|
APPROVALS DATE I 3BtG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rough)
<br />lvleter Release
<br />Rough
<br />FINAL
<br />Notes, Remarks, Etc
<br />-)
<br />ELECTRICAL.INSPECTOR RECORD
<br />OWNER BUILDER DELCARAI ON
<br />I hcrcby afi,rm undcr p.nauy of Frjury rhar I an .rcmp! rm,n rhc Conrr0cron Ltcnsc Llw for rhc followins rca$n (s( 701 I 5
<br />Busincss alrd Profesion Codc): Any Cily or County *hich rcquncs 0llrcrmil ro .oNrud- aIcr, inDtovc, d.@lish or mPrn any
<br />(rucfurc- pri,r Io irs hsurmc. rko rcqutc\ rhc appltanr lor such Frmir ro filc a sisn.d natmhr rtur h. or sh. is li.cns.n pursonr
<br />to thc pnrvhnrns oi lh. Conr,clors Liccn*d lj* (Chap'.r 9. commcmnrS wilh Scclion ?fiD o{ Divhion :l ofrbc Busincs and
<br />ProfcsionsCodc)or$alhcorshciscxemptlhcEfro.ndrhebnsntbtrhc0llcscdcremprion.AtryvnlrinnofsNrirnT0.ll5by.ny
<br />amlica.l Iorarmil subjcclsthc aprlicril lo ociviltEnallyofnol flmrclhan fivc hundrcd dollsh {$5(x))
<br />l.a\owncr.rrh.pmptny,.rmycmpk,tccs*iih$sgdazirhcn$h.{mlcnsdio..witldolhcwo,dltE(n urcisnol
<br />inlcndsl or ofi.r.d for slc (Sc.7(}!r- Busitrcs otrd Prolcsiotrs Codc:1hc Conrrictoir l,tenrc lis dEs nor arpl, b anowneror
<br />rhc In)pcny *ln hilds or iqrors rhcNn. ard rho des seh *ort himsclror h.sclfor rhmugh hh or h.r o*ncmplorccs.
<br />pr.vidcd rhar sxch inpn,€mnc m nor intcftt d or ollcR\] tur slc. Il h$!wr. rfu hribinS or inr,mEmnr is $ld wirhin on! ]cu.f..mtlji,n, rhc Owncr BrildE will hrrc rh. hxid.n of poving rhd hc or thc di'l tu, hrikt or in 6w rhc Jn,pcny lor th. tdlns of
<br />l.,\.\n.r.frh! ptulrny.. crclusivcly onrd irA *irh li.cnscd coffrcbr to conslDcl ric lmjcd lscc 70.14, Bd\i"cs
<br />Md lt',lsionCodc:lhcConrllcroisl-iccn\cl,awdocsnorlnrlyronno*ncroiproDcn!wh,)buildsornnpro!.srh.r.on.
<br />,n'l who conthrk fr such !$lc.h wirh r Cunaa.bilt li.cn\dl lur'x.nr ro tlf, Cofti.ttr s Ltccn{ uw)
<br />I arrxrnrt, urldrr Sr.li(nl
<br />Dele: oene.:
<br />wonxl *.s' colrtrrv.ilrrrol r
<br />DICLTEAIIQN
<br />I hcrcl'yafi ir.undcr pcnatryotnci!ryoncoilhctoll{,sin8 d(hrolion\:
<br />I hdvc uxlwill mai.rrin rCcnificdcofConscnr b Srlt-lnsur f(tr wortcF ennpcnsdion.as nmvidcd aor hyS.rrio lT(D.trht
<br />Ljhn C]Idc. tr lhe pe.f{rm'R of rhc wo* for which tfic ranrir i\ i\\ucd
<br />ffi-..,..,,,*.,-,,-,.rcr\'!iin'Nn\.(r l'ihc tr,trl'n{ trh(l' rl'tr Jrnn r\ rsqld Mr rnrlqr
<br />/t. D /;aR
<br />sunrcc. is rcquncd bySdinr:1700 olrhc lrlt, C{xlc, f.r rhc rdlornurcc ol
<br />comrcnsoljon insur cc c.tricr ,.d policy nunbu dc:
<br />we o
<br />-lccnilyrhd
<br />irrhcp.rf.rn nccoflhc *ork rir whth lhn tE nir i\t\u.d.I\hrllnorotrDk,yaiypc'$nn'anym..ncr
<br />{) a\ r, h.or {hFd ro rhl w.rkcn ..nf.trrrnni L'ws otCrliLriir. dd agtoc rhnl il I should hc.o,E suh,cd ro thc
<br />workc^'.onycn\arn,nttuvnioi\oaSd.riotr17fi)ofrh.ljlsrCrntc.lshall.fonhwilhcondywirhrhos!tr,vhions
<br />wARNIN(;: Ijiilurc lo ecurc workcn corpctr\rrn,n ..vcnsc i\ unh$rul. rtd \hrll \ubj.cr r't cnrl)fycr t() diDirrLi lEnollics utl
<br />civil lincs up ro onc hunlrcd rhousrn dollnF (Sl(r.fiXD- i! rkuni.n k, ih. con of.rniFnsmnnr. d{nhgcs {s an,viicd tor rhc
<br />wlil^b ,0,,**,Y-Ll!-tilu;LtQtil3]1rlllt' DECIAMIXA
<br />I hcrby lrtrmundcr Fmllrofperjuryltal I n lienst undcr pxrlisionotChrfl$ 9 (coEmncine uith Scrbn ?(]&) ofDivhion 3
<br />of rhc Buciftss lnd Pmlcssion! Codc, ond nry lic..s is i. tull lors md cltlrr.
<br />"iI"-"^ryTf;h -L*cn*Num*
<br />- qlY)-to
<br />*"-"*\ a::1- )z--<.t:-
<br />CONIIBIIqITNIBPIUIiIGENII
<br />I hcrby dirn undcr lxnrh, ot pcrjury lnar thcrc is a onnru.lbn lcnditrs lsency for lhc If,rfortute dt rhc work lor qhicn ihis Fnnn ic
<br />ksucd (S.. :1097. Civ. C.)
<br />AIII.ICANLDEEIAf,AI,ION
<br />I trah, dirm uDdcr p.mllyolpcdury onc oithc following d.cloririons:
<br />D.'nolirn,. Pcrfrirs Asb.stos Noriarcariotr rcdctul Rceulnrions (Tirlc40. Pln6)
<br />-Requtcd
<br />ldrcr ol NoiifElridn
<br />_l .cdiry rhdi rh. redcral Egulaliom mg&ding {sbcsos Rmvd m nor applic,ble lo lhh pDje.1.
<br />M.niiy rhrr I hav. r!!d rhis alplicarion and srorc rhar lnc atDrc informarion n coftcr.I agift ro 6mplt wirh.llCiry!trd Counly
<br />o,tinrnccs {nd Sr.rc L.ws Elarins ro liu ildi
<br />0hovc mnriomd lmp.ny for insl,.Tlion pu
<br />Appllclnr or As.Dl slsBruE K
<br />tr9.otr{n'.ri,nr. an(l h.rchr- xtrrl',trn. tuprt\rnrrri!r\ or
<br />r'"""ir- -,-",pri,r,, Y.-
<br />::":;rw;r
<br />Communications Cable
<br />Sub-Panels
<br />Service lvleter
<br />Irn'lc''\ J'l,c$
<br />I r
|