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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COiiTMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Sa fety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab i Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soflit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />Meter Release
<br />Rough I tEt .(,,(,t/{r1.)
<br />Service l\/eter
<br />FINAL filiull a\(al
<br />Notes, Remarks, Etc.
<br />OWNER !UILDER DELCARATroN
<br />I hrrcby aftrn unl.r p.nrlry or Frlury rhd I m crmfl fbf, rh. Conrrros Li;cns taw lor lhc follo*in8 rcisn (Scc 1):l l 5
<br />Busincss ud Proicsion cGlcl: Any Cily or Counr, which rcqutcs n pcnnn n' con(tucr. alrcr. impn,v., dcm.lish or rpan r.y
<br />{ocr!rc. Irrhrro n\ nsuonce. sko rcqutc!rhe arplicatrr lbr surh Ernri' io lilc, iiEftd sdcmnr rh,t rxor shc h liccost I)uNrnt
<br />r, lh. I'visions .f
<br />'h.
<br />C.nhclor's Liccn*d Lrw (Chapllr 9, commcrcin8 wirh Sccrion ?(X}) ol Divhion .l ofrh. Busincs an,l,
<br />PmlsionsCodc)orrhnth€orshchcicmprrh.rcrrcmmdrhcnlsntrrheallc-qcdcicnprion AnyviolnlionorsctionT0:ll5hy.tr!
<br />aptlicanr for a rEmilrubjNrs rhc amlicaor r{, ! cilil pcnolr, .a lor mrc rhan filc hundmd dollri (S50o)
<br />-1.
<br />as .wrcrofthc lrcrcny. (tr nryc,rtlores with enScs as lhct bh co pcnsrliotr. will do rhc work ond rhc \rdur i{ ior
<br />i'n.rtdd oroficrcJ,nr eh (56 7(X.a, Brsim$ and holtsions Cntc:'] hc (:ontactr'r I-i..n.c ljw doc\ nor rllrly to 0n o$rcroi
<br />lllc pmnfiy wh hxrds or inry.s rhcmn. and *h. dfts ru.h mlk himsclfor hclslior rhouarr hn o! hc, orncdployccs.
<br />ln,!id.d rhtri such irpmvcmnk m nor inrendcd or onbrcd lor sslc lt noklci rhc h{ildirg or inprcloBm is n,ld wilhi'r ..c Jr.tr
<br />ol otr{'ldion. tnc owncr tsuitlc! will iE!€ lhc burden of rnovin8 thlt ,E o! \hc dil dn hil(] or iq,rovt rh. pmFny rm rh- l,uqbs ol
<br />l. a\owtr.' olrhc pmpcnt. r'ndclu\nrltconrrJcri',C $irh lnrtr\cd coitr()^ n) $nnru.rrhc lnr'](d (SLr 70.1-1- ll!{trcs
<br />rlld PFlt\\onCodc:lhcContr.lor'sl-iccn\cL(qnocsnol.pllyro0nowncrolprcpcny*h{,buildsori pmvu\rhcr.o.
<br />xnd who coirEchlnr {rhfftir.rssirh (],nra.ktri, liccn\cd pu(urtrr b thc Cuntdc(tr s Li.cnsc hsl
<br />I m.rc.f( undd S*rt
<br />!.0ts[Er.$]l;oufrrsartoN
<br />DI'CIABAIIA!
<br />I lrrchy.lli' utrdcrpctrilry.,pcr.)uryo .olrhclnlhwirgtlc.h'rriotrs
<br />Ihiv.d willmainrninsCcnind..fcon\cdbSclalnrurcl work.i\' .omFnsnrion. ds pmvAcd for by Sdn,n :17(X) ol lhc
<br />I-ahor Cddc. ro! lhc oc,fomuncc oflhc work lor *hich rhe f.rmi n isurd
<br />rhc *ork lir whi.h rhis rcnnir is i\srd. Myw.rkcn rfl NurrN.rricr rM rii icy trunrh.r rc
<br />,4
<br />-lccniiyrh{lirthcpcrl'onnrnccnflheworkrd*hichrhnfcnn
<br />n nn'ed.I slElltror cnpkr,ary pc oninrny'n n'cr
<br />s asr. tr.om subjc.r ro rh. tror*cn ..np.n\,iion laes orcrlinmid. mn aBN rhd ill sh.uld h.EonE suhF.r ro itE
<br />workas.onrrcnsatnrntmvisionsofSc.rionlTtt)olrhct-dtnrCix]c.lshrll.fonhwirhcotrrlywirhrhorprorkn,ns
<br />IyARNIN0: FiilDrc lo *.trrc {orkcr\ conrp.nurion.orcrtrsc i\ unl *tu|. ad{l \hrll\uhi..r rrr. rflo)s I' diniftrlrMlric\ and
<br />.n'l fi r\ trp l,) ! r l,un,l.,! rh.r\rtr,1 (lolrr\ lSll[).lxxJ) ir] )tl(Lili(,r n) I .omp.n\arn . da,nrlcs rs Drovidcd nr thc
<br />Sn.-lion 1076ollhc L,torGnc. i,rcre{,nd dloflrcy\ rccsL
<br />I hcrchy rllirmundcr Ntrrkyofpcrjuryrhll I m lien\Lrl undcr trovnh olChalrcr r lcoarrErcing wirh Sc.rion 7{)0O) ofDi\isoi l
<br />of th. Busin \\ rtul Pmf.\\i(,.\ Co ., Md rt licc.{ is h fxlllnreatrdclli.l
<br />-/a t0/)z
<br />,+
<br />I hccby rllir n u dcr!.rrllyol Nrjurylh l[crchrconndcr lcndinsr8cncy lor lh. rcrlinu,rc ofrtu sork f$ qhich rh( Ilirni n
<br />An,ollrS.. rlD7. (' \ ( )
<br />A.TfLICANI.DEILAAAIION
<br />! ltdr, fim utulcr Fnalr y o, !.Drry otu of rhc follo*ing dNln.nr io.!
<br />Dcmolilbn Pcrmih Asbcsro\ Nolil-rc3li,,n Ftdcr0l Rcs!larions (Tillc 4r, trd6,
<br />R.qtricd llrcr,'l Norii.rri,,r
<br />1..'r'lirh.r rhclcdchl'cEtrld()fs 'c!r'di'r8 ash.no\ rc 'vnldr or,tdn_rhl.lr thn fr)l$l
<br />oftlir!nccs !nd Srarc hss rcllriu ro huil{linE tu{i7.rcprr!cnrrrivcs.trhi\Ciryr County r' oDr$ trBr rlr
<br />nhovc Enti(trkd pror.ny for in
<br /> ppll(r orA8enlSignoluE:
<br />Pemxc0nc(pnnrl
<br />g/zz/zarf
<br />18il,I
<br />If,ndfl r Ndm
<br />-
<br />L.nd.r'r AJdr$
<br />I
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