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APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab i Floor
<br />Bonding / Grounding / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)rA raAr ts./
<br />Ivleter Release
<br />Rough
<br />Service lvleter
<br />/1/iq )n9.,(
<br />Notes, Remarks, Etc
<br />ELECTR CAL.INSPECTOR RECORD
<br />OWNER OTIILDER DEI,CARAITON
<br />I hcrchy arfirm undcr Ptnahy {)a Frrnry r hnr I d cr.hpr fmn rhc G, a.tu6 Lt.nr t p for ihc followinS rclson ( SN ?rX 1.5
<br />aulrncsr and Pturdsion C('d.) Any Ciry or Countt shi.h rcqun.s a Fmir l. connrucl. rller. imnnvc. d.mlhh .r rcp'tr ,ny
<br />sddurc. ,rior lo ilr irsulme. trlso rcquncs thc rprlkrnl for $.h lErmir lo fih r si8ncd slll.m rhlr rt o, shtJs liccnrcd Nisu.n(
<br />h ihE pn,riqi{,ni.r rhe Cont&ror's I-i..n*d t2w (Ch+ier 9, Conm.min! wirh S.dion ?0(D oI Divhkn 3 oflhc Busin.r\ and
<br />Ptuf.\\ion\Codc)orrhrrh.r\hci\.rcmflrh.rcfroMandlh.hrsisforrhctrllcecdcxcnrl,tion.AnyviohrionofSccrir.T0.rl5byDn,
<br />0mli.{ for N ,rrnrn sxhj..r th. r0plicant lo acivilnc.axyorfr, mrclhrn fivc hundr.n d.lla6 lS5m)
<br />L dr owftr dr rh. plDp.ny. .r nry cmlhtd. wilh *ag$ * rh.ir $k .oftIEn{rion. wiu do llE *nk Et llE snrtu. n Bn
<br />inrctrd or ofrcrcd ior qL (56 7044. Busimsr and Prufc$ions (odc: Thc o)nrrad( \ L,iccnsc ljs do6.or arplt l.3n osftror
<br />rh. F,pcny qb l{ilils nr inln,B thmn..rxi who (lf,i {ch w)* himrcllor h.s.lfor rhouah hi( or hc, ow..q'Lrc.r,
<br />pmvidcd ihat sucn imln)rcrd\mn, inr. lcd olLr]d aor elc ll lx,*crr. rh. trildinS or irpbrmnr is $ld withirorc tu
<br />ofcotr{,ldion. lhc ourcr Buildc! will hlK IIE hud. ofrovitr8 rhd trorrhcdh mr tuiu or iqmw [E pDFnr aorrrxrn$)f,.r
<br />-1.
<br />a\ owmi ni rhc pmp.riy- !m crclu\iEly conrracrins $irh liccn*d conrracr,,^ t' onN!rucr rh. Ia j..r (s.{ 7o1.{, Bu'lm(
<br />and RlfL\si)n C.dc: Thc Contr.rtr iLidcnscLavd€( no.attlyk' an.*ncr olfmpc y*ho builds or imtrove{ rhc.do..
<br />rn'.r.md undcr Settr ! A &PC fo, rhtr 'cJ,nn -
<br />f, //l '."'z "_*J,/<-- (h a/1 2n
<br />w{rRxFtS coMpFNs^rroN
<br />DEII.ATAI]!]!
<br />I hcrchy !ffnmundcr pcnalryolFrju.t onc orlhc n,lbsin8 dcckrdrt'nl
<br />-l
<br />hlye aln will minroir a Ccrliararc of Conenr r., Scltln{rc tu sorkcn $n{rnMrn,.. i. FDvrd.d ror by Sdlion 3?(n of lhe
<br />libor C.nc, forlhc pdlornEr. ofrh. wo forwhkhrh.Fnnil ii issucd.
<br />ke 1,Z
<br />_l hlvclndwillroi lin*ork.F coqEns.rion ins!rumc- as requncd 6ySNrn,n.lT0Oofrhc tritxtr Codc. for lhc Inform0ncc nl
<br />_t
<br />who cnnrDci\ in su.h F)re.r! *nh aConrm.hrlt li..n{d nursurnr k,ihcConkmtr\ Li.cnsc Uw)
<br />i'Nurrr. cJricr nM fn'rynuinrrr ircl
<br />a< lt, <aL
<br />ciril nncs up ro onc hunnrcd rhols.nd dollan lsl )). rtr i!nlIi,,n rh rl[ c.n ol crtr,pctr\rri,tr,. Jrn']!r\ \ t,'!!vrl(L l!tr rhc
<br />s..rirn.lo?60rrhc lrhtr (ixlc. idrr.! rnd
<br />C
<br />-l.c
<br />ily rhdr ir th. NrlonMicc oi th. work lor wn ich rhtr Frnril i\ i{\ucd.Ish!llnor ctrDloyrnypcrsm in any nrtrkr
<br />v, r\ h hcq,m \uhjccr h rhe workcrs'conBD\ur i.n lnw\ ol Crlit rnir- L isftc rhrrirI \kruld h.om luhj.cr lr,lrE
<br />$orkcn on,pcnsxriln pmvii,,n\ o{ Sc.ri,m .17fO of r h. l ihtr C{xlc. l \hxll. fonhwith .o tply wirh rho* nnyhions
<br />^,,,€ l2/jo tz a L
<br />D'CLAI(AT'ON
<br />I hc6hy ,rfirm und.r p.Mlry or pcrjury rhar Lm li.cnqn undfi I' vi{i.n or (]}pr.. 9 (d'mmmina wilh S(rion ?OOO) or Di!ki{,. l
<br />or rh. Butims and P2[csi,rn\ Cud., rJxl ny lk.n.. t in fi'll nnm rd.n&a
<br />-o V.2.n
<br />o
<br />bn{fl.rr)n hMinel8cmy for rnc ncr,ornumc ollhc Nork fortrhi.h rhi\ p.n irk
<br />()
<br />"df'/t,t>,
<br />I hcsht dftr utultr F_nrlrt orr.rjury rl'dr Ih..c r
<br />k\ucd (SN .lll')7-Civ C)
<br />at[utaNt oEcl,llarur]!
<br />I trft+ry lnLn undcr Ii.nahy or p.rtury om ofrh. tulk,qing d.clr'rt,ns:
<br />n nnibn Pcrnih A\hc\ros Norificari{,n Fcdcrrl Rcsukrions (Tirlc 40. Pana,
<br />Rrttunc,l lrrr.r orNorili(rrhn
<br />-l
<br />ccnrlyrhr rhc fcdcrr I Esu ld ions rcBndin8 $tE{os rcnr!,lm n.l al)|)licablc to lhh roJccl
<br />-l
<br />ccnilylhlt I hovcrcadrhn rI k{rnnrud (irc rhlt rhc ahrlc inlon n'nncnrccr I rsre b @frply *irh all Ciry 0trd c.unry
<br />orliNnccs aM Srarc Laws ellir8 k'h.n7c rcprcscfrinrs ofrhtr (''r! rtrd (irunrt, ki ctrrcr trti rlr
<br />lhrc nEtrrioncd pmNdy for ins
<br />-,,,1G//s/:-,
<br />f &. Lz, ru
<br />lDDliunl or AEcnt SiIn{lrre
<br />d
<br />\\Y\rv' t
<br />FINAL
<br />,,,,'.,*,,,*,,"? ? Lt"C )t>1Vt ,,r,,".
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