|
ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNER BT'!LDER I,ELCARATION
<br />I hcrcby lm!fl undcr lE.ahy or p.ijury rhd I d .rcmpt rirm rhc Conlmct.^ Liccnr Law for thc followins rclen (h( 70315
<br />Buri.cs and Aofc$ion Codc) A"y Ciry or Coutrr! whi.h rcqxids a Fmn r. ..n{rucr, 6lrd. improvc, dcnsliih ,r rcrrtr sny
<br />nru.be. prior t, irs issu,ncc. aho rcqun€s rl.€ Etliclni for ru.h lf.n r ro filc i siemd {arnrnr rhd h.or sh. i, licned pu*unr
<br />ro rhc pmvnions of rh. Conmcktr\ Liccnsd tiw (Chnpr.r L CotumceinE wirh SEc{ion 7 x) of Divtion 3 ol
<br />'hc
<br />Busincss ond
<br />Pofcsions Cod.) or rhul hco.sh. iscrcmpr rh.rclmm lNl lhcb0sis aor rhc rllcfcd cxcn1rt,.n. Any vn,htionofS..tFn70ll.5 hy rn,
<br />applicanr for a pcrnl sunjcck lhc Ufli.anl lo,civilp.n,xyorn.r fr,c rr'M fivc hunddldoll, l$500)
<br />-1.
<br />as o*n$ or rhc ltrorxdy. (tr my .dpkryces wnh wosc\ as rhcn sob conD.nsd ior, qill do rhc work ind rhc dNrurc h nor
<br />inlcfttn oroflircd ror sl. (Se.704-1. Bu\in.\s dPmtc\rionsC.dc:1hcCoorracroisl"iccnscljudocsrelopDlyro ouncrol
<br />rh. pmr.fy sho bxilds or nnpnra rh.ma-,nd wlt) des (uh uo* hihs.la.r h.6rlfor rhmuSh hh or h.r ownrmploy.c\.
<br />foridrd rlEr such impmrcnEnF m mr inr.nkri n olT.rcn an sk ,l h,$rrr, rhc htriili4 or i'rpmRnxnr h sll *iihin onc ,!u
<br />ol complction. lhc orNr Buikld *ill haR rh. t trdci ol pmvins lhd h. or snc dn d tliLl .r iryrorc lhc flopsty rhr rhc I]uqx'e of
<br />-1.
<br />!so*ncr of lhc nrcI'.ny. { exchsivcly.onh.rin8 wiih liccnscd conrracron ro con(rucr rlrc pmrccl lss.7044. Bu!.c$
<br />r Plnrlslkn Codc: ThcC.nklcrofs Liccnsc Lawdocs nor,ttlytu nnowmrornrcp. y who builds or imt(^t\ rh.rd,n.
<br />and who.onhchnrsuchfrcicc*wirhaCdnrrdct(\)liccnscdnursuurlorhcGrnrrrcxtr'sLicctrsctjw)
<br />-l
<br />mrexcml, un,lcr Scclidr , B & P
<br />lf"24U- tt
<br />tlitln-llrJol
<br />I hcrcby aafinn unncr ri.nrh y ol xriury om ol I
<br />I hah ud *ill roinriin ! C.n iarorc oi Cons toScll-lnsur.f(rworkc^.omFns.rion.$pr,vidddlinbySc.rioi17($ofrhc
<br />libor Codc. for rhc !c 'oiriutre oflhe worl for whi.h rhc Fnnir is i\sucd
<br />I hrlr rnd sillhrinrain worhcri compcnsalion iNurrkc. r\ rcquncdhySc.riotrlTU).lrhclnktrCodc,forrMncni)ahm..f
<br />rh. work ror lhich rhn p.rmir i\ isslcd. My rorkcr' conEtrsrtiotr nNurun c.uricr 0fr1p li.ynunrb.rnrc:
<br />TawEL 4U4tr7 F 7-l )trlLl,
<br />-l
<br />ccnilyrhrr inthc pcrfonroftcofrh. w.rk nn which rtis pcrnir is isslcd- I shallnor cnuloranrpccon in anymunncr
<br />$ xs n, hc.rm uhjcct to thc workcr onpcnstion hws DrCnlift,nir. r*l Jercc rtur,rI sh,uld h....'ft subirr ro rtr
<br />workc^ ompc.sati.n provisionsofSccrion 3?0Oofihc bh, C(x].,, shrll, f.nhwirh.o'nply wirh rtkft pbvisn,n\.
<br />UARNING f,ailurc h $urc $ork.ri c.hlensrrion corcrr8c is unltr*ful. ard \hill \uhjc.r .n cmnhycr to crimirrL|Enalri.s rtrd
<br />civil fincs up b onc hu rcd rhousr.d dollr^ ($lo0.lxx)). i'r rddirion t, rhc .o{ ol coDDrn\lrion. dunugcs r\ povidcd lbr rhc
<br />Sdion:1076o,lhc bnor Cod.. nrlcesln.d trlbrmy s r..r M,f,V-ru-tr
<br />I hcEby dftn uidcr t,.nalryorrcrlury rhd I ai lienBl u"dcr rmvisionofChflplcr 9 (cummins *ith Sdion 7000) ofDivision l
<br />or rhc au\inc* md Pnrc$ionsCode, dd myliccnr h in tullrbra dcfid
<br />DIU
<br />",'7'3u- t t
<br />CONiIIIJSI]ONIINOINGIIiINII
<br />I hcrcby rltrnruid.r tfnalrt.ftf,rluryrhar rh.r. is a con(rucrion tniir8 ascrcy l;r rhc FnirrnEncc ofrhc *ork l'or whicl rhis lErflir is
<br />(sucd (sr. 1097_ civ c )
<br />AIILICANLIJECTABA]IA!
<br />I llrclry rtrnn und.r ,l.n,lrt ofFrlury onc drrhe nrlbsinE d(hrarions:
<br />D.n$lirion Pcrnir\ Asb.sror Norificarion Fcdcrcl Rc8uhrio.s fiirlc.l0. Pd6)
<br />Rcqurcd Irncrol Nor'licrri(tr,
<br />I ccniSrh rhc lldcrrlrc8uhrions rcsffding (h{os rcntr,rrl nrc orrmli.dhlc h rhi{rn+rr
<br />lccnit!rharlhrvcrc l rhnn|p icxii,nrarl{rrr rl,allfu rtnvc irnnnndlon h c.trccr Irsrcck,d )nrdy wirh all Ciry rtrd aounly
<br />or'liM .csntrd S(rrc I-xw:
<br />'rhrnur
<br />ro hcrcl,yaurhorizc rcprcscnlulivcs olthh Ciry ond Coutrryh cnrcr ul).r llr
<br />nlx,y. f, r(nnlf'ot,o'rr tur
<br />Q'*"Y.r., \h, -lhcrL,,r-
<br />7-ru'4
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Si NS monument )
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab i Floor tta\t\10 ll,tuttt
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilin gs (T-Bar Rough)
<br />Meter Release qtL\(h u41('l
<br />Rou gh
<br />Service Meter
<br />FINAL t[z\$AUA
<br />COMMENTS
<br />Bondino / Groundinq / UFER
<br />Rool Top Equipment
<br />Notes, Remarks, Etc.
<br />--T------
<br />f -T------
|