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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS COMMENTS OWNER BUILDER DSLICARATION
<br />I hd!6! !,Ir{ unkr Frry of F,try rti I b adDt ftom llr Co'r,-l6 Ltc4 te lor rlE f.lhsns idh (sd TOl l t
<br />BBin6 Erl ft ldion ( od.t: An' Cny or Coilty whth ,.qun6 . Fmr ro odrucr. .t6. inp.oE &rElirh .t r.,.t d!
<br />slruclue pri)r lo ir! isuecc. ds r.quu6 0E ttlplicul fot !u.h FEi ro lil. r tign.d ndffit lha tt or !h. ir lic*l- guo,.t'r r
<br />ro rh. Fviiiod of tlE Conrxloi! l-t.B.d tr* (clrF6 9. Con1rl@irB snh SBrhn 7000 ot Divlrion I otlh. Buin6 Dd'
<br />Pml6i.6 Co&) or lll, ll ( ilE i' 6€rpr rhd.troi &d rhc t-ir ir ilE dk8.d qdFiri. Ary rnbbn .ls.dnn 701 I 5 !.t Dt
<br />.ppli.&r lor . poon subjdt th. lpplicsr ro r ovi! FEty of mr turc ft6 lilc huid.d .lolld (r5m,
<br />l. s o*E otrh. FoFrt. or dt.opblc *nh wr{6 s th.r $L onFrEasG vill & {E*vr -d rh. rn$w i, Nl
<br />inldr&l 6 0tI6.{ fr i.l. tS6 ,044. B{siB xd Pml6i,B Cod.. t1E C.nrrroi! Lk* L.* dB ml +9l! l. m o{ffi .f
<br />lfi.!.lpcly whr hil& or itrtFlrd rlE@d. jd *h. dcMtN iimcllor tcltor rhmuah hi! d 16 om.mploy6,
<br />Foyih rh,r ru.h inFrvdEn! e mr i,rdi.d or otuld tur sh lL ho"66. tlE hrilt!{ q irryltffn n Fll within.E )a
<br />ofNrptr-c rlE O$c &drd \ h.w d. hnr, olFrrlB tL h.d tE dn dlr hild d irFi! dE FFly 6r tlE FlF*of
<br />t. B 0\6 of rlE F.F!r. m a.l6iv.ly onlrxi ns wnh [c@l codr*r6 to mdtud llE P.o]El {Sc 704.r. &!!6
<br />drj hlkn Co&: Ii.Conkr.roir Lr.e rir &6mr.rfllio eowE.rFoFn) *hd bg'kk d inFor6 rhcon.
<br />dd who F.rn<rr lf $(,r F.j.!i! $nfi r ConrEcro(, licd.d p{nuei ro rrE Conhclois Lkro l.*)
<br />I m.rmd ur.l.r Sdbn
<br />Ortr.r
<br />l.0tu(t R's'aoltrPeNsarroNlEga&flor
<br />I hr.hy rmnn !.d< p6aht of IEJtrry on. ofr h. ftlllo{ 'ry ddldth.6
<br />Itr!.lrtsillMr.h.CarifE.ofcoMrroS.lt-lo!@t'rsrl6dnFEiion..Ftvid.dlorbySEtionlrm.rlh.
<br />LrrF, cod.. fn th.Ffdrlrlreoflh mrt fG *trkh th. Fnn i ir{.d
<br />I luv. snd willn.inlain eort6 .oitcelnn iBuEs., B r.qul.rt by sdlior lTondllhc lrhr(oda for lh. psfon.lnc€ ol
<br />rh. *.rl for *hEh rhi] Ff,n a iBU<d My * o.ld' .omFsion iM. ffi !d Flq nudba e:
<br />Icdiryrhlt u lh. Fforrr@.!rrh. *orl f.. *hich rhir Fnn ir issu.d.Irhillnor dploy my Fsn in.ny n F
<br />$ 6ro baom rubtd hth.md6 onFE iln hs! ofcllifr'dia. tsE lh.l if I rholld b6oft subiGi
<br />'o
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<br />$$116 conDdMbn D.or i.FB oa S.(ion :l?uo olllt lre, cdL, t tlill f.nhwnh @iplt snh ltbJ Fo\ ithE
<br />WAIININC: F.ilur. ro su. $0116' omrE$llion covds. i! unlt*tu|. Md nldl 3ltU6l a dplorq ro dininrl FDhi! ud
<br />.nil 6c op r. oR huBi.d lhousd <d (ll00.O(l0), '. tdanF. to tlr coi ot (onFcai'.. d,nEsa B Fo\ij.rj nn rfi.
<br />S(ri,n 1076 ol'bc Lltu (-r&. in'6d ed nl
<br />o.,,. / of z o/zot7 n,o
<br />I hq.by .mrn u.do pcnrlry o f pdjrry lhar I m licds.d unds Fovision ol Cnlprd 9 (c.mmocin8 wilh Sc.lio. 70fl1) of l)irisio. 1
<br />of rhc ltuilB.!d PDIdirG Co&, !n my l*.e t m tull fora nd.frdl
<br />/o fzalzetz -."**X
<br />cqll[ElllllaxlJdDlrE-acl!(1
<br />I h6.6y.rm ui{d pcrtyolFjurtltr Er ! t ordtuction lcxjm3 ts*y for t,E Fl(M. of lh.8l 6r $nkh rfiit Fni a
<br />isud (Sc.1097,Civ C ).L-J.'! Nm.
<br />ATTU(AtrLDECIJ8AIIA!
<br />I hdibyrftnunda IErh,otFrjrry oE ofln lollo*inr &cl&.rhnr:
<br />Dsnolnio. P@n}Altdlor Norifi..lion Fci6.l Reuht ionr (Titl. 40, Pan6)
<br />R.quiEd ldd of Ntiiftnion
<br />I c6ritrhd th. toj(.1r.Bukri, esdiiinll dErd rlm\al&..or 4Dli.!bLlo thir rojtr
<br />I cdlify rh, I rL. rad rhn .!plk.!hn an i.rc thn tlE atov. intorn Fn s cdret I .8ra lo .om0ry wnh .ll ( ny a.d ( ounr)
<br />odin.nc6 ed sr.r. lrwi rhriig ro brilding ..Nrudio,! r,n h*by aurhoriz. tq,6gn iv6 of $ii ( hyed ( oonl, to 016 uron lh.
<br />rhJr. l6rDft1l phrp.n\ for ruFt1
<br />Appll.. or,\86rSl*tr.rurc
<br />Dkpt E c c-/-A
<br />e1^4,,,
<br />Site-Work
<br />Underground ll"b-lJ V.W!u)
<br />Pole Bases u \-t
<br />Light Standards ,A
<br />Spas, Pool, Founlains ll -b-17 ),,121L)
<br />Signs (monument)u\2
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor I
<br />Bond i n g / €trou€drFg-PUEER tt- 6.'1/x,w.v,)
<br />Transformers U \-/
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouah
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rough
<br />Service Meter
<br />FINAL s-zt/r YWIDI
<br />Notes, Remarks, Etc \7
<br />DATE I ID/SIG. I
<br />9*-.;Z ce.-r-
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