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ELECTRICAL-INSPECTOR RECOHD
<br />APPROVALS DATE ID/SIG.COMMENTS oIINIR IIt]II,I)I'R I)I:I,CARA'I](}N
<br />I lrrcby ainm hdcr p.n0lly of pclury rhd I dn cxcmPl tmft rhc Conk.clon Lk.nsc Uw fu lhc rollowins rca\on (se'703r'5
<br />Bsinc$ ad Profc$6n codc): Any cny or colnly whioh !.quircs I F.nir to con(rucr. alrd. imtrovc. d.mlish ur Elr!tr in)
<br />srrucr!rc. prhrl(, its is\lance, al$ rcqunes lhc uPpli.snr lor suchpcrnrir r, llle t sisncd *srcmnt ihi trorshc h liccnsed p!N,r
<br />ro rhc pmtsionr or $c Conlructn q Liccnscd Loq (ChaPrcr 9. C.mmncins wirh Sccriotr 70fl) of Dirkio' I ol &' Bx\incs !nd'
<br />Pn,rcslions codc) or liar h. or stu h cxcmPl lheEfiof, and rhc blst for !h. itlcs.t ciedl'iion Atrvviohrn']norsNti'n70]15 bva'v
<br />amli.trtrr for apcrmir suhjccrsrhc lptli.,ir lo acivilpcnalrrofool mrcrhm fiv. hundrcd dollan ($50o)
<br />-1.
<br />ar o*Er of rhc lioFny- ot my cmPloyes wilh qngcs ,s rh.ir sk flrnp.nslion. wiu do rlr Nolt ot lhc idm t nor
<br />inrctolcd or oficrcd 6 srk (se.7044. Businc* md Piofc$io.s Cods Thc O)nl6croi\ Li.cnsc tiw docs nor aPplv lo an owmror
<br />rhcpmpcn, {ho tuilds or in{'fl,!d\ itrro.. ud who d(B skh solk hins.lf or hcrcll or rlN'xeh his or her 6*n cnph}ccs'
<br />pmvidcdrnli such itrq,owm.h @ mr inrc*Ln orofltni ftn {L ll. ho'eu. rlt huiklinA o. iqrrcvcmnt is sld sirhin onc re
<br />;l@!pbrk)n. lhc Owrcr Bnildcr willhaE rh€ t rdcn orpmving lhd lrorlhcdn ml buiu or imprcw $c I'DIdv for rhc puqbs or
<br />I, ns owrcr ol rhc pmpcnt. ,m cxclusilclt .ont,din8 wilh liccn{d ..nhcro6 lt' $n(rud rlrc roi.r (s( 7044' Bn'i'r(
<br />nnl Eofts\i, c.d.r ih; C;nrrrrot s Liccnsc Lr* docs frtr.,,plv to sn own$ ofJ'ropcnv who huilds or inrrovcs lhcrcon
<br />dd who conrBcrs for such proj.{rs wnh a contDcto(s) ltcn*d ,rn6uAnl lo rhe co.lt.dors Liccns. bw).
<br />I a cxcrnpr lltdci sdliotr
<br />D.l.:
<br />UOBSDXI-.TOMtENSAIION
<br />DEII/8AIION
<br />I hcreh, an]rm undcr rEnulryof t rjuryotu of rh. rollo*in8 dcclamriotrr
<br />-liavcarxlwillminlsinacenifrcalcofconscnllos.lf.Insur.lo'*orkc6'conlPcnslion.,rlovidcdlorbys.clionl?flloflhchhor Codc. for th. Frrom.ncc of rhc mrt for which rhe pcmir; Gsucd
<br />Zt m'" u,l *lrr,n.i'roin *ur[.r\' conlosrr ion
<br />rlrc wort lff shi.h rhhJ)cmil i\nsaL{. Myso*c
<br />iisuraNc. rc lcquircd by soclion .17{n or rhc tibor Codc. t{tr lhc Perfortutuc or
<br />r'.onp.nsirion insurakc.micr and Fli.y.umbc! rc:
<br />\l E, La.k- Fs. e Cos.r"-l
<br />. 1c,lra lreFI./\ oo-rslroe,
<br />-l.cdiry
<br />rhar ir rh. Il..for.Dm. ollhc Iork ror shi.h rhG Pcrmir i\ irsucd. I shall nor c'nllov anv F6on h invnunmr
<br />s, $ hr b.com suhjccr ro rh. BortcB comp.ns,lion l0trs ol Culirdmia. und lBEe rh ir l should tf,com subid lo Ihc
<br />{orktrs.ompcnsarionF)v(ionsolsccrion:lT0oollh.L3lFrCodc.lsh l- lonhwnh mmrlv wilhthls Ffl'lishns"
<br />WAnNNG Fdlurc ro Brr. uorkc6'compeisa(ion.ov.r!8c is unltrqtul. and shall sobjc.t on cnrPkrvcr to niarinll pcn'hics md
<br />cililfifusuPloorchundrcdlhousanddoll6(stoo'0(x)).inBddiliotrlolhecoslofcohlleisalion-dunE8csa\Provili.df.rlh.
<br />Sccri(r lr)16.lrhc lihr Co .. nr.r.{ xnd 3rtnrtr's
<br />,*. 7f rzlre Applienl: --:>.^a!..,r.
<br />l,lcLNstit) (l)Nl R/\c ll)R
<br />DEII,AEAIAN
<br />I hcrchy lrrr und.r I.n!h, oa r€riury lhal I !m lia.r.d und.r Drcvision 6r ChaPrc. 9 (ohdminS with Sc'ri'h 70fii) ntDivkion l
<br />.r rhc Busincsa.d Psf.$ions Codc. dd nry liccns is in tuU ror.. { cnecr
<br />e-7,o G61953
<br />/,
<br />-
<br />.,,,*","", :=- -z------:--
<br />CONS'I'RT'(]T(tN LFNDIN(: AGI'N(:'I'
<br />I hctoby rlltrnr undcr lcMlry.fP.rjuryrhrt rhcrc is..oNrucliin LidnrS 03cn.v lar rhc FrlornutrEc ofrhc sorl i{' whic[ lhir pennir i\
<br />i\{ql ( Sc.. :10q7. Civ C )
<br />I odfl'\ \JJ,'..
<br />ASI!:ANLDEIIAEAIION
<br />I luctyanimundcr t]cnohy otr.rlury orc ol rhc lalk,snrts dc.lnturi.ns:
<br />Dcnhlriotr Pcflnih Arbc(os Noriflcrrion l;cdcral Rc8uhriotrs (T[lc '10. P] 6)
<br />-RequiEd
<br />hln of Notifi c i.n
<br />I lcnify $.1 rhe rcdcial rcSularioos ftgardinS ish.slos rcmlal src nol aPPlicablc to thh lroj*r
<br />lcc.lifyrhallhdv.rc&lrlisappli.rrion,.dslarcrhdficahov.inlormalioni!conNr'llsdrdmmplvwirhallCilvandCou't,
<br />ordinanccs;nd stdrc L.w. rcblidio buildins consrrudion. a.d hcmby aurhorla rcrcsnratiws ofrhis cityand coumy lo cnrer uF)n rhc
<br />,ti,v. mnr'on.d nmmnvfor nrsrction Dumtrci(-
<br />f.n r e re'l^
<br />'i4r"
<br />Underqround
<br />Pole Bases
<br />Liqht Slandards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Salety /Low Vollaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondino / Groundinq / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Solfit Rouqh
<br />Ceilinqs (T-Bar Rough)
<br />ltileter Release
<br />Rouqh
<br />Service Meter
<br />FINAL tlrflt9 /,1/4 {rq)
<br />Noles, Remarks, Etc.
<br />Site-Work
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