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ELECTRICAL-INSPECTOR RECORD <br />OTI'IIER BT]IL'BN DELCARATION <br />I hctuhy sllirm unl$ F'Bhy oI Frrrry rhd I u .rcs{'r fn,m rhc O,drackn' t,irir u* rtn rh. follosinS rav'n is.c TOll , <br />Bu\imrs . PrcL(bn Cd.) An, ( iry o, Coud, ehrh Eq!6 r Fn. ro arn<R1, .!rd. ir{|nv.. &ml'rt or Ep.n ..y <br />n .rurc, ttrinro irr irrurre, al$ rcnuiB rh. +pli(or Iq s!.t Frmir t, filc! rigrd {dr.rnr rh3r hcor rh. s li..r\dl pururnr <br />rr! ltr F[virnns o, rlE (i'ntErir's l.Bnsd L* lchrt{d 9. (immrinS *nn S..lhn 7tm ol Divi.bn ] of rlE B6n'c!. lnd <br />I'rcic\(ioff(i.)orrharh.orsltk.r.mprrh.rcrbntsrxlrtetErnfo,ihcrlLS.dcr..prion AnyviolaraonofSdrirnT0-llthrsny <br />lpt'lf,6nt f{tr . F m[ ruhFr rh. rJ'rlr.nr kr r .i*l trolr,.t n mErh$ fir. hlnlEd dollir\ (35fl, <br />_I. !r ow ofilE FDFdy, 6 my .trprrFl wnh *r8- ri ilEi, sL @rqEMion. will d.i rlE rdt .rn lh clfu ir d <br />i.rcdol or olIcEn to. slc (s6 7(x.{- Bu\irctr .rd ttof.$hns CnG TrE Conrrdoir l,t.n{ tj* dai mr {",1y lo rn owftr or <br />rlE FlFny rtn hoilk,r iqm6IE(r rn sn' d.E qh qnt him€lf or h.relf or rlFrah nn d lEr om.nebF1 <br />tmvilcd rh{ teh i,qm\ffilr ft hr itldicd olH tu sL. I( h,EB, $. llildin3 or irtlFltfufl t nld B.ni. n( Fr <br />of.a'qrhiotr rlr oqffi aujur wil lIE 0E h!d.. 6, Ftrring $r h. d rlt dil ml tliln q atrliow dE |fotsty ft, lll FlFe or <br />I h.rcbt ,rnnn ufrkl,ENlt y of Frjury oE ol rtr [i,ll'* ins &rl,r!rxm\ <br />-l <br />h.v. .nl uill minllin r C'.n ifrar. olcon€nr h S.lf. lNm (tr *o,r* Nn{Enq ion. .r F,vd.d nn by Sfilion .}?Ur of IE <br />lrtxr Cod., fi, rlE lErfIffiN of E *rr* ar shkh rh. Ix.rn ir h$d <br />_l hdE t'n eill oi.r.i. !0116 conqrBd$, in !le., I Ertuild $y Sdtnn l7(D of llE t nrCul..nnrlErrfcmNof <br />lhc wo.k for rhich thi, Fm t ir isqxn. My worl6 $q,.h9in,. itrsur.m. .uir dri Fni.y nuffi€r ftl <br />-1. <br />,r o* Er of rlE F!dy. .m .r.hlrrly (odr*1mA *nh lk..€d (n r&1rn ro .rrn{ur rtr Fl^t I S.. ?l}l,{. BuqF. <br />.d lh'flr.in Codd The C-ontscr.r'\ l-ic.$c l-dw Jo.s nor apnly b rn owncr ot tr,Fdy who hu ilds or imptuv.{ rhd.on. <br />rd *hl drrh_'lrtulKhrNFt*irnrft arnn lic.<d rr6M h rh.(i'dalor'i Li!.E Lrs) <br />,;|,-"diii"t;) <br />-lc.nilylh.l <br />inllEtEo,[Nof rlrBortrorrhrh'hrFmn iss .d. Irh.llnn.qhy.nyls$trinmytrUr <br />$ & n, tE$r subj.\r ro !h. trrkrr con{.n{tion lrws ol Cdl 'orni!- ud lsB <br />'h.r <br />il l rk'old ticon. uhj.d t, rlr <br />r$ 6 d,qrerin l,ovkh"t or S<di,n 17m ol ilE Urrr Cod.. I tlult ,.nn*irt ont)ry snh rL,r p$viriom <br />:::::",-'i;li{[L{ <br />AIEIgILIIECIJAAIII]N <br />I hdrt), !trm undn FnrX, of Frury om of rlE folLu int &rhhi io.r: <br />Dcfr)ln rn P.rmirr Aibc*rr Nd ilic.r irn F.iLrsl RcBUl,r irnr tTirk 41. Pd6 ) <br />-Rntund <br />l.trd of t*rifs!r,n <br />WARNN(; triturc ro <urc qrtfl onDcndrn m\rh8c r\ unLlful. .Bl sholl \uhr( an crrq,hF, ro mmiEl FEhF id <br />(A' rtrtrs trt, r. L{'. htrn,l'.(lrhLiNxnrl(l,,llr\ rslr txr{,'. tr,tr r "l.oaBNinnr. drN,Bc\ r\ ni{,vilcri l,n rhu <br />nt.Erl .nd ,Lmy r lel <br />I rfthy rtrm ud.r Ftulry oI F llrry rld I .h lienr.d unjs F)rnhn of Ch.I'rF g (.a'nmrins wirh S&rb. Tlrm I ot Diriri'n .l <br />ol th Bu\ir$.rr.l PmL$ionr Cod.. .rn nry lh.ne h i. tull ri,N ml.ftd1 <br />g)lliralgllllNt[uJtc.Ar !1:t <br />I hcEh, lmrn undd Fn.hyolp.rjury rhd rtrE i! n.o.rrudir. Lodint t8cky t, rh. FrritrmR orrh. mrk l'tr whrh rhh Fni n <br />F.u.n (S< .1197. Cat C I <br />l.nld . \!r <br />- <br />_l ldify rh,r r,E rcaj.[l Erlbrion\ qddin8.{E{G Emrd e ft{ q''ii.rhk n, rhr noFd <br />l6tfy rh.r I h.ri r:d rh* al'rli.!i) <br />orl'tutr.c\ nn,lSrnrr lrs\ '.hr'nSr, ho' <br />rhr. nrarbril pnlpcnv l,r n <br />\rrln,trr nr \[tnr \irntrru,r <br />APPROVALS ID/SIG,COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Llght Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Lile Satety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Bonding / Groundinq / UFER <br />Translormers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />BSo! Top Equipment <br />Facto ry Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soflit Rouqh <br />Ceilings (T-Bar Rouqh) <br />Meter Release <br />Rough <br />Service [v]eter ,/^\ <br />FINAL 6-ZZ)2-0s,,lzrrol ZD) <br />Notes, Remarks Etc.: <br />VL <br />onurnn ncor.d I lrra ro srr y $'rh rll Cn,ml C.uirt" * :';'.';Jidi;: <br />DATE <br />Under Slab / Floor -,4