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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE lo/stG.OWNER AUILDER DELCATATION
<br />I herchy lmn und( Fnllry()f p.rJury lh.l I m.r.mpr lmm r Conlrr1d trBE L.$ turrE r.lr,win8 l8,. tse.m]r.5
<br />Bu<,n.s. lrn PmrBsi,n C.d.): n, cnt or Cddy wh.l r.iiuiB . ,Ed k' 6dM. rlrd, in9.Dr. d.nni+ d E?.n y
<br />fiEir. Fix ro ilr irstlu.. olqr EguiE! rlr qdasr f.r sh Frdir ro liL r rirrd srd.enr thrr lI or Jr n lic.rFd FW.nr
<br />ro llr F'risi,ns of llE Conlrdlols Li...En be (Ch!pr.r 9. ConmNinS wirn Sslion t(m ol Divnion I or rll BuriErs &d
<br />Pn,fcsionr Codc ) or rhol tr or rh. i$ crcrDl llrEn.m ltn rh. lErn ror lh€ .lLs.ij cicn{ibn. Any liohrion of S..lion 701 I 5 by ey
<br />.opli.!d ror r Fmi rubj.iti rrE +plrar ro r civil Fehy or mi mF rh.n liv. hldr.d drllh,r (3100)
<br />-1,
<br />I owmr ol rtE roFny, r, trr, .nploFr wirh *aser !. rhcn $k ooF.orbn, vill do rlE qit .]i il! srae F d,
<br />intc cd or ofi.En for sL (S(.7o44, AuriBt .rd PrefdaN co&: TIE Coffin'r Liu. L.e &s 'Ir ?ply lo u owE or
<br />rrE F,p6!y *rD hirlr ingnB tlEtBr rn *ho d'E odr k r hidElr or h.Elad rholBh hit n le o*n €,r9l6rrca.
<br />prorilcd rhd tuh in{rtenls e mt inlcndql tr ofidcd ((tr sl.. lL lrww. rlE to dinS d inpiftld i. $B within m t*
<br />ofcoq,Llnn, rtE OrEr BuiEr wiU tlE llE Lllrl. ofJ'ovirts tl[ hdrh.dil d htB irFDE rlE Flidy fd dE tEIbEol
<br />_1, us owftr ol rh. fbFdy. rn crclu\islr.onbel in8 * h liccnsd.odr&lon ro sd{tu! rrE,,.j.d (sd 7or.l, Ba'rai
<br />rnd hotssir Caj.: Thc Conlrrttr r Ltcns L5* &B mt q,?ly to u ovrcr .f FoFny sno $uildt or hpoE! lh.rsn,
<br />rnd pho o ds fo. iEh F.ldrs rnh . Co.kdun O lttn(d puh@ r. thc CrnrEr.a: Lkenf tjw)
<br />I en.rcmfl undd SNrEn
<br />lhlr O*n.r
<br />ul)f,[E8i:tlNft:ris rll]iIJI:II XAIION
<br />Ih.'rhy lln rutrdcr If,trnlryor tr'ru,) on olrh.1,'ll(,sngd(l.trrrk)n\
<br />I Mr. elt will nEnnrur r Ccnnilr. nr Con{hr 16 Sclr lnsu( f(tr *orkei compt sr ir)n. r\ I'n,vrlcd tur 6y S.dn4 .17(xl ot rhc
<br />l:htr(rxk, nrth. p$fonEk.orrhc $.rk nn*hEhrhc Fnn G Nsrcd
<br />-l hrtr d will Bmrin *olt.6 coill.eri{ inrurac. r! EqLir.d by Sdrr,n]700 oa rlE L,bo, Ci{tc. tor rhc pc.f6rn@e or
<br />ItE uorl lor *hi.h lhis Fmi is nsu.d. My work6r' sn{Ensri.n ,nrudm. fft d Flry n!,$.r m:
<br />I cniiy lnd ! rts Frfornr.N of 0E ,o.t lor sntn fiir |lrmir is i\iucd. I lhnll mr .dj,loy dy pd&, ii !i, tuL
<br />$ sr lo tEem rubl.d lo ltE mrt6 omFnr.rir. h*. or Crlif.mi:. d.!N thd I nnuld tE r$bFrbllr
<br />srtdi onp.trsrion prclirD of S..rbn lr0o of ttE Lrto. Cod., I {rll fonhEnh orply pilh th,r F!vii,n!
<br />D.L: - _ - _ _ _ App{or:
<br />r rcnrsro cir-rrriri:nrif
<br />IECIJAAIf,XT
<br />I h.E$y !It(m un&. Frlty of rErjuy th.l I m Li*nsd undcr pmvision or Chlpls 9 lcommrin3 uilt Scclbn 700()) of Divnir l
<br />of lh. BuriE$ s'l hofcs.ions Cod.. ort my lic.nE i! in tull foR !n .lfsr.
<br />toNlIf,uguoNLENDI!$lGENlf
<br />I h.Eby ,lnrm ufld.r Fnahy ol l.rjury rhd rhcF ir r 6dMbn bndr8 rBCfty fo. E Frfollrlr. of dE wt 6r shth tlir Fnr h
<br />Esu.J (Sd 1007. Civ C )
<br />lin,lcr\,\ndrc\\
<br />,..nifyrhd I tu\. r.d rhi\ rppli.di,,nurl {nrcrhar rh. ah,vc intu'uin,n nroturr la!ftb.omrly*nh,llCdyindCoumy
<br />ofl]'nr r.\ rrtl Srrt. l nss RL in! n, hu iU
<br />'nS
<br />.on{ru.r nn. rnl h(rhy rurhnrt r.I,.hhr1.r of rhn Ci t anl ci)unr, t, .ntf uF,n itr
<br />rtrtrr n.nrDmd,'n,p.ny in m\F\ri,. pull,r\
<br />AppliLanl or Atctrl sianrluR
<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 />Communications Cable
<br />Building n
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER +-t\-2_
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />Meter Release
<br />Rough
<br />Service Meter
<br />FINAL -?l 'rtl-.\[\
<br />Notes, Remarks, Etc V
<br />COMMENTS
<br />\tL\{}l
<br />Air Conditioners
<br />u
<br />WARIIINC F ilurc lo M turk s mmpcn!.lion own8. i\ unLwlil ond srull sbr.ct an cnllorlr lo sininll p.Elis .rd
<br />.i!il fircs up ro ot hutrdrcd rbusond .lolls (tr00.{m). in lddnbn b th. ron ol coqEnelion. d.m86 !r Fovrl.d lor
<br />'tESftrioo -1076 or rh. L,b.r C.dc, inrftn.,n droEyt rar
<br />APPI ICANT DrCI {|rATTON
<br />I hddry.Irmu is FnrllyofFrFry orc olOE nnhsir8 d(lzEronli
<br />D.nelnb. Pcrnir]AstEirot Norificrrion ftdcrul R.suhtionr (Titlc,I0. P0n6)
<br />Rquird L.n.r or Ndiltlrion
<br />-t
<br />enily rhl| rl* fcd.nl cs{llri,nr Eg.rdi.B r6.rkN cmri m mr qlllEblc b lnn F,j.{
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