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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNTIT BU!LDEN DELCARATION
<br />I lErchy .rtrm xftt r FElr y or Frjury rhu I m .rc,r{rr rmm llE Co Eclor' Ltcn< lj* ror rh. lolLein8 rc.rr ( Sc 70l l 5
<br />Bur,6\ .d Prof.ssnn Cd.) Any Cil, nr CNdy *hi.h Equircs ! Fni lo (,.{er, rlrd. nrfntrc. &dnnh .r qln ey
<br /><dE, rnr ro irr i\uN, rl$ rqln. lr +tli.mr for tuh Fmii ro liL t tigmi (.l.lmr thn lE or t r ir lirnEd plBun
<br />to ll. Fovirh6 or r Conrftttr r l.irn<d bp rcbFd 9. Collwrins snh Sdli.. 7(xn nr Darnr'. .t .r rlr Buriml! &d
<br />Prcf.ilioN Cod.l o. lh.l lE d {r ir.i.rltr rh.E,n,n.id rh t{(ir for itE nkr.d .ftnt{ir. Any lnh bt of SdtrM '71).1I Jbyuy
<br />Dppltr.r for, F,nn ohFk rtr rFIlkm! k'..ivilJEMhyorftn lmrhdiyc hudEd dolhrr I l5{n I
<br />-1.
<br />.1 o*N.lrlr FoF.ly.., ny oq'l!B. *ilh $rsc!.\ rh.ir erlc oqmrr.. *ill*' rlE *,rt l E{nrlE a on
<br />inrorLd tr ofl.rcn for qL ( Sc 70,1,{, 8ulaEs rnd Pn,f.traoni Co& Thc Coddd . Litn* ljr ttE fln snlv ir' I o*F ol
<br />rhc tmlrny llb t{iBr n nF'B llEFn rn *t, d- uh urt hinElf or icr{ll or rhmnlh hn ., h.r ovn .qrhtt6,
<br />tf,f,riLd rh kh iqnmdr e n irarldl d rfid.d fd sb. r. bE?. tlE txilin3 ( urF,Emrr t ]U *lhn oE )dr
<br />of cmD|riotr ilE l)*E Auius *illhlE rlr tnnlcn of FrinA rhd lr or trF dn n hiu or iqnrE rlE F{Ely n,llE lrqrr. oa
<br />l.a\o{ftrnfrhc|x)[.ny. r.r.lh'r.ly.Dntn.rnrr *hh h.cn\.d cotrtr(trtrl r, !1[{ruLr rtr nrl}rr (SN 7(r1J. lnFn\\
<br />rnd hrtssiotr Codc lhc(-,,nlru.ntr \ l,'c(n\c l.!r (nr\ nolonplyb rnorn.rolIln,l. y*hu hx'ldror nntt,rc! rhcrcotr.
<br />trd qho cnnrnrrsttr\urhfn,)cr(wirhi(i,nr!.hns)l'c.r\r ruBurtrrtorhc Gn rocl(tr'\ l.iccni( l.!w)
<br />I xnr.rcn't, trn,!.r S..r ,tr'
<br />]IIIBKE85-IAIIIENTAIIAN
<br />DIig.ABAUg!
<br />I h.rcby rmrm undcr Felry !l lxrrlry trft uf rh. tulbu inl d(Lhr i rs
<br />_l h& ad r ill minirin i C.nifr-.k or C.nrnr ro S.lt l.M fd wdrd. o.p.trsrhn. r Frvii.d l(,r b, Sftrir l7m ot rh.
<br />t t'or C.d.. n llEF f(,Ere otrlE nd nr*ii.hrlt Fml i kntn
<br />_l h.E .d *ill minr.in *ortcF o,i!'.nernn iNrft.. ( EqliEd by sftrir.]TmolrlE lrhtr (i'd.. tu ili Fr(ffi or
<br />rh( {ort l(tr f,h.h rha F-rnnr 's
<br />rahl N\xln Nrrrirndin inslrN ffs.nl Jll.y numlE c
<br />(tril lrtrc\ ut, ro oft hutulr.,l rhnN!kl ,lolhr\ {11(r,lx)(rl'lirion k) rh. ron .l.o ,fr \rti, . ,lntrrlrc\ r\ t,ori(1.(l li,r rtr
<br />::;')";'")*/te
<br />r9.rstal](Ilalir.l,tiDlNi-dlillrr
<br />Ilfrcbr_ rlfnru'xkJ II.nJlryor lrrjrr! rhn r,r. 'tr on{t.rxrn L d'n! r!c'{y tr thr Bnor ! f( "lrlr}dk l,n tnrhrht Frntr n
<br />t\ucdrsa 30c7. civ. c )
<br />l.Rlcas Nnm
<br />AIIIIIAILIIDILABAIIQN
<br />I tmt y Jllm undrr pcnrhy oI p.rJU,y ok rfrh. n)lk,s
<br />'nS
<br />d.rlnrri{ntr
<br />l)cft)llir Pcirn[\ A$.{ 1Noriti.Jr*'n 1..i.(l Rc3ulri'n\ rlirlc.l). Pd6)
<br />R.!ut.rr lJtrq of Mririrri,n
<br />_l.dritrhar rlE ltdcrlrcsrl,r$h Etdins r\h.{os r.'n,r'lar ir amlaahL () rhn F,Fr
<br />I (dity rhrr I hnt Edthn{Dkttrrn.d {ri.rhd rh. ahow inaomtbn nc.lN I.Acroo,riil!rirhilCiryrnd('ou y
<br />ordh.flrr.nl Srr,. t'f,i ELnlla r l'{rtlrn8 on{Mlbr.rd hft6y.ditrt. rcI'.sr^rr of rni! Ctr! rn (tunryro6rd uFn rlr
<br />nt-k rniioEd lrnFny (n
<br />.\ pplic.nl r ,l!61 siaDr u
<br />D)T<o >
<br />,/"/r/A
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lite Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />/;\
<br />Rough [2-r-lc h-w-1i)
<br />Service lvleter xx
<br />FINAL I-?-\q \w.$
<br />Notes Remarks, Etc
<br />COMMENTS
<br />Site-Work
<br />Meter Release
<br />I ccnify rhi in rhI p.rfonruNr or rh( w rk tur *hi.h rhr tl.rmir r issucd. I shlll nor cnploy iny l,c6nn i'r 3ny nEimr
<br />$ usro h..om rubjRt t,lh( *ltrI.6 .nnln(nurnr l0*\ olCrlinmic. {n rsN rhrr ifl \h,ultl rx{nft iuhid x' rtF
<br />vortcr.nnrn,rqrn,ntn,visi('n\olscrt,nlTl[)olrh.lih,Oxlc.l\hxrl,ronhqlhcon{lywirh'h)t|h'lnlnN
<br />l,)Euraarlati
<br />t hcrht rmrm ufli.r r.tulrtol Frrry rhd Irn h..nri ueLr |nrsirn ol (lsrr6 9 r.omnrNrn8 tr h Satnn TtrI)rol Drn$n:l
<br />oi tlr Busimssaln ln,acsonrC{xL. !d n,y lr.nr i\ n tullrrcul.fir-.r
<br />,"-*.,-.- T, J,ncn<Numh., 7o'!7',",.,/y'e//t*"@
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