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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER Df, t]CARATION
<br />I h@by rmn uid6 p6,lry of p€ln t thd I B .x.mpl from lhc Corft*loB Li.!e l rw ao. rh. followinS ta6i (SG.?OI \(
<br />Durin6 and Prcfsion Co&): Any Crry or Counly q'htn rqut6 r Fmil ro @tdru.i. dra. imtrov.. dqmlnh or ,qat dy
<br />ntod@, Fid. ro it. isee.ko r.qut6 rlE spltel for.uch Fnn h 6k t 3's.tl ntioal th. lE or iE b li.E6.d FEd
<br />ro tlE Fovnioc ot tn Coirelois l-icae.d tr* (Chrpra 9. Comnrm.in4 wilh SElion 7000 ol Div(ion I of lh. Bants ed
<br />ProlBoG Co&) o lh, h. or rhc ir qdp{ rfiddom .rd llE hci lo, lh. all.s.d darFi,,. Any rioLtion ofs.dn. ?01I t hy uy
<br />lpplicdt ror , Fnn ubjal3 rh. rprli.ul ro r .ivil p.n ]ry o a ml mor. 116 fiv. hundEd dollc (t500)
<br />l, s osE ofrlE FoFry. or fty dplo,6 *irh wasd s thct FL mmFGiion. wil d, llE wt .ld UE nixrE i! et
<br />inrodBl or olldrd for sal. {56.7044, Buind dd ProfehB Cod.i Tnc (.or rcloir l-icGe Lrv (b.. @l tpPly to D oMs of
<br />dr FnDdry who hriL! w irqlr6 $.o( il q'ho dB *h e* iirulf o, lEelt or llEwn hi3 or hd oM oplotG
<br />Foridcd rhd rNh inFoEsa ed i orldl co,tald 6rde lf, hoEq, d!. bildioe d Dp.otqEd it FU wilfiin ok tr
<br />of(omplc(ior\ lh. O^,n6 Builda $ill h!v. tlr hd6 ofproving Ud tE or srE dld mr ldld o. ihp.ow lh. Fopdy tu tk FnF& of
<br />I. G ownq ofrh. Fopsly. m .Kluiv.ly co' B1hB *irh li.d!.d coMaro6 ro cotrntud llE Foi6l {Sd. 70,4.4. ABild
<br />lid Ptotosin Cod. Th. Conrr&1oi! l,t.e tlq,do6 mr .pply ro D ownc of FoFny wln hild! or imPtor6lt6@,
<br />lnd who coit6cl! for slch plojdr wirh ! Co!tr6.lo(s) licdts d puBulilr ro rh. C. rsdot ! u.cN ta).
<br />I Grmlpl und6 S6rnrn_
<br />D.r.:__ Otnd:wonxr-s.coMPE sATroN
<br />DECIdAAIIO!
<br />I lEcty irm unda pqIlly of Fjury orc ofrh. followitB d..lr.rioB
<br />I h!v. &rl Bill @inrin . Cdif{arc oft..nst to S.Mnrur. lor worl6 codpdB{ion. a FovirLd for by Sclion 1700 ollh.
<br />Llb( code for rt FlM. of rh. voit lor *tth lh. Fbir a sucd
<br />_l hsvc and will 6iinr.in worl6 comtm.lbn iNum.. s r.qun.d by SdlDr 1700 ol th. t b.r Co&. lor th. Ffom'ec of
<br />rn wo'\ for "hkh rh6 Fnn ir isd. M) worl6' onFuEi lcff.(lB !!d pol(y nmbc i.cm-r fi +e {'ud
<br />",n,n"-*' L--:11/;ilt/r)'1 -,,*: rolzr /z{
<br />l.sti6 rhr h th. pqrorr nc.^rth.*o,l ro, sh{hrhBFEn E iq.( Iih,llm! drplotx,*.l"""-J"-*
<br />e d ro b6on. sb.idl lo fi. m*6' .oors8dioi kB oacttiaomia .rd lgE thr if I slbuld heom 3ubjd to fi.
<br />@116' ompc.rio. FbviioB olsdion l?m ofi,E L.hor Codq I sl!.tL tonhvnh @n$lt *nb tlr FortitN.
<br />waRNlNG Fntur. ro suc $!rtd' comFEario. (016+. i unLwtul. ,.d shall $bj.<l m oploF b simind FElis lDd
<br />civil fins w lo on. hundrd rh{usd dollm (tloo.mo), r addinrn ro llE cos !t io.. d6nra6 a providdl [or llE
<br />i.rd.sr &d dh@y r fG
<br />DPCllEArlO!
<br />I t@by rrum lndd FEIy o f pGjury that I d. licd!.d udd Fovilion of Orlprd 9 (conmo.ins *nh S.sion 7000) of Divilion l
<br />of rlE BuinB -d l,ml6ioB co&. &d ny ltoe i. in flll fore od .lT.cl I
<br />R 131oz_)q ,+l* <..,'."".)!
<br />I0IITAIJqUAUIEEDTdCICf.II:I
<br />I tab, .rm ud6 FElry oI pa;ury rtra rtrc s r ooro-6@ a4y ror rE paromm. ot$c @r br *tth rltlgmir i!
<br />nsudJ (s6 1097, ci!, c.).
<br />l.md.r'3Nmc'-
<br />--
<br />APDLICANT DECI AqATION
<br />I hadr.ftm uodq Frdy of pqjlr, oE ollh. folhwi.8 (bl[.l68:
<br />Ddrolilon Pmirs^rhcror Norific on F.dol Rcaoldon! (Tnh40, P.n6)
<br />- RcquiEd Lal6 ot llorii.ab.
<br />I cdiry rhr tt fcd.r.l rcguhlioc r.Asdin8 6bdtd rcmvd a. @l +plicabl. lo rhie F!i<1
<br />fuft:drry thll I h.v. rod (h8 .rphcinon a d.r(lhd rh. sbov. inroEdion is cmdt I .s'6 ro comply with all Ci1, ud Counrytord,le6 rd Srd. LrE EhlB lo bu'ldE* coNrudbr sn h..b, .ulbj+ rcF€dd^ 6 of rh! Cny ud Courty to 6lo uFn rr.
<br />!to( Mrioidl p'!p6ry ror iBiarion p{rDosE. ., f7 / / /
<br />^ppro.rorAs6'sr.'*,L Z/r.-Z-4 , , n,' -///:?4 ?)
<br />r.mxeun.rerinr):r( 7Ztt4<f At/,('A*Ct
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communrcations Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER 2 W+s7
<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 />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />Meter Release a bA+gt1
<br />Rouqh I I
<br />Service lvleter "r bryn ,
<br />FINAL ?l DA{(,a
<br />Notes, Remarks, Etc.,l I
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<br />Rev 08-07-2015
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