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APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDEf, DEI-CAN TIoN
<br />I lrrchy lrrm undci pcndry ol Frtury rh.r I m .r.n{,r lhm rrE Coddm Lirre lr* tu !h. nrbwn!8 F.$. ( S.! n,J r lr
<br />Boritur. rn PrDrdri,n Cod.r Any Cily o. Cody *hah ,qu'B t Fnil ro on{Gr, rxs, inrrr.vc. d.mlish nr mnrn liy
<br />rhduE. Fior r. i'r is.um.. llvr EquiEr rhc olplicant for ru.h Fnril ro liL r n!ftrl d.mnr rh.l lE oi rhc i lk(scd podrd
<br />ro rlE lroynnN oa rlr ColnBrd \ Lk.ncd ti* lcht d 9, (i,limrins *trh S.dion 7([) or Datisitn I or rh. lluircli &d
<br />Pnfcr\i,nr Gxr.) or rhrt lE or rrE i.rcqrl tlEElmh url tlr tErir for llE su.scd cr.hption Any vior.lmnolscdion?0ll I by dny
<br />dptli..nr rd rFrnir rubjcch rh. q,plic.nr ri, !.ivilFMlryofmr mn.rhd riv. hufti,.d doller I t5d))
<br />_1. !\ owm, olrhc I'l'Fnr. (tr
<br />'nycnqruy(\ wirh wrers dr rh.tr $h..nlFMti,n. *ill do rlt *ml {rl rh. {drm n n
<br />inr.ni.J or ollcrd tu sk lSd.7(}!. B!.imr. and Profcrrhn{ Cd.r Tllc G)d6tr'\ l-knc ll* d(6 mr.l'!ly l. !norturol
<br />rlE rroFny elr tuld! or inF)6lh.E)n. snl wh' dx! {ch *'Il hinNclfor hcrtlf.r rhflnr8h hr or h.r orn c'rrloyt.l.
<br />pr,ridcd ih, tkh itrprorrldr E dn inr.nhl d ofiotd ftr qE lt br6s. rll llillrq r iq'rrcftd n $U uah..F Fr
<br />o,.r'nt,Lrion. rtE ()wEr Bu kr qill hsF rhc tud.n of F,vi.B rhi lE or \hc drl n hlitl or inlnmE rh. nn{dy fin rh. N4rE of
<br />l. ir nwnd of rlx!)$lEny, umcrclurivcly(onrErins *irh li..nrn co r&Jd r, on!tu1 ttr FoFr (S< ?(Il,., aunfts
<br />!n lb6sin Cat Th. cl'6rdror'r l-i...{ L.* drf,r en rmly ro t. o*mr of pr'rrd y *ho huild\ o, nvr.v$ lh.rcntr.
<br />rnd *ho ronrRk r(tr such In,F.:ls *irh ! Cofllrod('n.) li-.nEd ,llrrudr t,rh.G,ntrrcrd'r lr.ns b*)
<br />llqaf,ll5:ilru[lulA.Dt !
<br />DISAEAIIO!
<br />t lB.by trrfinnun(l.r |xnahynrFrrryorc llh€ nrlt,w'ns &rluario.\
<br />-l
<br />h,v. ,id witl tuinrdn . Cdrlf,.rr of Co.sd h S.lf.l.iuE nr *Gtsi oryrndnn, xr F.lildt in by Sarbn 37lL of rh.
<br />lrnr ((rj.. fq rhc IEf.]lllai of rh. xs* f wikh rh. Fmir ir hsEd
<br />I h!v. !'!d will mmrrin *rt6' oqENlh. iNUrtE.. !r EauiEd by idri,n l rllJ ol lhc lrlF Cqic. lor rh. Ff6h[ft. of
<br />llE sdt ror wnah fiir Frmir i! i$ucd My workctr coqEn$ti.n inrurM. cnEr rnl |b|f,y.utr6.. @:
<br />(-<dz z ,zlC,ltZza (/:
<br />-lcnifih.rrnrhcFrformm.orrh.uorkr(,f,hthrhr,rrnirti.s!.n.Iihrlln.$by{ny|*rktninrnytunrcr{, {r ro lf,(nft ruhFct b lhr work6r'd'mFcn\lli,n luws olCrlil,'mi!. and,sft rh.r iaI rh'uld tt .B.uhFrr b rlt
<br />s,lr6i dnqxnqrln tmvti,.r of S.dhn 17(I) of r,E L.tnr C.d.. I dell, fdh*iih $nl01, Eirh ltnt Pmvhi,.\
<br />l'l,lRNlNC F lurc h ccurc r(rlcn n,nDeneri,n .o!cru8. i\ u.h*ful dn <h.ll ruhFl r dr{,h}!, k,dif,iMl Fnl; ltl
<br />('il nRr uI t. oE huidFJ rhu-nd dolh6 ltlfi)-(lr,). in xrciri,n tr rh. do{ ol.ohltn{lion. diE-s$ dr Pn,vid.d for rh.
<br />y',.,ta.+.tz
<br />DEcLdlArrlr8
<br />I h.Nby atfirn und.r FEhy ol Frury thet I !m liurn ondcr I'orii,n or Ch.fl6 9 llnmrm.8 *ilt Salion 7m)) or I)n 6i,n ]
<br />.f rlr Buii6t rlj PEfdtk n\ CdL. .nl my lacnr is in full foE lri clfNr
<br />v,.",,.",,.,.. c.Jl)
<br />l\v" /7'{-/ 4
<br />, dtu'3dr._
<br />CONSTTUCTION I NitDIM: AI:rN('Y
<br />I h.eh, sfim u.dd Fmlty of Frjury lnd rhsc t s .a,n{tocri,. lndinS !8.my ror tlE tErfmmN of ltt krk ror s hth rha Fmi 6
<br />i!\ud rsd r{r7. cf c r
<br />JIULT,\U}:UJILUI'}
<br />I t[rl'\ Jntrmu'kL, N h\oltrr]ur!!ft 'nrl} t,,lh'trtr'rLl..h'rrn
<br />l\nx,l[ir[l'.r,isA\h(!,^Nor'n1rr'rI.d(,nlR.,]tr|.['tr\rl(lt.rl).r',rn])
<br />_ R.rtrtr.(l l.rr.",l N,i,llrrnr
<br />I.r'r'lrrhirlx l..,rl,rr lJr('n\ r((.r(lii)! r\lr{o\rr tr'hl r ri rnt,l'.rhl.1o rl'tr pn,i(r
<br />onlrn.rccr !d Srurc Irws EUtins lo iulhrt lmloftd ,'rlEny fir inrFcran
<br />rhG lnd h.r$y gxrhni,. ,.F.€d ry* orthn Cn,.d Counrt ro dd uFr. r
<br />k:."-;""-'G,Z."^" /?'/'/<l
<br />Underground l't/rz,/s iA€*
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lite Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />Meter Release
<br />Rouqh
<br />Service Meter
<br />FINAL 4/U/r A4tr,ffi /M
<br />Notes, Remarks, Etc
<br />ELECTRICAL.INSPECTOR RECORD
<br />Site-Work
<br />lrn'rr.tr,tn tr'k!.r S.rf'trr ll ,!l'( r'trrn\ralr
<br />lrxrr
<br />86.7
<br />I
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