8461 • FIRE DAMAGE
CERTIFICATION STATEMENT
BEFORE FINAL ELECTRICAL .
PERMIT No.
BUILDING ADDRESS: mp'y7 x�
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. ci.rcuits.
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 signa re
Owners a rens ontractors icens% um er
Contractors Address, ity, Zip
•