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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER tz-l3hd bA Wg /
<br />Transformers
<br />Torqueing I
<br />Sub-Panels lZ4l-?D 7
<br />Air Conditioners I
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />7/Alu-S[hr n.Yr'rWalls (Rough)
<br />Ceilings (Hard & Soffit Rouoh rU,
<br />Ceilings (T-Bar Rouoh)
<br />Meter Release tltbw DPg,,"It,
<br />Rough lt
<br />Service lt4eter l-LJ 517t ,7
<br />FINAL kl qt l'q->'/
<br />Notes, Remarks, Etc.I
<br />OWNER BUILDf,A DEI-CARA'ION
<br />I lE t, r,Im @& pa,lr, ol Fjury fid I m crmF ioD th. co r.cloR' Li..nE b* fot th. folhwiq l@n.S4.703 Lt
<br />Buin6 ad ltotsion Codc): any Ciry or Cobr, uhicn r.qu,6 r Fnil ro rcnsrrud. .h6, inrovc &,nolih or E+ai e,
<br />n^due F6r ro nr i$U4., &o r.(Iln6 rhc rplicd for such,Enn b frk. rig..d ndclmt rfin lE or iE ir ltda.d purur
<br />io rh. F.vuirN of,E contrlcroi3 Lic.nkd t$ ((.lEF6 9. CoMftins wilh scrion ?mo of Divnion ! of . Buin< dd
<br />Prca6ioN Cod.) or rhd lE m rlE t .rdfl tld.lioo !d llE h6b for lh..ll.a.n aaFior Any vhhrFn of Salion 70ll.s by tny
<br />r@lic! for,,q6 3ubJ6l3lnc applicor to a .iv il p@ty o f not moE th& fiv. tun&Gd dolld! (t50o)
<br />-1.
<br />s o$E of rlE FoFny. o, 6y 6nplo,6 vhn w.s6 s rh.n eb onFMhn. siu dr t,F wt .d dr rid@ h mr
<br />imd&l or olIdld for elc (Se.7044, BuiIB ud fr.fdioo Cod.: ln. ( odt.dm't Lic6. Le dr€ ml +ply lo & ollG or
<br />rh. Fpdly *h. tiild or i!!.o6 0E6[ id *lE &6 $i h,t hiro.ror h*laor lhoush ha d ha o{r . plorG
<br />Fovit d ihn rkh imp.o\.lEac mi ds'd.dtrolE.d 6r rt lf.ln*w.lh. hitii's o, irercc,l.n i! 5ld vihh or yw
<br />otconpriior [E o*G Buildd wi! hrs trE hrn6! orFDvins ftd tE or nE di] ml toild or iqrcv. ln. ploFy tu dE FrFcol
<br />-I.
<br />s owE ofrh. prrpsry. m dclsi!.ly conlr.criq wnh ko!.d conrrdoB to codrucl llE Foj-l (Sa ,OL, BBiIB
<br />,nd Ptnfi!.bn Cod.: Thc conrkrofr Licd. L.$ .b6 mr rp?|, k e ownd otlnopdy rho hrildt or mFors ln.@r
<br />dd $rr odEls for 3sh projdl3 wirh ! Co'nrrlo(il ltq!.d plrulr lo rh. ( o,nr..lr'3 Uc* L.*).
<br />_l ar crcmfl @d< Srtion__. B & P C. fo, rhis rd,n
<br />rQaf,l:ScgDttlltarg!
<br />DEII.AEAIIO!
<br />I h6.b, dff(o unda F..lt, .f psl!ry on. oath. rokr*in8 <k lmlioN
<br />-l
<br />h.rr &l *illnuinrd. ( dil-r.r. of consr u s.lf-lBur.lttr reorhgi .on, p.n.il r' n, 6 Favd.n rM bt Sation 1700 olth€
<br />l ib.r (nd.. nn th€ FlomrMc. or lhc *orl for \vh'ch lhc pqhir i Lrs cd.
<br />-l
<br />hr!. .nd will mainrli. wo*.t comrENlion iNurse c r.qun d b, s<lioo 1700 of rh. l it$r Codc for lhc l6fonndc. oa
<br />rh. tr drl for which this Fnrrr r Ls.d. My wo.[d' conpa$dion iaurdcc .si6 dn Flicy numb6 r.:
<br />Polk) Numbcr
<br />-F(pi6
<br />-l
<br />cdlfylhar in th. pqfo@nc. oaihc work aor whkh rhi3 Fmil rJ i$u.n,I shltlnol nploy My Fs. in Dy hMc
<br />h 6 to b..om subj.d lo rh. mrt@ onFsd6r las! of c.liLmit ,nd.gr fi{ if I slnuld bdoE 3uqel lo tt
<br />*oil6'@npa&ri6nF!!i!ioNofSa:lionlT00ollh.hbrCodcl{ull.iodhwiihcomplrwilhllFspmviioB.
<br />NARNINC l lr.lo Bur. \orlds .ohpdrs.rion (\d *€ ls u.la\ltrl. an.l 3hrll su a dploF
<br />'o
<br />snn,.l FEhi3 dd
<br />.Ml 6nd up r. om hut.n thoBerl dolld (llm-000). in .ddni,n ro rlr.or ol d!ux6 a pmrid.d tu'h.
<br />\ h sdrnn,'0{l(ir nfl)ns$n r
<br />ol rh. Bsi.6 dd tma.sE Cod.. !d hy lkde 6 in fuu nR. e,l .fi.d
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<br />ctrynf-
<br />I htrch! ,rtrm undd FMlly o I pgjury I hs. i3 , conlltuIion Lnding !gdc, for lh. Frondc of rh. \srk []r *hid thn Fm'l i!
<br />Bsucd (Se. 1097. Ca!. C ).
<br />l,nd6 t NinG
<br />-AITIJ!:AdI.TECIAIAIIAB
<br />I My rJEn udls Fr.lry ol Fjur,r otr. of rh. lollowing d<l,r.rioro:
<br />lknslitio. P@il!.Ash6ro! Nolifielion !.1160l R.suht i.o (Tirlc 40, Prn6l
<br />-Rqun.n
<br />Ldr6 ol lhi6.dio.
<br />-l
<br />.di! rhd rh. H6l Fs.l.lioB ..Bddin8 sbdG rmrd fl. nol 4drablc to rhis F$jd
<br />n,n 0rd sllrc rhflr rhc slrvc inn
<br />,'"r-rr*"rnrr(rr, /
<br />' in! con{ru.tn n. dxl h.rh)
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<br />o comply*irh aI ( nyaod ( o! t"_,',,"i'))77*
<br />DI trz
<br />ID,
<br />7.-\ ,>!
<br />I hd.6y .mrn' ufrja Enaliy
<br />7
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