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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation /A*vt;6Smoke Detectors lnstalled N-lJ-/5
<br />Rouqh Ductwork (/
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranoe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openings
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Bough Mech.
<br />Final Test
<br />Meter Release
<br />FINAL tr-r3-{r D
<br />Notes, Remarks, Etc.
<br />OWNER EUILI'B DETTA&ATION
<br />I hrnby affrn und.r pcm,ty of Fdury lhd I o cr.ryl fmn lh. Cor mclos Licsi$ Li* for lh€ folloDi.g E&en (Se.7oll5
<br />Blsircss !,'d Prufcsior Codc): Any Chy or Counry qnich rcqlnes u I'€rmI Io on$Dcl' alrr, improrc, .lcmli3h or Bl,eir My
<br />{o.t@, ,rio. ro irs Lssurrcc. !l$ Equies ric rp,,ltant for iuch pc.mir to th "
<br />si8n d aIcftnl ihrl h. or sh. G lic.ns.d l'uNdt
<br />lo rh. lolishns of tlr Co reror's Li.c.*d kD (Chlprd 9. Cormtuin! wnh Scdion 7000 of Divirion 3 of lhc Bulinss mn
<br />PN&$ioN Codc) or rhdr hc or shc h cxcnpt rncBfiom Md th. b{ris lo, rlr dlce.d ercn{,lhi. Any viohliof, of Sdtion ?031.5 br rny
<br />lpplicul lor a tcml subicck lnc lpplicanl lo a civil p.mly of Nr mrc Od fiw nundrd dolles (3500).
<br />-1.
<br />ar owtur of rhc r,!Fny. or ny.nphlrls with w.ge 6 rlEn $k onp.trsrio,L wul d. tlE eo* r,n ll'c sl.rt@ is ml
<br />i,l.nd.n or o6.rd f6r sh (Se.7O4a. BNimle d ProLsrions Codc: TIE Conl@lols Ltcns Llw does nol alPly m a oeM of
<br />rfi.rftFny slb hikts or inpna lltBr! dn qho dGs Mh hrt hinslf or herslf o, though hii d ha, ou employ.ca.
<br />,mvi.hd lh.l such in{mwnrs @ mt inr.idcd trotu lor sL ll howcK. tlE huildiq c irytuEmnl k sld wilhin oE y@
<br />oi sdrplcliotr ltE Owmr Buiu.r will h.w ff, budn oflmvinS thd tE .r :h. dil ml boild m in{mw nE !m|El, aor llE p'q,* of
<br />-I.
<br />{sowmrofrhc pbpcny. mcrctusivclyconr$ding wirh limr*d conrr.cror ro con(tucl rhc pmj.<r (56 7014. BLciE$
<br />ad EoftrsionCodc: Thc Coflrrrrols Liccnse Lr$ des nor !t ly ro.n o*M of p,opcrry who blilds or inprovcs d.rm..
<br />a.d who .6fl6ds fo, trh l,nF.l3 with r Conh.rods) lhen{d puNunr ro rh. Conrucrols Li$n$ L!w).
<br />lrtrrcr. rtr utrdo Sccri{ .8.&P.C lnrrhLsnrn
<br />WOR(EfS' CONIPENSATION
<br />DECI.AAAII!}N
<br />I n.rcby amirn Dndr ,.nshy of l'crjury onc ofth.l'ollowitrg dccleltions:
<br />-l
<br />hlvc !.d will @inllan a C4nifcrc ofcotr{nl ro Scll-ln$rc tor mrt6 otrp.ns{rio.. s lorid.d aor by Selbn l70O of fie
<br />L,bo, Cod.. for rlE pdf.,lree of & e.l fo. wnhh rhe |im! b is.{.
<br />t hdvc nnd will nuinrai. so,kcrs comFnsslion insuramc. as rcquncdbyScclion1700oflhsL{horGdc,forrhcptrforNnaoa
<br />rh. wo.k ror ehich rh( p.rnil i( ksucd. My wortcrs cotrp.nsr io. insunncc oricr and Flicy nlnbd e:
<br />-l
<br />ccdiry thal in thc FcdorDtra oathc uorl for ahkt thh Frnit is irilca. l.h,ll noi cmploydny f.Mn in rny monkr
<br />$ 6 ro b..rm subirl ro rhc srLdc con .nsalion hes of Cdlirornid, and aBE ltal if I itDuld t oft subi$ lo lL
<br />workcm' co'np.n*ario. pmvhion* of setion l70i) of rnc Lihor Codc. I srtrll. fonnvirfi sq)ly *ilh IlnE Pdvisio.s..
<br />WAnNING: F!il@ b sw workcs'.ompcnssdon .ovcE8c n unh{tuI. lnd sh{ll subjel s mploFr lo ainiId pcElls tnd
<br />civil lincs up ro onc hundEd rhouMnd dolhrs (11m.000). in cddnk'n ro rlE @sr oI con !.nglio., dlmg.s &i pmvn.n for llt
<br />Sdion 10?6 oatiE L.bor &q inlcEsl lnd lllomy s fei
<br />D,le: Applimtl
<br />LICENSID!.QNI&!.]OB
<br />DIiCLTEAIIOtr
<br />I hrchy rlltnrufttcr pcnllryof pdjury rh, l.d ln{i*l riJ.r prov,sn, olChnarct 9(.onrmn.in8 rirh Ssrirn 7([n) orDirisi(,n ]
<br />ol rhc lturims\ ind Pdt$ion\ Codc.rnd mt licctrs i\ in lull nn.c rxl clft.r
<br />iqi Liccns Nunb.r:
<br />Conlrxdor:
<br />AIIIICAUIDIICLAXAII!}N
<br />I h*,,rmdundcr Icoalry ofr.{ury onc ofrhc lollowine dc.l rriotrr
<br />Dcmhiotr Pcrnrik-Ashc{or Norifiolion Fcdcnl Rceularion{ (lilb.rt}. Pnn6)
<br />-Rcquicd
<br />tarrcr nr Norilirdior
<br />_l.cnifyrhsi rhc lcd6n I Egu l,! ions rcB ding asbcsos rcnm!0|.r. nor qlltrbk ro lhh !roj.{I.
<br />-l
<br />c.nify rh l nlvc Ead rhis lpnlkaraon dn sr . rhar lh lboE inlomrbn n .oGl. I sgr lo otrtPly wilh aI C!, ad Coury
<br />ordinoffi ord Srsr. t ws Ehin8 h hitsing co.irturhn ad hcEb, Nrhori4 GFcs.r{div8 of6is Cnydd County lo eme. upon llE
<br />lbow Enrhmd pDFrry fG insperion pu4bei
<br />Af,rli.nnr dr AE.nr Si!nrrurc
<br />Pmire tum (rriiDr-
<br />II
<br />DfrTNI
<br />caNuBtiqIloNIINIIN!3liIiNcr
<br />I hcrchr or'ltr undcr Fillry of pqury rhtrIhcrc is d .\,,itudbn lcn nrS aecmy for thc rdonMr of ltc $ork fo, *hth rhn lf,nn is
<br />hsucd (Scc 30r)7. Civ C.).
<br />ttr'nJc'-. \,nr
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