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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinos (Hard & Solfit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Ivleter Release
<br />Rough
<br />Service Meter
<br />FINAL
<br />Notes, Remarks, Etc
<br />OWNER'UILI,,ER DET,CARATION
<br />I hcrchy aifum unihr pcnllly,)r r.rju.y rhxr t .m cx.m i,on r*( Conrtacl,F l,f,.n\c tlw Inr rhe rdbwmS rea$n (5&?0115
<br />Busiocss anJ Pnnastun Cod.): Any ciry.r C.unly which r.qufts ! Pcrmir b .on(ruul. .lrq. imrrov.. &mlnh ur qat,anv
<br />dructrr.. t krk) irs tru c.. rko rcqunes rhc lppltranr lor such J'.mir nr lilc, \eNd daictr nr rharh.or rtc tr liu'ncd tu^ulnl
<br />k, rhc on,v,lonr ol rh. C.orrk(tr s Lic.nscd L.u (Ch,Prc' 9. Commcnui!3 wirh Sc.rion 7000 ol Drvino. I oi rh' Irtrnm( rd
<br />Polc(n.ns Codc) or rhdr h. or sh. ir c\cnpr rh.t.tio sdlhe hsq\ li,r rh. atlc3cd qcq{n,n AnvvolaronotS'crDn70_ll5hvany
<br />lpph.rnr tur a p.mll suhjcckrh. {nl,.dnr ki.civrll)cnrlryol norm,rc lhan I'v. huh,lredJolll6(s500).
<br />-1,
<br />as owrcr oi llE p$a.dy, or my cmoloyc.s w h wd8.\ $ lhcir a'L o'nFnsalon. will Jo rh. wol* axi r {tutK x nor
<br />'nr.ftlnl or onard lnr ek ( Scu 7(144, BusN$ and Pnnc$n,ns Cdlc: I hc Cin rrkr'r Lt.rse Law ,locs ndr atplv lo $ o*n'r of
<br />rhdtlnltny th) trius or nV('Es lheB4 ud who dttc su.h u)* himtll or h.rcli or rhn,ugh his I he, o'n 'hpbvc'r.p",vA"lrlur.uttrimpowmntd,tr{cddototlbrdtbriaLltlnrw.lcr.rhcfaillin8.rltrllmvcmds$Ll*ithinun(}t{
<br />i .omnk{i,n. rh. Owmr BurLlq *iI hiv. tlE h{rJcn oi PNving rhi hc or $e 'l!l rn bxi! or rvnrvc rhc ln)Fnv nn rll ltrlr'* of
<br />-1.
<br />rsown.rofrh.F)I'e(y, rm.rcbsntlycodtacrh3 wirh henscd Lonrr rori,codruct llE IxU.d (Scc.
<br />'(l14.
<br />Bosrcs
<br />ind Pniisbtr Cole: Thc Conrr..ktr s l,ic.n* llw dks hor apply b an ownd ofp!'Fny who hurlJs or impn)v'! thcrcon.
<br />,nd who ontEds ior \u.h ptu ..( w h r 6orh-.t4r l ltr.hed pucuanr t, rh. Ornlrr.rrr's Li..n{ tjw)
<br />_l ahcrcnrpt unlcr Sccho
<br />Ir& t,Alt\1(r\
<br />I hlrchyallnnrun(l.r p.nrhyol r^-rjury.ic ol t
<br />t havc anl wrll mlmrlh r Cenifiurc of Cons ro Sclllnsm fdr workcn' @hp.nsrt$n 0s pnrliJcd lot bvSarirn.1700 oflh'
<br />bbor C-oJe, nx rh. p.rlorntrc. of lhc srk ror whf,h rhc lcmir s issucd
<br />I luv.,tu]wiu Ehlain work K omrcns.lon insuanc. ar rcquircn hvSe.x.n J?00 olrhc t,rtr Cdlc. ttrrh' rrlirlmLr 01
<br />rhe wo tur wh.h lhG p.6ir ir irscJ. My workeG .oml!.ndio. msuranu. ffi.r lxl F,liv nunb.r Nl
<br />-l.cnrly
<br />rhll rn rh. FrlDrmlnc.olrhc *ork Lr which rhs plrnnr r trnEd.l shrllnor.nlt'l.vrnv n ron in,nvnranNr
<br />$ r\ n' h((onr ruhrLt lo rh. w(rkci\ (.nfcnsanon kw\ ol Crhlomi!. rnJ rsN rhat d I rh'ull h.conf, \rh].(r brli
<br />*orkc^ co Pcftal.n F,vr ions ol Sccron :l'r(x) or I h. If,hn CDtic. I { 1. tudhw[h cdnplv sirh rh'}{ lrrvsions
<br />IVARNINC !_arltrrc t' {cuE w(trkcs cdnrl.n\il.n rorcragc i\ unlxqlul rni !tull \ubl.d cmpkrycr h c'rmmal I''Mh'r lnd
<br />cNll lincr np b on hu,ilicd rhouvn'l dollds (Sl !)n r,) rhc .o{ ol cDmD.nsd(,n. drmPcs is pr.v lcd Inr th.
<br />ScdDn 10?6olrhc Lrhtr a-otlc, irrrclcn dd
<br />I hcrchy illirm und( p.nrltyot ncrjury tlur I d li€nkl un'l.r Fuvt\r)n dl C1laPrcr 9 (.unnf,ncin3 wirh S"t$' ?(tX)) nrr''vKi('n
<br />ol rhc A!!n.( imt P!n.s$n\Codc.6 my l'.ctr\c I in Iilll i'nc rn(l.l]i\r
<br />Conlmclor-
<br />CONSTRUC-TION LFNDTNG AGENCY
<br />I hcrty afirn und.r Fnrlry ol pcrj!ry rh rh.rc is . d,nsrtuiion hndine q.fty fdr ihc Pcnir@tu oI rh. *o lor which lhis pcmit i5
<br />ssuc! (S.c.3097, Civ. c.)
<br />APPL!CANT DECLARATION
<br />I rEEhy {liim ondcr p.n.lty oI pcrjlry .n. ur lhc folbwiry d.cl,raiDns:
<br />r).tulin,n P.rmilsAsknds Noriii.arion Fcdc,al R.guhtDn\ (Tillc 40. Pln6)
<br />_Rcquir.! Lcrls ol N,rrulion
<br />-,Lqr
<br />lnJ Cor y b cnrc! uIx,nrh(
<br />COMMENTS
<br />Site-Work
<br />lr.k:_
<br />lrarc:_
<br />I rc8uhrtr,n\ rgddrn8 Nh((l.rrcfr'val rto not {IiEahh t, rhis Pror.r.
<br />,*,",tfa^
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