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8461 FIRE DAMA( CERTIFICATION STATEMENT 13EFORE FINAL ELECTRICAL PERMIT No. BUILDING ADDRESS:1a�55 �'lrlej ��. 6`� DATE: /y�'6 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. niers signature ContractoisigturONnerSareser7ontrct r ontractors A ress, rty, -i-p/,