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ELECTRICAL.INSPECTOR RECORD
<br />COMMENTSAPPROVALSDATEID/SIG.
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Lighl Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bondinq / Groundinq i 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 />Ceilinqs (Hard & Solfit Rouoh
<br />Ceilinqs (T-Bar Rouqh)
<br />It/eter Release
<br />Rouqh
<br />Service ltileler /A
<br />FINAL D--+-lK w$a
<br />Notes, Remarks, Etc.
<br />OWNER EUII,DER DELCARATION
<br />I hcr.by ailth und.r p.mlty ol rrjury (ia! t d .r.mp( tt,nr rhc G,nlrluros' l-knt hw n lh. t,llowhs rcr n (Se...?trll.s
<br />Bunncrs drl Pnrcsion C,iic): Any Ciry or Counry rhf,h rcquncs r IFm to ..n(ru.r, 0llcr. impruk, d.m)lsh or EPlt 3nv
<br />srfl.furc. prMn' irs xrumc. rlso rcqurcs rh. Tplranr t)r \r.h ttmnt n) lrlc ! si3Ej {are'Enr rhat h..r she s lB.n{,] pursurnl
<br />b rh.,,ovso.r.l rtE Conrra.tn's L,c.n{J Lf,r (Chlnrcr 9, Conmcfth8 wnh Sc.lnh llx)O ol D,vtrn,n I orrhc Bu\incl\ 3n'i
<br />PR .son\ Glj.) or rh.r lE or rh. 8 crcq rh.rch,m.nn rhc l,ast nrrh. alhlql crempiion AnyvdrlDnotScctbn70.rl:hyaiy'
<br />appl'.'n! ior,p.m \ubj(tsth. atplicrnl b!(iv'lFnrny.inor mtrcrhen rivc honlr.JJollas rl50O).
<br />l. .\ owrcr ol rhc pn,p.dy. or my c mfloycc\ * h w{8cs a\ rhctr n,L omlctrsar rn. w'll !t) rh. w(,* rnd rhc nndm r frn
<br />inl.DlcJ or oll.(d tur s.lc (S!r.?l)44, Ilu\ocs oJ Pn,f.*onl C(tL l hc Conrtrrkr's L(cnsc tlw d'Es nor rptly iD an o*mr oi
<br />rh. FrtEdy wh,borlJr or inymv.\ tlxN,.. afil wht dcs $.h *ort him\.lfnr hcr{llorrhmu3h his orh.ro*n chlhrvc.s.
<br />pruvidcrl rh{ such mFrwmdrNfr inr.nldl r ol,.ttl ld elc ll. r$wcvs, rlt hu 'rlm! dr iq,mkmnt ii sU eirhs oN }trr
<br />ofonpLri,n. rh Own.r BurlLr will h:t rh. lau&n ol !n)vo8 rh.r tE r sh. dil R hu l ot ns ne thc ImFiy tnr rtF I'lrlnt o,
<br />-l.
<br />r( owmr oi lhc pn,pcny. d .rclunv.ly .onlt-rn3 wrlh lrccnrd codrnckF t' con(rucr ill lln,ici (St. 7044 B!\ucs'
<br />.Rl h,l6 'nCod.: Ih. cd.tr[loir Liuctrsc l.r* dNr noi rtttlyLt.nowner o! prop.nywli) buillr orimpov.\ rhocon.
<br />rnd who.. ra.ts lor surh I'ff,Fd s Pnh , GrhrEcro(r l(.nEj purrd nr rh. conkacttr \ l,iren{ l.rwl
<br />I {mcxcmpl unJcr S..i!
<br />EABTEES:COMTENIA]IO!
<br />DECI.ABAIIO!
<br />I h.rcby alfrm undcr FnahyofiEturyonc oflhc tulhwng ddcldtr(,ns:
<br />Ihjvc n will mainrrd , C.nrr.rlc ol Conscnl b S.lunsurt n, work.ts drmlf,rsrri'n. ar ph)vrLd n)r tv S(toi .l7m .t th.
<br />Lrbor Colc. tor th. pcdnmxe of th. k)* ntr *tEh lhc p.rnr B ssu.J
<br />-l
<br />hrvc and w,ll nlrnla,n work.n romtc.srrion 'nsurrtu.. rs !.qureJhyS\.'r('n:l70Oulrh.l-rlxtrCi .. ntr rhc P.dnrnBnee ol
<br />rhc *ork iai *hich rhr !.m is tsucLt Mywork.ra (omF.ns.ri)n rnrurdtu.tmd *rtF,ltynumhq c:
<br />R,ln.v Numb.r
<br />-t.tw.
<br />-l(nrlylh.l
<br />hrhc pcnnrmax. dl rk$ work lor qhrhlhFt rm '\ L$ucJ.I drill n.r .mpl,y any r^_^.n r d.v mrnmr
<br />s) is b lE(onx sutJ.d n) lhc p lkcs comIt.slri,,n hw\ ol C,l'tnQ..nd agEc rhd ,l I \h'nu tEom rit']ccr (, rht
<br />workcs ompcn\aron tovtrbns olS6..ii,n.1700ol rhc If,htr Cdl..I \htll. ilrih*[h romfly wrlh rbc Povisi('n\
<br />W,{[NIN(: Ij,ltrr. r) k.uc *rkcr( $mfrn\lr ov.r4. s utrhwlnL uil shall suhF.i .n cmlloycr ro fflml pcDlrE\ 3n.l
<br />('!rl linc\ ut h oDc hutulr.J rhou\xnd dollrr\{D.UXr. rn a'ld n,n !, rhc .o(t ol uom!.nrarkn,, Jrm8cs as PoviJcJ lnr ih.
<br />Sc(rtr,n .10?6 ol rhc lf,tx,Cdc, !trc!.( rtrd !l 9ov.7 20
<br />u!! !t!u9\
<br />I h.hhy nltnmundcr Fnilry., pcrjury undcrF{)vNNnolChaprdI(lommhuing* hScd()n?(Xx))oiDrri\trn'.r
<br />ol rh.lluucr\xnJ Pnn.(trsC tlc. )ftt my lr.tr\. '\ 'n
<br />ltrllnr.c (l.lli.r
<br />170 6 L-t
<br />c lzs r
<br />I
<br />I hcrchy aattm xftLr Fn.lly oI Friury rhar ttct i d r.nntucrarn k*lh3 r3.Ny iir rhc n rfirmEnuc of rhc work ntr whlh rhs rmi s
<br />nsucd (Sc.. ]m?. Civ. C )
<br />tindcr'" N.mc
<br />-
<br />trnJ.i\ A'l.irc\s
<br />APPLIC,TNT DECLARATION
<br />I h.rclry anim un lc, Fn.xy or Frjury om olrh. nnhwins d.cld,rons:
<br />ocm'ln()n PermrrAshcnos Norifi.don Fcdcral RcBulnrion\ (TitL 40, P.d6)
<br />Requirc'l Lellerot I'Jd nalr!.
<br />l.cd'lyrhxr rh. ltdc l rcgulalons r-3ding J\h({o! krrrv.lrre ri rPnl'r3hl. h rla( P$jccl
<br />4,,-rrn vl narc rhrr rhc .h,!c mtur lrsd.(,comdyw(hrllCiryrtulc"utrlv
<br />itdmS( tr(tu!rrrn dBl hcrchyaurhorn. rcPkrcnrJrrvc\ oiihr\ Ciryatul(i)unrrb.nr.tutirrlf,
<br />q L9 2-o(1
<br />Under Slab / Floor
<br />lht.-
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