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ELECTRIGAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNET BUTLDER DEITCARATION
<br />I lEdy .rm u,r& Frny or Fqury rhn I e a6rF nm rh. Co'nr*16 LaC4 L,* ao. rlE folLqiI3 rd)n (S< ?01Lt
<br />Buitrd sd ftofoion Co<t J An, Cty or Comy which ,.{un6 r Fht lo @drud. da. itrproE &slah d E!.it at
<br />nMrG. FBro in agre..bo'!Sri€rS.rylk!!lbruhFnilioliL.l'snd.liffilfirh.ottlEirlkaEdFrM.
<br />r. rlE Ftrviliod of rlE Conrr&toas Licolcd b* (Ch!pr6 9. Cosfftins sih Sdion ?000 or Divition I or rt BGilB od
<br />Prcf6sd Co&) d rh.r li 6 lrE a aarq rhd.non r.d rh. hGs td rfi. n4.d ddt$ bi. Any ri\ldion of S<rion ?01 I I b, et
<br />q'?li.er aor ! Fmir rubJBl3 rh. .pplicur lo r civ il pmhy o f mr m.E rhd iv. hund.d dolld (1500)
<br />. l. B oM6 ofrh. FoFny. or ny splotB uirh wrg6 s rh.n FE omFBaion. *ill &J a *dt an dE riarE i mr
<br />dci.n or otuld f eL (Sa 7014, &!ilE id Pmftsn6 Cod. TIE Co'rndd! LrlB lr$ &6 ml .pply lo u orE of
<br />lh. prDFry who hrits or impovd llEbl! nd *lb &E 3u.n wB hi@lf ot hq*laor rtmuSh hi! ( lEr o{r @plo}6.
<br />ForiLd rhn ui iqD\6ldJ E d hdxLd d olEql 6. el. ll how. tll hl'ld4s d ilslEld ir $ld *ithin on. t@
<br />otompldioll. rh. O.r. B!i6d ,ill hrw dE h,{.r of Fo6B rhr lE ( nE di, d hiild or irryort dE FuFlr- Ior rh. FnF or
<br />l. 6 orE of rh. Flpflx mdclEndyco Elin* $ilh lic6a.d .orlrrdo6 b coutu.1 rh. Fi..l (SE. 70.14. Fulird
<br />rld hlisin Cod. Tli.Co ,rro1.l-t.e l,*'dod @r.rplyto &o$nd ofFtrpdry rn h{ild! or inFord lhn@n,
<br />.nd wh. offi! an sfi Fnjrrrtwirh I collr-ro(rl liccc.d ruM,n ro$c conb&roi. Lic.M tts)
<br />I m.tdpr ! Lr Sdtbr
<br />1r08lit85:ra!rrEU,tauo!
<br />DEUIXA]IO!
<br />I lE tE !,Im un& Frny of Frur: oE of 0E lollo*,8 &.Lr.ii.Nl
<br />I h.\. rn f,ill minl6. C6rifxlr.ot( o6dr ro S.lf'l6ur. for ro d ..niFB.li.o a FrviLd for by SElnrn 170(j ot lhc
<br />lrhor ('od.. rd rh. FfoiM. of
<br />'h.
<br />mrt for rikh rpant itB{.d.
<br />I h!!r lrd witl dd.'n *ortd orp.G.dion ,i!llft.. B EqliEd b S<lbo 1t@ or t Lhor Cod., f!.lh. rqfnlrltl8 of
<br />::
<br />- :"ryp)y:ry.*i'n
<br />i.,.rc tr d id D' i'v nuobq e:
<br />I cdtiry rnn in llE Ffotruft. oalh. work for stit lnn ,6mn n i$uaL I lrrll Dr dploy My Fsn in uy lffi
<br />s rro b<!m uBcr ro rh.,qI@ Nr46rio. lrs! of (.liaomil rd rsr fi, if I snouE bdor tltixl ro dE
<br />wort6' @mF!.rion FolirhB of S6k'n l?m oailE t t n Co<,c I tldl fonltPil' .oqlt q-itlt thor F!vi!iE.
<br />WARNII\C: l_ailu.lo Eu. uorl6 .orpoel'o. ovd.rc n unh*tu|, and sh,ll ebjd' a dplolw lo (miDr F$16 rd
<br />.n1l fiE up lo oE hulxt d rhound d.ll6 ltlorJ.(loo,. in lddnrn !o rh. cd oacoFFNln'i. d.n46 B Fovidcn ror
<br />'nsEr(rn 107( ofrn. Llhn cod!. ini6.n a*l dronEy'r ldf-
<br />I hdlt,l .rfm und.r poulry orpdju lh,I rn lrcds,uidq ofChq,r6I (.omFdcins wirh sdr6.700(D ofDnision 1
<br />of !h. Bo.iK $d PmfdoE CorL. axl my lE@ B i!
<br />Lk@Clts: g
<br />^,, - 81t-(7
<br />I hqlby iffm u,'d6 Fuly ol pqllry lhr lhc. b . odrudiot
<br />is,.d (Sd. 3017. CiY. C ).
<br />Lcub'r Nm.:
<br />-
<br />rsc) for rlE pda(nlre. of rh. rct tu r't*h rhn Fni t
<br />ATIUCATfDECIASAIIO!
<br />I h6*r .trm !nd6 Frty of Fju,r oE of llE lollowin3 d6lr.l bru:
<br />Damlt6. PmiteAsb6lor Norifidlion [.d(.1 R.UuldioN Gnk ]l0. Pd6)
<br />R.q!r.d l.ndnaNdrfi.dbn
<br />I .d,ry thr th. f.d.nl rcsulrl@d csrdins atreo. llmr d r. k{ apl..bk 'o
<br />rhir pmj.d
<br />Icditlhn I fi-.rddlh! iptltdion !d.d.lh'r dE .tor. ,nfonnr.i !(nd I{E'osod}$nh Cn}..d(oor!
<br />drd,nMc6 and Sritc,trrer.hrin$i,! hu'ld'n! co adhdriz. r.D..dali!6 of lhirC y dd Couly lo drs ul-n rh.
<br />.b.\.l6lrn d FoFr! for Bpdnn
<br />^ppllcr.r
<br />o. Ardrsl*n.rur X
<br />Iltmlk mmtrp;nrt, F 5.J tL,s-6-17
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)I
<br />Walls (Rough)1lz/rt .*u4.fn
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />Meter Release
<br />Rough
<br />Service Meter tt
<br />FINAL I
<br />Notes, Remarks, Etc.tv/
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