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ELECTRICAL-INSPECTOR RECOHD
<br />DATE ID/SIG.COMMENTS
<br />l. 0s osmr ol r hc pmtf,ny. or my cmplo'€cs with w0gcs is r h.ir $lc oryEnel io!. will do lhe wort ad lhE {tuim n nn
<br />jnrcftH or ofrcrcd for sb (Sa.7l)14. Busincss o Prolcssions Codc: lhc Conrracro\ l-tcn+ tl* dft1 m' ap/y lo Nn owncr or
<br />rhc F)Irny wlbt ilds or i'qmrtr rh.6n. ud *h) dcs skh k)r* hinNrlI.r h.r$tf or thmu8h his or hcr own cmplorcc\.
<br />providcil rh,r \uch i,nprcrc.EnG m mr in!.nd.d or oncEn nn sb lt hrM6, rhc htrililing or i'rgmEnrnt is $ld wnhin om yw
<br />nf comtlcrion, rhc OwRr Buildcr vill harc llE ttrdcn or lmvin8 rhnr tE or shc dn ml l[ild o, inlpot rhc tDFiy ror Llrt)uqrt or
<br />_1. trro$Nr olrh. Iropcny. rm erlusilcirconrra.ring wirh liccn\.d conrrcd\ k,.onntud rl[ p$jc.r (Ss. 7(114. Bu\inu$
<br />.trd t\llisin) Codc: Thc Conrr..rols Liccnsc LlN docs tror rt',ry k) in o*rcr olnnpcny who tJUild\ or iniprov.s rhocun.
<br />nid sho dn dc( nn srh lmlcc* wirh r Conarctnl \ ) lic.ns.d pu*uii o rh. Co r{.ktr s l-iccNe ljw )
<br />I an.xcnrpr undf sNii.n .a &PC f.rrhisrcdvnr
<br />l)erc: ()PNr:
<br />trotrtrEB[.(:outlNtarr!]N!&cI/&uIaB
<br />I hcrchy rilnD unncr ncmlryolpcrjuryonc oflh. nn[,sins d([rrrion\.
<br />I hrlc rnd*ill nDnnrin rCcnifi.arcofConsnr b S.lalnsrr r(n sort.d.oNlrns on.as[ovid.dlbrbySccrion]7(I)olrhc
<br />l-an{rC{nlr- li'rrhc pcrlormancc o f rhc wo* ftn which rhc pcnnir i\ i$ucd
<br />I llvcrntlwill
<br />'nainrain
<br />work rJ c.mlr srttun r\rric.. r\ rcqur.d btScdn r lTU,olrhc Libor C.dc.lor llc pcrfornEnc ol
<br />Ihc worl fi, which rhh pcmir ii issncd. Mysorkc^ romp(trsrriflr iNurm.c.Micr rdtFlicy numhcrffc:
<br />_lccnily rhrr in rhc pcrl.nMmc orrh. *ork for qhich rhi! pcmir i{ n\ucd.I rhtrlltro' dlpkry y txilon in a.y flunncr
<br />$ist,hc.o'mquhj..rrorhcs.rrcn..mp.nsa'ionl,ws.rC,lirdtrii..nd Srcerh.t illshould tEom s!hj..t
<br />'othe{ork.N 6'nn rsrn,n pmvisions ofSccrion lTmofih.l]hn Gntc. l \hdll, lonhwirh lonl,ly wilhrh.s [ovhions
<br />wARNING: uailurc lo surc sorteF conrpcns0rion mvcrlsc i\ unliwlul. rtrd \hrll \uhJc.r ,n cnyloy.r ro mmin.l lEn.ltis and
<br />civil &rs up k, onc hund.cd thousand dollnn lSl0O-(]Oo). i. lddiion r,, rhc cos .f.on\,.nsri.n. danDscs 0s trovidcd foi rhc
<br />S..ri,,n lr)7. olrlr l-'tb' CodI inrcm{ Jnd . Iorm\'\ lm\ I
<br />",,,, Q/1-gJtg ^ep,,*.,,v- g47 ^Gi\J)gi^
<br />!
<br />I I r tc[NsED coN]'!lA( TOR
<br />DECIINAIION
<br />I hcrcby 0flnm undcr ncn.llyofpcrjurylhal I an liencd undcr lDlision ofChdflg I (.oDnf,ncin8 trith Sccrion 7000) ofDivhion:l
<br />of rtu BusnE$and PmL$i.ns Codc. ond nrr lc.nsc h in tullf{tr.c tr cliirr
<br />.,,",.".,.. Y-- Dtt\--
<br />g)!flau(:Il(rNlENDINCIC[llI
<br />I hcrh, amrn ondcr rE.al!, 6l!.rj!ry tlDr rh.rc n a 6n{tu rbn Lndog !8cm, ror lh. Frfomna of lhc rcrk for -,'tn lhi rEmn h
<br />t\ucd(sc 3097, civ. c )
<br />A.TTIII:ANLIIILI"B/IIIOIi
<br />lhrhlnlinrnMcrF-nrllyol ncrtur}oncol rlEltll eirsd.(hrrri,nN
<br />I)cnn,liri(r lrcnrirs A\hrios Nori,i.rriotr Ftdcr.l R.gulnro'\ I l irlc,l0. Pin6)
<br />R.qr rrd lxrr.' ol Norirnln.n
<br />l.c'tlyrlrrrhc lcd.rrIrcAulrrion\ rcBdlirA r\h{.src tr)vrl rc r rt,fli.rhh n) rhis tnlccr
<br />oRlinxNc\rtrtl Srrrc lrw\.eLiiD! t, hdiltli',9 con{flcinnr. rn,l hori?c dprc\cd,rivcs .f lhh City.nd Countylo.nlc! uron lhe
<br />ihovc nrfuoNd f()Nny l.r iNncclrn
<br />ADptir lnrAaorsi,:nrrnr€x-
<br />EblLEb---z.
<br />af$rr
<br />Site-Work
<br />Under ground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Faclory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Solfit Rouqh
<br />Ceilings (T-Bar Rough)
<br />It/leter Release
<br />Rough tqltllL Tt /7$11€,4 'jr)
<br />Service lvleter /_.----\
<br />FINAL tlAA ti 7e/
<br />Notes, Remarks, Etc.U t \--..'
<br />APPBOVALS OWNER AUILDER I'EI,CARATION
<br />I hcrcty nfino undc, pci,lry of lcrjury rhd I on crcn'pr fmn rhc Conr(lfr' Lic.n* ljw f.r lh. followinS rcasn lscc.7oll.5
<br />BurnDss nnd Proicsion C.d.): Any Ciry or Counry which rcquncs , trnnn ro con{ru.l. altcr. improlc, dcmlhh or Epan lay
<br />sdcrurc, rior Io irs hsuamc. ako rcquircs rh. iprlian' lor sx.h Fmn lo fih. si8ncd slllcmnl rhar h€orsh. n I...rcd Nrulnr
<br />b rht pmvistun\ oa rhc Coirracrofs Licen*d ljw lchtrprcr 9, Condeking wirh Sc.tion 7mO of Division I olthc Businc$ rnd
<br />Profcsrions codc) or 'h, hc or she is excmp' rhcEtom and rh. b,ris lor rh. rllc8cd cxcnrttion Any viollrionorsccrion 70:rl5 bra.y
<br />appli..nltuapcrmilsuhjcclsrhcapplicanrroacivilDcnalryofnornDrcrh.nfivchxndredd.llsr($50O)
<br />tg
<br />L.ndcic AddEj
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