8461 OFIRE DA IMT
CERTIFICATION STATEIENT
BEFORE FINAL ELECTRICAL
PERMIT No. �7�(
BUILDING ADDRESS:
DATE: l
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. G.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 signature Contractors sigma
Owners a ress ontractors is nse Num er
ontractors A ress, ity ZZip