HomeMy WebLinkAbout2002 Jun - Electrical Permit<4
11
NO
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rr lc�l Us c Culy
BOAPO OF
occupancy attd FCC `heckcd
=IRREYENTION REGULATIONS (Rev.
A :
PLICATION
FO�!'. P'ERMIT TO PERFO RM ELECTRICAL WORK
to he ruloffile.'
I
im:1GCo1j;wCCwi0l tile mzis.ludwsns rlectric:11 ckxje ""v1cc).521 CNIR 12.00
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flt:'T�sn es, notice ol'bis or her iu1a;jtjm to perkma the e1wriez,( work dtscribed Mow.
A �111 111C I o
stmet {Number)
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b'nicr
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M11 os f� I" OA Telephone IN-1.
Ts this P
),Iplt 11 Junclion
rich -I
kj11J;j1'j' perfilli? 'Yes NO (Check Approj)'Hn'te I3ox)
io
—I
Existill-
b
service
Volts 0 vcrllc.zd L"Jidurd No. of t� Iders
Atilt!,
Vol($ overhead a thidgrU of iNje'
0
'wild INA(ur'p of Prop 4
�sed F:
I;A,I'dcatiuq
k H61 ork!
table mar be waimfbi: [lie his
No. off
MC5 f4 Fj
No, of Cell_-Susp. (Piddle) Fatis
""""Of rrEI-3forl"rs XVA
4,40. of Lin
litin'4 oikilds
n IP
NP,_ or not 'ruin V. XVA
0. of
ighting Fixturcs
Aboyc m In
1111111g Pool
'lle roen-t f
tin r-e"e
itS
I
eceptadcoutlets
I .
No. of ners
tl A L "AIjIMM s No. of Zo it es
1,40. of$
•hidathic
No. of Gas B U'--'-"�
IN*. 0 ctiou amJ
Devices
No. OM11117CS
%.OrAir ConrOt
No. of Merlin- Devices
of aste yls ei"s
PURTWun .......
-----Hll
NO..'-O--f---S--
el—fCon aivctjNo.
DOectioniAlerfing Device;
No. or ;5llwzsl1c6
Spx -ea Heaths KNY
'ilualcipol
1 0 "1., collilettion
No. of fryers
ating Applinoces 10V
sec Ir! LY tetras:
No. of 2 rritialeilt
"o'
N O. of
B-nilu-s"s
"Mrin-
No.
OfUes-ices or Trl elit
No,-Hydromassage Bat
No. of ilintors Total Ill'
..... ...Y
No, Of I)evircS or Ejul aient
OTHER:
Aaach additional derotl ildested, or el relm-red by Ilia
Unicst, by f0c
'aived the oA",'cr, 110 Pern"it the PUF01-11'a race of electrical t'vw` may issue uWe"
itic lic4lin"
�iiuraticc hicluding "compteted operatimi" coverage or
Y its substantial equivalent, 1,11V
1h1.UCmg11t:d
cerkifics'tliut such
qoveml is its forc,:, and has e,cIjibjicd prooforsnAtc to the Permit jssqjjj1' ocr";'t.
13 NI). C] Uj'ljF_R 0 (Specify:)
1:5
`(aI
C' lCy.pirafion Dw,:)
tim:wij
e oft'lectriezi voc)d.;
00 (When toquircd by municipal poiw)•.)
WCIR (Q
'1:3m
luzsi ections to be uqL1e51Cd in accordatila 'Vill, 1011C Rule 10, and upon completion.
I CCrlrfy'
1111 dcr tit'! 11 1 �?hjs nnJitrrrrlfli4l�
qfpeijw)-, flka the iitfurnmrivit on INS applFewivit is bite *;:j courl.71LIlLf.
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Signature" lul I,
CIO) LAC, NO*.
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lic-10" IJus. TO. No,- Tj 7q:
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cric
Mi. Tel. NO.:
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A IN'S Li il..�N CE- vi;
ow icwsc.- "';e
AVER icmisc.- (foes 1:001ave the lhbl!"'ty insur:krcc
r1qwrAzd
by I;-'w' Uy ply signaki
)"Y sItn"t,
re bel ly, I 11ccehy waivc 111k. rquircillent, 1 2111 dw tkalicck onc%' owner 0 owt1vt%i m4cw.
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