8461 FIRE DMIAGE
CERTIFICATION STATEMENT
BEFORE FINAL ELECTRICAL
PERMIT No. � q /
BUILDING ADDRESS: �U z/•f 7 ! `l/L F �p
DATE: Iqr,
I certify that before final electrical approval, that a written
signed statement by the electrical contractor who is in compliance with
the state licensing law or the owner/occupant, that all electrical cir-
cuits have been tested for the following:
1. Grounding conductor continuity.
2. Correct wiring polarity.
3. Overcurrent devices.
4. Appliances and special equipment.
S. C.F.I. circuits.
6. Integrity of wire insulation.
The tests required above shall be recorded and shall be made avail-
able before final to Building Department. The recorded tests shall be
signed and dated by the testor.
Additional testing may be necessary on special installations. A
determination will be made at time of final inspection.
Owners signatureCont actors sign ure
Owners address Contractors License er
Con tractors A rens,_CJ_ty, Zip
s