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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNAR BUILDER DELCAR,ITION
<br />I hcrcby srtrn undcr Fmlr, of Friury rhlr I m cr.hpr fron rh. Conricrm Lk6E trw for lhc foltoqing rcd$, {Se.7oll5
<br />Ausin.ss aid Pmlcssion Codc): Any Ciy o, Cd.ry qhich Equi6 a Fmn lo onsltul. ahq. itllioG d.mlth or Epai My
<br />ir.uchft. Fiq 16 ils L$usq dso Eguircr lh. q,plicanl for sch ltmn lo fiL a signcd sltrmfl tM lI ot slE is lien.cn Pueu.
<br />ro rh. prctsions of rh. C.nr&ror's Lhc.rd Lrw (Chaprc, 9. Co@.Nin8 wnn S.clioi ?000 of Divirion I of rhc Busincs lnd
<br />Professn,n. Codc) or $d hc or snc L, ctcmpl lh.Efron nnd lnc bclis for lhc illes€d denprion, Ary tiolaritn olselion 70.11.5 by lny
<br />appli fl fo. ! ,'.mir snhjccrs rhc sppliclnr ro a civil psmhyofmr mr thm fivc hudrcd dollrs ($J00)
<br />-1.
<br />.s o*Ds of th. IxDtf,ny, or hy cqrlorEs oilh wagca $ fict sh onlcosarion, will do tlf, wk !d tlE stttE i! ml
<br />inrcndd or ofrcrn for slc (56 7044, Buiimss dnd ftoiiisio.s Codq Thc Co.lBlm s Ltcns ljw dcr tul agl,ly ro a .mr of
<br />rhctmp.ny wlF hiikls r ir'Il'or rtc@n. lrd sno des sI sn himlf or h.Elr o. lhrcu8h his o. hct a*o cdplorcg,
<br />providcd rhd suh nnpmEEnls m mr i.rc lcd oro,IcEd aor eh. tf, hoftE, itE bildi,S or inpftmnl issB*nhir6ft tld
<br />of erDlcrio[ rhc Oemr Buih€ will tuvc tlx hmhn ofrrcvinS lhd tr or sh. dh br boild o, iqmw lh. pDFtry for tnc plqre of
<br />l, ^owncr.lrh. nmpcdy. omcxclusilcly contr0clins wirh licctrcd conlract Fb.on{rucr rhu |,(iNr (Se 7044, ts!\itrc\\
<br />ond l,mfc$hn Co.lc: Tnc Conuactr'r Li..ns. h* do.s nor ryply ro atr owncr olprcPtrly*to hoilds.r nnprovci rhctcon.
<br />dnd sho.onra.Nforru.hri{,jccrswithoCo.tncro(r)licctr*-dp!^udhrhcCoiktutr\Liccnstiwl.
<br />I r rkcnrtr utrd$ Sccr B. & P.C. furhn rcamn
<br />wolxFRs' c(ltrtpFNsArI0N
<br />PECI.ASAIION
<br />I h.rchy alfirm undcr Fnolty of ldj!ry onc ot rh. follo{in8 d(hrrrionsl
<br />lhvrnnd*rllnrinrd$rCunill.nt.olCutrcdbSclllnuctor$orkcrr.onrFnsrri({,r\fntidcdIr'rhtSccli,,nlT{xrollh.
<br />L{bor (lxlc. lhr lhc lcrfo unccolrhl sorkh)rwhi.hrhcp.nnirn nsucd
<br />ralhr.rx,ir'llmx'nrJn$'{\cr. r{ nc \.8{'trFurincc.J1 rcqutcd h} Smiion 37(xrofnr LnhorCodc. htrhc |En. nnrce.i
<br />rh. $ ork ktr whth rh^ F,nnn rs il$dl M y *or[c6 conrFnsnli insurlncc crris d B)lk) nun$(r atcFat-s L*<g'
<br />I
<br />-l
<br />ccrliiirhot in rfic p.rr.hdmc of.hc wor* ror whi.hrhis pc,mil k hsucd.l shall.or cddoyanrrcmon h lnynunmt
<br />so Nro tE onE subicl ro lhc wo*qs compcnsarion L$s ofciliaofri& and 4r.c rhtrl if I should bccom subjd to rtr
<br />workc( om!.nsolion pmvisionsot56lioo l?00 otthc Lalhr Cqlc.I rhdu. fonhqilhcompl, vith thos Povnbn.
<br />WARNING: Failure ro su. *orkerl mmFnsari.n .ovcmec is lnbwtul. lod shall suhit! r. coplorcr ro aiminll t'cMlris ajd
<br />civil fi.cs ut ro o* tuft!.d rhouend dollrs ($100.000). in .ddiln,n lo tlE osr o, coot .qrion. dalMgcs ar Pmvitn for rhc:::1ffr,i*:
<br />ulENlELllJ)N]3.AerAts
<br />ITECLASAIIAN
<br />I kEb, rmrtu!nd( p.Mlryorp$jury nd I !fl lia.$d undcr ln,visnnr alChrtrcrt) c\'nrkn.in! Rirh Sccrion 7tu)) ofDili\ion l
<br />ol rh,- Bu\ir.$atrd Prcicsn'nxCod., dhd nr! li..n\. ir i rullr(,.tnndcriccr.
<br />calsmlcll()li.LlllrllCrllI .CI
<br />isruo{l (sN :r097, crv. c.)
<br />-l
<br />*nify rhar lhe t dml E8lrlsriof,s rc8.dinB sbcslos rce,val urc mr qDlklblc io rhlr lot{!.
<br />-l
<br />ccnify thar I h.r erd ftis applb.lio. &n shlc lh.l th. 0bovc informlioo is .orel. I a8c ro con{,ly eilh lll Ciry &d Coufl,
<br />ordimo.c\ ann Sllrc Lr*sEhri g io huildine c.nsrudn'n.8rl hcrchytrurhtrize rcfre{nhriv.s o
<br />trho\( rBnri,,ncd pn'ncdy f,tr in.r^_uii,n f urDietr.:7\t.-
<br />\rn'(rrr,i Ar(d S,slJru( I
<br />-Pcnnnc nom (I,inr):-
<br />lrhis Ciry.nd Coutrr, t{, cnrs ulx,n rlr
<br />"'"zrf / s
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />[/isc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rough Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Besidential Range
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinqs
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />Meter Release
<br />FINAL ,e 4 R/fi urr{?,qlh ,1)
<br />Notes, Remarks, Etc -ll I \r \
<br />COMMENTS
<br />6/-7 a{3
<br />.-.<._-
<br />trndca\ ddr.ssr
<br />-
<br />,tpprrciiiliEii ailnoF
<br />I hmby dtim undr ltomlry of pcrjlry .ic o( rhc touoR in8 dcc ldurn rs:
<br />Dcmolirnr Permirs Asl,c{os Norin ion FcdcdlR.Sulati.ns(tirlc 40. Pan6)
<br />Rrqut d t lrcrofNorifrolion
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