8461 • FIRE DAMAGE
CERTIFICATION STATEMENT
BEFORE FINAL ELECTRICAL .
PERMIT No. p may(t!
BUILDING ADDRESS:
DATE:
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 n actors s na e
Owners address Contractors Lice se Number
Contractors� $�
Address, City, Zip
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