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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bonding / Groundino / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceilinqs (T-Bar Rouqh)
<br />N,4eter Release
<br />Rouqh El4l ty lvvnru-;t r bz)
<br />Service I\/eter t I 'U\
<br />FINAL qtntfl'r 4/tnlrt 'Or+>)
<br />Notes, Remarks, Etc
<br />OWNER BUILDER DEI"CARAIION
<br />I hcrchy atfirn lndcr p€nall, ol pcrjury rhd I m.xemp! fD,h lhc Co.raclou Li.cns t q li'r lhc followiog rct$n (se.7o.l't.5
<br />Busincs dd Pr.rcskn Codc)r Any Cily or Coutrly which rcquncs n ,cmil lo connod. rx$, inD.ovc, &mlhh or rpat ony
<br />strucrurc. nrior ro ns hsuana. aho rcqutes lhc a')I,licul for sucn pcmi b tuc r siSmd sralcmnl thll lE or sht h lkcnscd puruanr
<br />ro rhc ln,vlsioni orrh. conraclors Liccnscrl tjw lchipE 9. Commncinr wirh Scc'ioo ?qn of Division 3 oflhc Busincss und
<br />Polc$ions Codc ) o. rh0r lf, or shc t crcmrl thcrc,iom a.d thc bash [q rhc alL8.d .xcmpthn. ny viohtion of Sation 70.] I 5 by rny
<br />,!Iltant aoropcrmir.uhf(clhc sfl'lksn,rod.*,lI.nrl,rnlnor r'.rhrinrchu rcddolle.rl5m,
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<br />t rhc Fmpcny *h, hurU\ ( inlnmE( tlENn. d * lF does such w* hnnself or hcrclf or rhronBh hk or h.r own rmtlolss.
<br />F,!id.d rher ruch imrmbftnk m mt inr.nd.d or olf.i.d for $L ll hoRcrcr. rh. toildina o. iq,oxrd L sB *nhin.ft ttd
<br />ofcorll]lcrio.- ilE Owmr Buiucr uill hnh Lh. htrdd ofpbving thd h. or sh. dil nn t ild or iqn,vc the pmFrry {or rlr pury)* of
<br />I. rs.wncrofrh.prup.ny, dmcx.lurivcl!.ont..rin8 Birh li..nsd.ootlcir\ro conrrncr rh. pn'jd (S.c 70"1t. Bulincs
<br />$n Pnrtssirn Codc TncConlncror'sLiccnscLowdoesmrrnplyhsndsn.rort(rt.dywh.huild\orimrrovcsrhcrcon-ind *ho .o.tadsnn ro.h pioj G wi'h . Conrocion sr k.nscd,,unumt hrhcConroclols t,iccnxc liw)
<br />I hc.chy rllttrrtndcr Nrlrtol tdjr!otrc olrltc lnlk)
<br />I hdv. r'il willmrinrtrin rCcnifi. .ofconsctrrroSclllnsurcforqorksrcomp.ns ion.is prov .d r(r by Su.lnr 37m oi rM
<br />l- hrCodc.lorrhc Frtnrfrrnc.dfrhc work fd shi.hrhc Fr.ir n issucd.
<br />Ihrvc. d*illDrir oin w.rkcrs compcnsrtion insurrncc. as rcquiEd by Sccrion.lTooofrhc libor Codc. id thc l{rl'ornnrcc 01
<br />lh. sork r(tr whichrhispcnnil is nsuct MyworkcG coarpcnsliotr insuruncccrtricr rid B,liy nun'h.rm
<br />$,::ilylhar i',lhc p(rlornhrtrc or rhc worl for ahichrhi\ pcrnir i\ n1ucd,I shru not crtloy yl(6on in any Mntur
<br />smpcns.rnnr hus nl Cclilonria. ind asrc har ifl s,x,uli h.{ont subFt' hrtr
<br />.dion l70O orthc bh.r C'.ilc.l slulL nnlh$ilh.unply *ilh rlx,* ln,vi\htrs.
<br />{r n\h tf,con. \uhj(r t) rht *urkcn
<br />wlfkcri o rFnsari,)n ln,vnhN ufS
<br />WARNIN(;: Iirilorc h {curc qorkcn .onlpcnuriotr .o\crn8c n lo .rnnnrllktrrlric\ rtrd
<br />.ivil rnr\ ut r) ono huidrcd rhouutrd dollrr (Sl n. danrg.s a( Fnidcd d lhc
<br />bqK'1
<br />t hcEhy afinm undcr ltruhyol pcrjlry rhnr I !n licen{rl under fn,lntun orChrlld 9 (comnEncins wilh S€cl
<br />ol th. Busin rs rtu Pmlcssnns Codc. ond my liccns n in tull r'oc ud crccr
<br />;ilD-,
<br />-ic.n* Numbcr:
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<br />CoDlr.clo.
<br />CONSTRI](:T!(IN I FNDING A(iENCY
<br />I hcrcby ritDlntur Fnrlry Dfr.rjrry rhd rhrc h a.on{rudn,n hndirB r8cn.y,{tr lhc pcrl'ornErce ofrh. tork f.r uhrh thi{ tEmir il
<br />i\nRl rs.. l(D7.ci\ ( r
<br />AIILI{:ANIIIICLABAII()!
<br />I ts{ y dlinn undcr pcnlhyotncrjrry onc orrhr rollosins dc.laftri.trs:
<br />Dcmlnn,n PcirniKAstEsros Norificlrion Icdcal Rc3ularion( ('l irlc J0, Pd6)
<br />-Rcquncd
<br />lxlcr.t Norifnri{]n
<br />sd;xrrhc frdcrrlr.lrhri, \ nerd1tr8 a!h\!o\r.mvrldc 0.1{r|]li.$ld trr rl,i\ pn'
<br />b comply wirt lllCiryand Cou.ryIhr\c rc lrhi{)plLi.rri,)n xn,l(rrc I
<br />rhov. truri(lncd ftup.ny lor
<br />"l,\DpliuDl or /\Artrl Si[nnlu(D*:J e W
<br />Under Slab / Floor
<br />L.ndcis Ad(LTs:
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