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ELECTRICAL-INSPECTOR RECORD
<br />APPBOVALS DATE ID/SIG.COMMENTS OWNER AUILDER DELCATATION
<br />I hcrhy trfiirm u*1( p.nnlry (,f Frlury rhlr I d rxcnfl fDm rlE G, r4roft Li.enE Ilw (tr rh. folbwsg Eay,n (S..70.11 5
<br />8u{trc\ lnl Prrfc(nnr C,n )r Any Cily or Counly vhth rcquircs I lEmi n' con{Nd, drc., rl|lrovc. 'lcrmlnh or Ntln ,
<br />{ru.rum. pritr b irr isurrt.. rlnr r.qun q rhc ,rpli.{nr fnr ch pcrnir ro lik r \i8rd rrd.m rhr h. .r sh. k lic.nd l)ursunr
<br />rn lhc lovirnrns or rrE ConrEroas l-iccnrcd Ij* (Chiprer 9. CommNins *nh S(lirn '7uD of Divnir. I of rh. Burnt$ ond
<br />Pnnar{otrr C,rl. ) or r hlr h. or shc s crcnllr ttErcfton d{ rhc basir Lr rh. alhB.n .kmti$n. Any !i.lrh.n ol S&r i,n 701 I I hy !n,
<br />apth.anr ror a tcrnrir \uhrcck rhc lrrplicanr to acivilFMhyofnor mrc'hmnv. hundr.ddour6($5q))
<br />-1,
<br />I ow, otrlt FoFny. or my cq'loyEs vith w.g.s $ lhct bt otrr{Enrllbr *ill &, llt ** &n ft ir*16 k ml
<br />i .d.d or orllrcrl ln slc lSa.7O{4. B$imls.rd PElc$ba Cod.: Th. C.nb.ld . Liee L* &3 mr +ply b e o{ftr oa
<br />rh. FsFny *ho t ild! oi intftG tlsa^ rrn wb dc. srd! mrt hielf o, h.r$,f or (h6!Bi hir 6r h., own rrpbF.i
<br />pNviLd rhlr rEh iqroft s e d i'rciiLd m or.d fq rl. If. towE tlE l{ildinS or iqmErd i! $h *thin .m Fr
<br />or onphirtr ttE OwE. Builrtq wi! h.w dE hd.. ol Flein* hd lr or iE dn Dl hild ( iqeE dE FrtEr, [r dE FIDoi or
<br />-1.
<br />rs o$tr of llr FDrEly. m cr.tusivcly coffii,B *ilh lirn,.d codeloR
<br />'o
<br />coniM llE rmr..1 (Sa ?O!a, Buirs.d Pro[ain Co&: Th. Co.k{roi s Lk.n* Lr* &a mr .}0ly io u orftr of tioDcn, v,h brildr or ii!b$ rhc6,rmd *h @nrrdr rm sh FDFr pnh t ConEro(o li. .d pulld ro E Condd'r tirR tr*).
<br />_l mc&t9t uil6 S6ri,n .8.&P.e6r$LlEf,
<br />lr.ra orG
<br />1{OBf,!8Ii:C!}UEUSATII}!
<br />PECIJAA.IIO!
<br />I lEr.t, dfirm und.r FolyorF.rrryoft otrlE follr$in8 ddLr bns:
<br />-l
<br />h.w rrn rill flirlM r Ccnrfr.l. ofc.tld b S.r-IM ld vd.t6 onp.dntr B FovirLd fo. by Scrbn l7m of lh.
<br />l,lE c'.d.. ror rlE Fn ,lrmorttEwt fd whth rlE Fna b irqrcd
<br />-l
<br />h.w .d *ill mi.rin rorl6 6nFcdi[ ill.tlfu.. & cquidd b, Sftrbn ]7@ of $. L,rb, C.d.. ror 0E Ffqll.E ol
<br />tlE q,t r rhi.h rhi! D.mi i! iard My *6t6 orD.rlaiin iffi ffir rn Doli.y dntd d:
<br />cM r E-/f4Ff
<br />-l
<br />enify ld i. llE FrformN of th eort fq whtn tnt Frhi n i$Ed. I slrll mt .nplo, st F$n i. ..y ME
<br />b .r ro beom surlj.r'
<br />'o
<br />rll wt6 onp.eir'n lPr orcnifmil Ud l3,!. rlEr ir t rhould lEor otlrd ro rL
<br />Nlt6 a pcnehr Frviii,N ofsarion l7(roorrE Lrbd. C6<le I slulL ronh*irh d,npl, enh rbe FDvirnG.
<br />WARNINC F.ilm h .m eort.6 snpcndbn ov.ne. 6 uhstuL !n ddl rubFr r mproF ro duid p.nlB md
<br />civil nrr up lo oE h!,nEd llDunrd &'lLB (3lm.0m). in .ddrbn
<br />'o
<br />l& or of 6np.nslbn. 6fl!.. .r Fsvd.d for rlr
<br />of rli lr6q c.cc hr.d
<br />7y', /z-z I
<br />DEct'&IlN
<br />I h.Eby llfm u,rk FEly of Firy rh.r t M [a!*d urlda povirbo ofo.pla 9 (@.,!*irt rnh Seli], 7$D] ot Dni.i,a l
<br />of rlE BuiB.,n P' fc.nrB Corl..d my lite i' h 6rl tuG.rd.8.r.
<br />rt * 6u-,' 1- - /L)hn<Numrrr, . /7.2/Sz
<br />o^, ' / /,zr'/,7
<br />a
<br />colsrBlJslloN.t EdDMlcE!.g
<br />I lrEhy irrm und.r p.rhy ol Frrury thd tlEE i! . oddbn L.din! !r!my 16r tlr Fll)l1rl@ of E wk tor rtih rhi! Fmr i
<br />r\urlllS!\ r(t 7. a (')t
<br />AISLICANLDECUAANOB
<br />I ho*, rfm u.d.r F.!xt of F.jury oE or rh. rollo*i.B deLdirN
<br />o.mliri,n Pcrnirs-A3bciror Notificlrion tu ml Rcrlhtioni lTnb 40, Prn6)
<br />RcluiEn L.ll6 of NoliaEdbn
<br />-l
<br />.cnil, rhar rhc tcdcral E8]llorions rc8editr8 astEstor rcmvll {. fr, Aplt{bh ro rhi\ Imirr
<br />luerrlyrhrrlhivcrcrdrh1\r,'tlurx dlnricthrrrh s\t ritun,ur(r, s rrr.cr lrlrNr'lo'nflytrfhr]lCitrtrJC,'unry
<br />onlrtrtrcc\rdsrsrcl-rw\rcbr'trsio$ur[n!.onntdon.d]hcrch,rurht'7crprr\cttrr,v.solrhi\ciy (i,u ryt,rnrrrrjrt,rh
<br />ot mtrliomd lorEny lhr insr<rlion purpo$s.
<br />Appllonr or &.nr SknotuE:
<br />""-U""
<br />*.",rnn,,, ('1- Za.l/ z
<br />n*,' o/' /, ,
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Satety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor -l r I
<br />Bondinq / Groundino / UFER K z '7/\Drj &\g
<br />Translormers I I
<br />Torqueing
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceilinqs (T-Bar Rouqh)
<br />Meter Release v/)NI ,\La
<br />Rouqh tl
<br />Service [Vleter g,1 7t
<br />FINAL
<br />N emarks Etc
<br />c eL-
<br />N0t, $.oP \tto.^U.
<br />--+
<br />Sub-Panels
<br />I
<br />I
<br />v*w.4K'IL-A
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