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ELECTHICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWN[N BUILI'ER I'ELCAR IION
<br />I h.rby ar,m u.d.r Fnihy or Frury rh.r I d.xcmfl ft,m rhc Codrtrrou Lic!$ Us ro. rh. rdkrso! E $n (sd.7oll.5
<br />Burincs\ a.d Prorcssi.n Cqlc): An, Ciry or Counry which rqut Fnnil t' .un{Ml. ,lrn. nryn,rc, .Lnrlth ot Epon ony
<br />no.lm. I'i, b ir\ issunr., nko equircs rh. ,prlaor ro. 3uch ,Emi k' fik r ri3ftd rhrc'Enr lhdl h. or in ir li(ncd tnNM'
<br />ro rhc Fovtbnr oI rlr ctrnrrkrt Liccn(d Ire lch!!r.r 9, ConDkki.S wnh selo 7(m or Dirnior :l of lhc Ausim$ sd
<br />PNr.tso.l Cod.) or rhd lr or sh. is cxcnY rh.Efrom ond lhc b{sis tu lnc .llcsd crcm,rio. Any vt,trr ion ol seri,n 70]lSbyrny
<br />appli.lor lor ! Fmir suhj.rh rlt lPl)lio ro!civiln elryrf ht eErhf nv. hnndrcddollr3 (t5&).
<br />-1.
<br />$ osg of rhc Forf,ny- or m, c'r{'Ly<i Bnh wlscs &! rhcir $lc onqarerir1 pill do
<br />'lE
<br />v(t !n llx {rErN is mr
<br />inr.d.d or olt Ed ror eL (Se.?Oi4, ausim* d PELsion! Cod.: Th. Conneld! LarM Lre &Es nol tpply ro .n osmr of
<br />lh. I'qtny *hr bdLtt or irlrDrr tll.str !d *hr d..* sh qnl hincu or h.BIl or rhrcu8h hii or h.r own.mpk,r.s,
<br />Eovrlcd rhd su.h i"smwm s e r{ id.d.rl or oftcrd f.r slc. la. lrftEr. tlr tioillin3 c iqmEmnr is sll rh6 (x Jd,
<br />ofNrqllcrior rL olrer Blilt *ill h,r 0r t{r&n of ptuviq rh.l tE o. !n. did ml hrld or inpsr tlE FntEly fM tlE pu!.E of
<br />_1. r\o*mrolrlr lt)rdy. mcrcluw.ly.onrdinS e h la.ns.d cofierou ro onsur rlE F$i!t (Sd.l0+{- guriNs
<br />aBl Pmlc{sbtr Codc: 'rhe (onrBcror'r Liccnsc L.w dd! .or aprrlyro en o*nd ol rrop.ny wll) burldsor iniprcv.s lh.ron,
<br />t.d who.on'Ed\aurrkhFDj.fswnh!Codmbns) cc.si pu6unl lolhcco rrloi\ Liens L,*,.
<br />I mcr.n r ond.r Sdri,
<br />D.t. om..wonxr:[ri rwpnrs,rrrrrr,r
<br />DEqIJAAION
<br />I h.Eby afitm u dcr pcnrlly of IIfJury one olrh.follo*inr &chariDni
<br />I hivc unl will tuima'n r Ccn ir.d. ol Con*d n, S.lf l.surc fn rort.n comrc!\.1ion. !s [6vilcd Lr 6y SNrt,n .1700 .r rh.
<br />lrLtr Gnc- t rh. pc.L,tuL{ otrh. *ort ld ehkh rhc tl.mit i! islkd
<br />_l h . nnd *ill runrxi'r so*rr! cohp.n\rrii,, irru,rtr(. at rcquftd hy S..r ! 'n l?(x) ol rhc fnhtr Adc. nv lh. Frforrum. ot
<br />rhr sorl lir r h'.h (hi\ I.rnnr i\ i\\kd Niy $urk.h $n{rn!!ui in'unfr c catric. el diy nunficr u.
<br />I*d'ryrhi inrh( p.rronmN.olrlf so,k tor {[.trhr n irn tr n{ucn.I \h!ll fr rn,pbyaat pcten, 'nany.xn'trv' a\ ro hc.onr \uhirl lo lhc *ollcn corqr.uri.'n ln*\ ofCrlitunir rnd u!ft rhd il I \tbuld t n,m \uhlcd x,ltE
<br />hlts conpcoiarn,n Dn,rr\kih.f S\-.i rn ]7m.f rh. Ijllr C,xlc.I {Bll. (odhunh conDly r rrn ih'E pro'A$nl
<br />WARNINC: lniluru x, {.orc workc.r onlllcns trrn c r.n8r r! unlrrrul. inJ \hnll {rhF-' on $Un,)tr ro mdinrl Frulri\ .nd
<br />cilrl llnr\ up t' .tu hMdrcd rlxrsnd dolla* (!lm.(Xxr. m ddiriri t lf, ..( or.oqrnsln'n. nrnuEc\ rs Fn'vilcd ,o, ihc
<br />sc.rion .l(176 olrlr tihtr Gxl., n .rci $d orBy s f..1
<br />D.Lr-
<br />-
<br />-
<br />applloll-ucelsffi
<br />!EC!I8AIIQ!
<br />I hcrcby ! nm und.. ttulrt ot Frrur, thlr I !h licNcd udd Imviiion ol Ct prd 9 (mr:m-..io8 w'lh Sdion ?000) of Divhb, l
<br />ol ItE BusiEss.trt Prcfdsi,trs Cod.. ud my lien* h in tull lorE rld.Oel
<br />$NIAICIXINU'NDN;.&GENqI
<br />I hcrcby ,flnn undc, Fnalry of lBrju.y rhrr thce n r .o.socrirn Lnding !8cmy for fi. pcrfornErc of rhc ftrk tor *hkh rhn F.n t
<br />issu.d (ss.llr7. cir c.).
<br />Lc ei\ Addr\s:
<br />-appt tcaNaDFcl Al rloN
<br />I h.r.+y dIm undcr |lcnalry or F4ury ot or rhc rolkrwing d.{lnd io.rl
<br />D.nblnnr Pcrmne Ar&sl{tr Nor i,icar ion ltdcr RrBuhrt}nsl'rnlei0, Psn6)
<br />Rcquncd ktrci ol Ni, ilicarbn
<br />I ccnilyrtu thu l.dcrnlrcSulrrioo\ rc8u'iirs r\hc{o\ rcnx,vd xn mr rtpl'.61c r.lhF Frccr
<br />I ccnily lnar I tuv. Ead rhh Ertlicarbn &d lllrc rhd rnc !b.vc inlonMrion k.orer. I rge tomtr[ly *nh ull Cn, uid Colnry
<br />odiMtult !.d Sr.r. L.us Ehrins ro lloildins convtur iotr. util ,EEby rurlbro. rcF.{ddiwr ol lhis Cny o.d Counly ro cnld orE. llE
<br />ubov. mnr i(,n.d toll.ny for insration purtbscs.
<br />ApDlic{nl rr Atrtrl SiInntuN
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Sarety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor r. .l l
<br />Bonding / Grounding / UFEB I lb A w4y
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners tt ,l
<br />Roof Top Equipment 4 lr 7^Dlt*Yl
<br />Factory Wired Unit t
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)tl rt q
<br />Meter Release zl ,lr -v$ry,
<br />Rouqh
<br />Service Meter ,t
<br />FINAL ,t tlr A Dti+l
<br />Notes, Remarks, Etc
<br />I
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