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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS
<br />Site-Work
<br />Underground t/2/ n 1\r{
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />lln{er Slab / Floor
<br />jBondingy'/ Grounding / UFER ), Tn X{",rll'tYM. 1.ffiformers VLlE {l\r(
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Rough
<br />Service lvleter
<br />FINAL qlilt4 //zfrn
<br />Notes, Remarks, Etc lt
<br />OWNET AUILDF-R DEITARATION
<br />I hd.ty dlm u.& Dquly olpatu.y rhd I d dmpr tDa rlE Co.l[cldt Lk.M trs for rh. fi)llowq l6,n (Sd.70]1.5
<br />&!iis .,i Prct<ioi ( odc) ary Cily 6r couuy sti.h r.q@6 . Fnr lo o'( cl, 116, i,!Fott- datulah or E .j, &y
<br />rMEq Fi, to iB irE . .lo r.$iiB th +ltd tu st Fnn lo ih . !ti.d ria6t rhr b. ot lt i lkaEGt Flrd
<br />rc rh. Folnrcd of $c Cont[.Id ! l-ic.nEd t * (Orpl6 9, Comma.ing *nh Sclio. ,000 ot Divilbn .] of lhc Ir$iE od
<br />Pmf<io6 ( od.) d $d lE d ,E it q.n'{r llE iDn .,!d fi. bGt for llE dks.d ad{ibn. Ary yblrio. ofs<lnn ?01 I 5 bt 6y
<br />Tplicd fo. . Fnn $t*(r rlE rp?lidr ro ! civil pc t) of rcr ma tha li$ buid.d &lle ($m)
<br />-1.sorcolrlEF!F!r.6n!@lptt6*irnr+66rh.n$k6mFE
<br />ior rdl do th. nui .d lh. inEc it rn
<br />idorlal M ofir.d for $L (Sc r&1, BuiB ed PrefsbE (-od. TlE Codr.cld. Ltqe Lt* do6.ol4ply lo & o*E or
<br />rh. rrDFty who hild! or itrF.lE rt.E( rn who &E f,En N* hid.lf o, h4lf or lhrclrh hi! or hs oM .nployd.
<br />Forir.d rhd kh imFotErEae d ndxbd dolir.d 6. r8. l[ lNe, rlr bildiiB d.s6sEr i5U*ihifttc
<br />ofoRplain\ llE O$c Blild6 will hr. lll h,&n or l'oviid rlr lr o. iE dA d hrill c ulsur da FDFry r,. tlE Fr!.a or
<br />l. s o"M ofrlE t'op6ry, m Gxcluriv.ly co r&rils silh li.ds.d coord.to6 ro .oi!tu<r rlE FDjd (sE. ,0t4. &rIB
<br />.d Follin Co& 1'h. Conrrdoar l-i.# Irs &'6 mr .9ply to u osrd of FoFny $ho buildr or inpmv6 thdotr
<br />&d $'ho od,x! lq sh Fj.Tlt *nb . ('oirr!(i) lrd!.d Fsld ro tlE Cd..dG r rim LE).
<br />-l
<br />h .ropl !rd6 Serion-. B & P C for rhir lE$n
<br />Drl.: O*n(,worxrt(' Iolrpttrsr rtotr
<br />DEllJBAIq!
<br />I h6.5t.mnn ond6 p.olhy ofpsjuryorcorlhc lollowin3 ddl rtioN:
<br />I hlrc rn rill m'nru. Cqiiar.r. otcoM ro SctllBU. fd r*ld omFEtion, 6 Fo\r.lal ,or hr Sa:lion 11700 of rr.
<br />Llbor cod., for th. Faontrdc. o alh. rc* fo. Btth thc Ffrn i Ltu.d.
<br />-l
<br />h!v.8d *'itl m.inuo wdk@ .orpd.lhn iBul8., 6 Fqlt.d b, Sdlirn 17(I) of llE L.tor Co&. for lt. Fnhlffi. of
<br />ttE f,olk for which rhi! pqlir i! isLd. My wortdt comF!.li(in iN! cc .Ei6 drd policy nunb6 ac:
<br />Rrq< Qt-rrrt:rz/rr /rl-\tr
<br />_l (difi_thd inrn Ffornlm.of lh.wort for shkhifiisp€!tri i nsu.( I Jallnol un loyet T T
<br />r u ro b<$E $bat ro tl! *dld or@@dion lh. otc.lifomj,. .d.er rhr lfl nDuld bEor et*tl lo llE
<br />qIt6' ompqEdion prosnc ol s€io. l7o0 of th. L!!, ( ode I .ldL tonhsth conply *nh $o- prov.oc
<br />WARNI C [{lu. ro su. *vt6' onF6rion covcr.8. b unt qtuL rd Jall $brcct 6 @doF ro aimind Frnb rd
<br />civil lind up t. on. hondEd thoulard dou6 (tl00.O(l0). in lddilion to lhc cox ol compcMrion, d&Ig4 s prnri'icd ror lhc
<br />S-Itr,n Ur6 frrh.lrh{ ( G!..
<br />Dr,.: , t1 /11I--T-lr}.(altrltl]:
<br />I lElhy lllm und6 Fulry ot Fjury thd I 6 li6..d u(b Fsvilb! of ChFd 9 (sffiiIg wnh S(lbn 7000) ol Divi.i.n ]
<br />of th. B6itB .d Pmf6.s Co&, rn ry ltaE ir in tull loR tn .lld
<br />! Ezs*.'1
<br />*
<br />cQNilal]cuourfdlllc-acllcx
<br />I h6!by .frm uds FEly of Fjuty tb. lh6. a . otinrl6 rr<Iid3 .gd, 6t tlE Ffoffi oa tlt rtt lM *trh lhii Frr ir
<br />i.sual (Sa 1097. Civ. C.)
<br />AIIIIIANTAECIAAAIIA!
<br />I hd!b, rerD !n& pa.hy .a Fjuy oE of lh. follosrns d..lsdbnt:
<br />D.mliaon Fdi6.Atb.go! N.rifE.iotr F.d.r.l RcBlhrioa tlnb 40, Pd6)
<br />-R.quiBd
<br />Ldld of lL.iftrioo
<br />ale not applnohkn, rhs pnldl
<br />'naomdrn 6 ..rd I .rG u .ompl, n'th ill (iD M.l ( ou.ry
<br />lr\riu r.D.Mtdn6olihi!C y ad Coun! lo oro uro. dr
<br />,{ppliutrl or Ap6l Sl8nrlurc
<br />i-., .- r\-,r- r-r J{ur--I'enn ir( nin. (pnnr ): K '/'/rl
<br />rI 'a
<br />Meter Release
<br />=
<br />I
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