8461 CERTIFICATION STATEPENT
FOR TEST AT TIME OF FINAL ELECTRICAL
PMffT NO.
BUILDING ADDRESS: 5.7 /M& fI; -
DATE: �6
I certify that within 30 days from the date of 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 circuits have been tested for the following:
1. Grounding conductor continuity.
2. Correct wiring polarity.
3. Overcurrent devices.
4. Appliances and special equipment. -
5. G.F.I. circuits.
The test required above shall be recorded and shall be made avail-
able on request from the Building Department. The recorded test 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 ontractor signat e
Owners address ontractors Llcense' . um er
Contractors address