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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS ID/SIG.COMMENTS oWNl]R AU II,DT]R DT]I-CA RATION
<br />I h.rb, nrftD undf t.nrhy or trjilury rfu I m crcnry fo,n rlB Codncror\ Liccn\c l,uw tu rh. l,)llowirrg rcr$tr lscc rlr.llS
<br />Businc(! rtrd ltot$n Cqlc) aDy Ciry or Coutrry *hich Rtuncs f, p.rnri !, .1r\rru.r, nlr.r. nnpovc. dcmohh o, rcPrn My
<br />inr.trrc. nridn, ir\ n{uitr.c, s requircs rhc {pDlE$r ior nkh |tirnn ro tilc r \ignc{t \rlrcnrnr rhrr h.or \lx- is lnr$cd Nrsuitrl
<br />|o rhc pr.yhi,'n\ olrhc Cotrrructn\ l-icen\.d I2u (Chrr,r.r 9. co,nnrn.nrg sirh Scdirr ?0s) of Division I olrhc tsu\i,'.s\ dtrd
<br />Pnrcsnrn\ Codc)orthlr lIorshc i\.r.nfr rh.rcho,nan rhrbr\ntdrhorllclcdcxcnrpritnr.AtryviohrnnrofSNrbnT0ll5hJatry
<br />Nrr!{,1,{ "F1n.i !'hJ,\\rhr rml'.Jn'rnJr'r'l|cnrlrv.{n"*{.'lr ir( I'un,[(.1\l ll'(1r{r)'')!r
<br />,11J...,,*n{.,llhcr,,Il.nr.ornr)cn'rriiyrsrtrhqrac\i\rhcnv,LconrtriMridr.sildorhcqo unlrtEsr'ulEr i\ ior
<br />-Iinrral.,i r.nrrql ntr.ilc rSr 7rs!. auqrf,srnd ltolc\sions Or,c: ]llc(.nrr ri, \ l,i.nsc li* doc\ tor rlply ro !tr owtrcr ol
<br />h.!m|En) sh. tiuildsor in{'n)w\ rhNn. n *hoJr\\u.i,{orfthinsclrorhc*clfortht'ulhhirorhc!owntDnloycc\.
<br />olo'rlI]trinr iltO$ncr Blilnr qilll$!rtt huntc of l(,vn! dd h. or JE dil nn noiB or irylovc rhe pDpsrt f(r rtu llrF'$ of
<br />l. r\.$nf.l rhc lx)trny. .n.xclu\ ivc ly co.r.dirg wnh li.cn{dco.tractr('.on(ruclrh. tmjccr (S.c 7orrr,3un,E!t
<br />r h,rcsshnCodc: lhc Co ta.ttr s Li.cn\. L,w doci trorritlrb ntrosrcrolirop!r') sho $uildsor nnrovcs rhorcon.
<br />,Dd $ho.onrndslorsuchrm]e.l(wirha(nnrridorlrli.cn*dpuruu brhcG)nrDcktr\l-kcn$lrNr.
<br />I hcrchy rlnrmundcr EnallyolDcriuryonc oflhc follo*inp d.clffntion\:
<br />-l
<br />hrvc d sill maintoin rCcnifictrrcofconscnrr{' Scll lrsurc ntr qnko\
<br />'\)
<br />conrdnsrio..,s ihlcid.df by Sccrn,n l7{x) ol rh.
<br />trb.r Codc. for rhe p.rlo.lM.c ofltu wolt for f,hich rhc Frmi n Llsuc!.
<br />-lhawandwillmli.in*orks'conpensdrioniosuratu.,asrcqliEdh,Smlion1700ofrtuLiborC.dc,forthcli.rt,)rumofrlE wort for *hkn $is 0cmir 13 is cd My s.*ca odIcnsrio. ins!6mc ffi.r lrd lElicy numbcr e:
<br />N,,.
<br />*';.
<br />yNlmh€r Exp
<br />ccniryrlnr inth. pcrrormtrcollhc worh for rhichthh pcfllil n hsucd.l \hau nor cntl.y,nytxrsnin onymn.tur
<br />a.d lBN rhrl il I snouk hcroft subjei ro ttr
<br />slull, fonh*ithomply snh rho* pmvisi.m..
<br />lo hccoN sutjccr rolhc sorkcn compcnsarnrn hwsorCrlir.inir
<br />wo*cn con\*nsrionFrviri.Nof sGiion 1700orrh. t hor code I
<br />$iRNlNc I'r,lurc r, ccurc *ortcrr
<br />civil lincs up k) onc hundrcd thousand dollurs (Sl
<br />\",
<br />I hmby llim udcr F.!hy ot pqjury $,r I sm liensl uod6 !rcvision of Charls 9 (snmrciry *ilh
<br />of lhc susiEss a.d Pofcssions Codc. s'd my liccns k i" tull fore ud clrei
<br />CONSIN.UCIIONIDNUING.trAIIiII
<br />I hctohyafiinn und$ lttrllry.l F jurylhd rh$c nn.onsrru.lirtr lcndinsslcmy ntrIhc FrfonMflcc ofrhc*ork li,r hichrhi\ Frnn n
<br />asucd rsu :l(ri)?. Civ C r.
<br />ll.etul tirul:llA-E1tlla!
<br />I lr'r$y lli uddcrpcmlryor l)crluryonc oirhc lolnrwirsd.chrilnnr\:
<br />Dcnrliri,. Pcmns \hc{o\ Nolillcrrion li.dcrrl Rrguhri,nr (Tirl.10. Pr 6)
<br />RcquncJ l.(crol Norifirrrx,l
<br />gotdinS osh.sos rcrmlaloE flol lptlicoblc lo thh f,sjccr.
<br />v. infomrion is conccr.l og@ lo mhply wirh .ll Ciry ond Co
<br />abovc m iotud rm!.ny for
<br />Srptlconr or egcnr s
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace )
<br />Compressor C-
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rough Ductwork
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<br />Other
<br />Hood ,,
<br />Type I Hood L.,
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openings
<br />lnstallation
<br />F.D. Drop Test
<br />Above T-Bar
<br />Rough Mech.6t4 r(1 nqul(,{'&l)
<br />Final Test {., \r
<br />Meter Release
<br />FINAL L4 to rtl ol*rtto ,{.9D)
<br />Notes, Remarks, Etc.U\
<br />d
<br />)
<br />DATE
<br />Vents
<br />Above Hard Lid
<br />Lic.n\c Chss:-Li..n€ Numhct:
<br />-
<br />lcrdcr'.NUT
<br />-
<br />t nda's AdrlrBr
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