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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.'GIMMENTS OWNER SUILDET DEITCARATION
<br />I h6.B .,Id un<b Fulr ol FJ!ry thi I m da4r noB llE Codr.d6 L'cdE r^ 6r tlE lolbwi'A .6tn(s<70!l,
<br />B6i.B .fij Prolision Co&): Any cny or counry whi:h r.quB i Fmil ro cordd.( .IE, inF.r.. ddFlitn or lFat uy
<br />!r^ds.. Fir lo tr iquee .k t quiE ll! +pli.el tor such Fnt lo 6L . rbn d {dcrEl lh, lE o, dE it lic6.d FBrr
<br />ro rh. Flvirb6 ot iE Conr,xld t Li.d!.n L.r (Cll.Fa 9. (offire wni sariln 70@ of Divnbn 1 of rlE BEnE !d
<br />Pmfsionr Co&) c thlt tE or rh. it ddp{ lhd.troh ud lh. bd6 tor th..lkS.d .r@ploi. A.y vioLlio. ofs.dion toll l 5 by uy
<br />.p?licer tor r Fhir {Ud$ rlE eplic. ro . civ il p.uliy of D! mrc tno fir. hui&.d &rll&. (1500)
<br />-1.
<br />s osB ofrlE F$pdt, or m, mpbrc snh sig6 c th.i hk cod96!6rion. wi[ d. tlE *dt !n tlE nntl@ i! mr
<br />i.Eial or ord.d [r sl. (!ia.7044, lt6itB &d ProldioB Co{. 'rt ( onr'..idrr Lt!* ltf, &q ml sply lo u 0\16 ol
<br />ihc FFr) rho h, dJd irglc iE@G ad *ln dc idr ggt hiEllor lE*lror rl@u3n ht d lE osn alolottq
<br />provid.d llur luch inFolqlr6 e d ndrld or offod n r rj.. l( ln6d, ilE &ildlB r Elnqci ! $td *rhh* )s
<br />oaconpki.tr rh. Os6 B{ilda w h.w tlE h,&r of F.vi,{ ihd h.or$. di! mt bui( o. iflFok 6. FoFry ftr th. FrFeof
<br />-1,
<br />Bov6orrh. Fopdy. m .r.lu i!.ly .o nlr.cl ins wilh lics!6l.onk!(oB lo $nrrud !h. rojcl (sd 70'14,llam6
<br />.,n Pntsi, Cod.r Tt cont&roa! Lice tr* do6 ml plyio xouF of F.Frysho boil&or inFov6 thaFn
<br />ed rho 6ffi!f sh Foj.rl' * nh r Com*lo(r) I.a!.d Fllsd h lh. ( odr.dd ! lilE l,w)
<br />I m.rmd uftla Sdhn . B
<br />LalZr.lj:cl9
<br />o&clJSarxl!
<br />I hErcby .mm uftlc. rEEly ol pdjur oe of lh. folb*'in3 d.dDhB
<br />-l
<br />h&. ,!d *ill uieir . cai6.d. of co6d lo sdf-l!!@ fd wtar otrE nt rE \ E Fovit d lor b, scltrr l70o ohlE
<br />l$c Co<L. tu tL Ffotjlr.N of lh. $dr 6. wnth llE Fnn a i$.d.
<br />-I h,r..id *illdi.rrin ell<t odpddbn illsl]fu.. c a{!i.d b, sKio. !r(r0 ollL LrtFr ('o&. tu tlE Ffolffi. of
<br />th. qvl l whih rhi' Fnil ir Ed Myrdta @.4dr6. iElm. i, rnlnl.,nunbq E
<br />PolicyNumb6:-EiPiB:
<br />-
<br />-t
<br />cqrib lhd
<br />'n
<br />rh. Ffo,ile. olrlE wort tc $hth rhn Fni B is!.d I sh.ll m' @pt, uy F$. ir.., Iffi
<br />ii s b hdom subid lo lh. ruid @mpclIFn hE .l Ctlifomi( tnd .src lhn ,1, lrbuld heom sbi6' lo llE
<br />srltd'c.hD.Ntiotrpmvi3o6ofS<rio.lT0oofth.LrtbrCodelshsll,tonhwilh{mplywilhltorFNvnioB
<br />WARNIN(;: FailuE ro s@ "0116 .onpqsllion cov6.s. i! u.lautul, !d shdl subFl u @doti ro dinird FtrllB ud
<br />.r 6,6 up ro on. hmdr.d th.us'd &Ud (tloo.mo). i. .drl[id. ro !h. cor of comlEturio.. rtln 86 6 provt.d lor lh.
<br />S61En 1076 ofrh. l-hr Cqi4 idad !d rndrEy ! fc
<br />,". pfLg/s'. irK
<br />TECIAIAIIO!
<br />I hdr$y srEn unds psEh, of pcjury rhd I d lico!.d unda FlvLion ofchlpld 9 (com6.ing wilh S.dbn 7000) of Divirion :r
<br />of th. Bun6 &,1PmadbN Cod., !d 6y lr6e u in tuU for. tn.lfd
<br />colsugcu0l{.LlNDrNli.Acllcl
<br />t hscby sfltn uorls Fnrlry of Fjrr rhsl lhs.6 a andruclion lotdiie rsn, fo. th.F orucc of rh. sort ror f,tich lhi! Fril B
<br />is!.d (36 1097. ( iY C).
<br />aflll(alr.DlgJ8alr0!
<br />I lEtb rrfm uald F[lt] ol Fjury oE of lt. follo$i.s d(lgithtu:
<br />D.ftolirDn PdTilJ-tub6rd Notia.dion F.dailR.Bul iof,r (TnL 40. Por6)
<br />-R.qun.d Ldls of r*i,ft ,in
<br />I .d rat rhar rh. f.dddl r.sulrrcN tsddins abdN rdmv.l ar. nol lrrlicabl. lo lha D^rl.n
<br />I.diftrhd Ih^.radrhir !p?lr.lh. an d.rhn lh..hdr. 'n(r,di. it corrEi Itscro@nlpl,$nh ( ny,nd ('.unry
<br />ordi.cdMdSrd.tj$Ebrinsrolr'ldi.g.odtucrion,mdhd.by.uthorn.EF6drdivdolrhtCilyudCounrrro0'6uponlh.
<br />ah\. n6rird FoF r lor ftpdnn nurpoc
<br />appr r orA86, shn.,u* t 1r,L'JL5l"b8
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilinqs (T-Bar Rouqh)
<br />Meler Release
<br />Rouqh
<br />Service Meter
<br />FINAL ,-4r-l ?Zc z7
<br />Notes, Remarks, Etc
<br />Pole Bases
<br />Under Slab / Floor
<br />Air Conditioners
<br />l-.idd r AdlB:
<br />T
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