)holi2. rqr6drdiv6 o I rhB
<br />ah\ch6ri0n.d tmpdv r,tr
<br />,\ppllutrr or rr$t Signri
<br />I fttovtlan
<br />.:si;Tly.
<br />Site-Work
<br />Under ground
<br />Pole Bases
<br />S S Pool, Fountains
<br />Life Safety /Low Voltage
<br />Fire Alarm /Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Transformers
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceili Hard & Soffit Rou hS
<br />Ceili S -Bar Rou h
<br />Meter Release lr 7-l7 z{,A4(r'D
<br />-BgcsflService Meter I ueqfr,)
<br />FINAL I 7 t1 _-{,1rL4 /ti)
<br />Notes Remarks, Etc.
<br />I
<br />Light Standards
<br />Signs (monument)
<br />Bonding / Groundinq / UFER
<br />Torqueino
<br />I
<br />I
<br />II
<br />I
<br />a
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