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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE OWNER BUILDET DELC trATION
<br />I hcrchy affifln uutcr tttulry of t r,trry rhar I tun crcmot 6orn rh. Conlr[lon Ltcn* Lie lor th. lbllowing rc!$n (S.c.rorl 5
<br />B$iturr rd Prcrc$'on C&Ll An, Cn, or Coudy *hth Eqon.r ! Fmn lo @trn d. .116. irrh'rq d.mlnh or EDln sy
<br />{trrm. Fin nr irs ksuNc. rls rcguft. th. +Dlt6t for rkh Fmi r' nh u ri8rcd slltctuil rhol h or dr h li..n*d lluB!.d
<br />ro rlE Fovisirnr ol rtE Conreroa! Licencn b* (Ch,flcr q CohmMin! *ilh selion ,mO of Diltion I of rlE ltu!i*3s ud
<br />PmLsF.s Cod.) or rnlr lE or rlE h crctrr$ rlLrrtom ,,rl th. hsir ror Erlhs.Jcxryrirn Ad, vi,l,riotrots<dbn 70.1l.J b, a.,
<br />llpliclnr for . Fmn ubj..k rlt lPpliu.r r, a cilil p.nallt of not mr. lh6 fivc hundrcd dolkr (l5uJ).
<br />-1.
<br />r o*ncr ol rhc mrltny, ,, ny cnDhyKs viri *ucs 0r lh.n srt cohpcnr hn,willdo'tr*dkultEslMlwi\rul
<br />i.rl<i orofi.Ed fm eL (Se.?04r. Busim$ ud ftlfcssbns C.dc TIE CoMrors Li.rM bw.lo.s n q'drloeo*Nroa
<br />rhc ptr'rEny *lDl i[.! or intrFw! rhdsc o,ir *hi rk6 Mh $,t hiBslf o. tsElf or ltoush nir d lE ov. cr{byc.\,
<br />prolild rha[u.h nnpmEN s w ml inrcrneJ or or.rd lnr !id. ll k,wcv.i dE hdillh! or inrmrcmnr i. $ld vilh ok ytu
<br />otonokrir. trE owmr BuitLr will h,E lh turd.tr of,m{ie tld ltorltE dii d triB or inpmE E F,tEly lor tlE Fqmd
<br />l.1ow*, olrlr FDFry. mcrclusircl, codr rins *irh lic.nrd conr.d6 ro NNrud tlE l,f,tFl (Ja*.7orl. Btiit*
<br />lnd lhfGsionCdc-lhcconrrrtr'sLiccnrcL.wdD.snorrpplyroono*rcrofpropcnrwhoblildsotimProw!'h.r.on,
<br />nnd who onhds rir \uch pruFlls snfi ! CodEro(r lit <n ltu^unr ro ilE C.nr&rols Lacoc liw).
<br />I !mcx.mU rndcr Scclirnr
<br />!rJr5!rN:glMf!$a a
<br />TIECI.AI'IQ!
<br />I h.rchy itrlrtrr undcr pcMlry.fFrjury onc fllhc lolh'qin8 dcclirurrn\:
<br />-l
<br />h!rc 3nl *ilt @inrai. . Ceniff,rt of (b,*d t, S.lr'lnsrc for rorlss .n.rtindi,.. ar pnrvd.d ror by SelFn l?m of rh.
<br />Latu Cqlc, rt r rhe perlo,r@.c or rh. sorr fir whi.h rhc Fa,nil is issucd.
<br />I hlvc rni wrllmn rJin worlcr! romI.!\]rk)n tr^urJn(c. r\ rrqdtuJ hySc.rir :l7rx)ollhc lihrColc, forrhc pernrtun.cor
<br />s
<br />rhil rhir limir is igu.d Mv *dt B dlund
<br />lz-( q ;.i..ki*.| .-.1,-^r 0n ftudrc .sbl rn lt,ri, dnb., m
<br />T,,^^E{ ooz!oo (.'o*", D S 4
<br />-l
<br />(dify rhrr in rhc pc.tormft. of tlE *ork for *hth rhi3 Frn is trkd.I rhlll mr orytk,y rny IER,. in.nyrumr
<br />s !$ro tE onE suhjsr ro rh. *orkcrr corq$qrtun kws orcrliforni!. ind 08r lhd ifl slnuld ttcoB \uhj.d ro rhc
<br />ertm' omtrtr nm pmvirions of S(ii6n -1700.r rh. h$r Cod..I slull rontwilhotDl, unh Ds l)nrvisj,on!..I
<br />WARNINC hil r. (, {rurc $ortc^ .rnr!.n{i({ $rur8e i\ unla*tul. a'yl \hrll \ubAr trI c Ployur l. dhrul lrMlti.r dli
<br />68 hrdtd rhouond tlllhB (Slm,mo). h addirDtr kr rrE .o{ or cr $n. d.m8.s !r pmtitn ror llE
<br />sNr(r.r07a 0r rh.l]lo (ixlr. d (c{ 0 rl NL rr}'\I \<,.
<br />O
<br />2 \1 L
<br />I heEhy allim undtr pcnrlry oa p.Urrr rh I nnr lN *n utrd drns wnh S.rt Dn ,UlO) ol Drvisi'n l
<br />or rtf, Busircs ,d ltofcqr)ns C.nlc. ml mt lr.n{ i\ irr
<br />-e3
<br />2r
<br />43-tzs o44-1
<br />I hcE6, ,lIEm un&r FDlry ol Frrlry lhlr lhcE ii . @nntucri,. L.din8 .8crcy lor rh. tEr(otuc or rlr rdl for *hih rh" Fd is
<br />tr\u.J lS.. l0')7. ('i! C I
<br />AIITCAII.DICI.AIA:UO!
<br />I hd6, trtun !d.r F.rlry of p.+r, oE ol .h. follorirs &{l,nr h6l
<br />Dcmolilion P.rmils.Asbcsror Norificorhn F.d.rul Rc8lbiions (Tnt 40. PJn6)
<br />-R<rt!iE.l
<br />LIr.r dt lsrif$ri{
<br />-l
<br />.cnify rn! rlE fcn.ral rcslLrioN rsudins rdEno. Emrd !r. m {,pli,bL lo lhir prcjd
<br />I c.nit$,r l[tv.hnd rhis,!plicn'i.n l rllrcrlu dcrh I o8,c to conDly*irh allCiryanl Counry,ry{.r,hwsolrhN Cny lrl Counryro cnrs qln tlrt1 z(
<br />v*O*ll n--
<br />rdrutor\ rnJ srrrc LrB\rL 'nIr.hu'Iltrk!unnru tr
<br />uts!c ntrnnnr.t nr,n!n) hnn.n"d.. r,,lar,*.
<br />n*rr*^*n**r**,al 'ff
<br />P.mi,F mm , prin,,: J uq.." I r
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />lvleler Release
<br />Rouqh
<br />Service Meter
<br />FINAL trr4t /2c19,q)a/z)>ez-ry
<br />Notes, Remarks, Etc.
<br />ID/SIG.COMMENTS
<br />Translormers
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