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MECHANICAL-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS (,IVNF]R BUII-I}OI' DELCA RATION
<br />I hcrcbt lfltnr hddr pcnrxy or Frjury rhnr I m cr.mpr rio'n rhc Conrrros Liccnsc L.w anr ihc folh*ins rcN,n (ss?l).ll 5
<br />Busincss !M Piuf.s\bn Cod.l: Any Ciry or Counry which ruquncs r pcnnn k, .on\rtucr. rlrcr. imtidvc. dcfr'lNh ot rcprn'rny
<br />{ru.lurc, prnx b ns ku{.cc. sle Egun slhcapplicanl l$ ch Frmir lo filca silmd \rd.imnr rh0t lror shc r liccn$d Pusu.Di
<br />tu rlx pmvi(ionr ofrh. Q)trr,.tor's Licctrsd ljq (Chal,cr 9. (bmncNin8 *nh Scclt,n 7l]00 ot Dili\tnr -l orrh. aulincsr ind
<br />Pmltsions colc ) or rhd h.orshc iscxcm0l lh.rcliomlnd rhc6asi\ turrhc allcgcdcx.nfli,,n Anyvn)hln)nofScdtunT(rll5hyrny
<br />lplli.anr thra pcflnir subjecrsrhc amliclnr h r.ivilpcnalryoitur n$crhrtr nvc hutrdEd dollurs lS50O)
<br />/1r.,",""'*"r'f*r",,r"ny..r,,cn,rh)(\qi,h{lgcs*rhcrsrcdnnn!tr!($n.*lud,,rh.*o*drrrrr{nEruEnmr\ ir lcJ . { .rflycLl l, { tL ls(\ 7l*r U usnr* rnJ tintsions Cdc 'l M Cont&rof s Lic.trr ltr'w docs nor ryply ro an oqnf of
<br />rhrIn,trny wln) huild\ or im8,vcs tlErsn. dwh.{nu\!chso*hi'nscllorhrrscl,orrhnnrShhi{orhltorncnDloyc.\.
<br />F)vnbd I hur sucn irnprxurnr\ ar B, hrcflLrl u ollcrd ror $rd ll. howc\cr. rlt h{ildirs or nnno.mnl is {,lr wnhin on. ,t,tr
<br />oI.oq)Lrkr rh. osftr auiucr Bill h!\r rlE brrdctr nlrn)vir8 rr$t hc or shc dil 'nI ttriu or impolc rh! Fopcny ror rhc IU4r,{ of
<br />-1.
<br />I owEr oltlE lmpcny. m .rclusiv.ly conlrsclin8 snn Iccfl$d conlra.toF ro $nsmd rtE te.iccl (Se. ,044. Ausirc$
<br />ad t1D&sshx Cod.: Thc ConlIeroi i Liceie Lae docs rci apply lo u osncr of pnp.ny pho l,uilds or idnowr ficr@n,
<br />and who .oor@k for $ch pmjccls wirh . ConrEdor{s) ltcn*d !us!a ro rh€ ConrNrr r Ltcne tjw).
<br />liner.nnt Dnricrsftr'.n B &PC rbrihi{*a!,n.
<br />/,,," ,//- 2?- / ".",, Z*t A'\ \!o{xFts coMprNsarloN
<br />,Z.z
<br />DECIASAIION
<br />I hftby rflirn un.l( nenalry of oerjuy oE of the folhsin8 deh.arions:
<br />Ihrv.Jtd$illnui'rrni'rxCrnillcrrcolCoi{ ri) Sc!llt{h nJr sorkd!- co.r!.fn[i(in- !\ pmvidudtrhrS.trt,i:17(X).lrhc
<br />Itrhor CoJc. li,r llr pdiir Nne o, rhc *ork rarshirh rh. |rnnir i\ i\\u.il
<br />_l hilc snd silln9i.toio workcr' .onFnruriin i.sxrdftc. dr rcquncd6yS.crion37UJolltct tor Codc, forlhc poto.mncc or
<br />rh. sort for which rhn l€mn is issB{. My wor*c6 comF.stio. imurMcc cmicr ui ,olicy nunbcr e:
<br />tr rr'.l).'1,trtrIN.,)lrlr. {1tr1 ntr \h'.h llrA lu nr r is tsu.d. I shlll mr cmpl6, {iy pcen in !n, semr
<br />iL ud lse thar ifl .h.uld b.rom.ubj.rl to lnc
<br />I \h.!l- fonh*ih ontly sith lnos pmvisions
<br />suhj*' h rhcBorkcr{ conrFnsurion liss olCllinm
<br />eorkc^ ompcns,!io. povnio.sof Setion 3?(x)olrhc Llhrr Codc,
<br />WARNTNC: F&ihrc ro sur eorrcm' .onFns,r i(,. orcmB. is unl.wtul. ud shrll {obrrl !n dnploFr ro oif,iml lEmltts mn
<br />ci$l fincs u!' ro one hlndrcd rholslnd dolles (SIm,fllO). h addniotr lo lhc cosl of cohltniarion. ddmgci a3 ptovtcd lor lh.
<br />GYiUv::X,"a . ,4-'" I
<br />LI!:ENSDTIS,NIAd.CIA&
<br />IIEIIdSAIAN
<br />Ihcrlbynmrmu cr pcnohy oi tErjury rhat I am liEnsd udc, provi{io. of Chnprd 9 (.onnmn.inB wilh Sstion ?(x )olDivi\ion3
<br />Dt rh. ausindss md Prcfcsiors Codc. drd ny lir'ctrsc h in full lors onl cficcl
<br />I-iensecl,s: Liensc NunlEr
<br />c()NslRt,( I()N Lt:NDIN(; A(:I NCY
<br />i\\u.d (Scc .1097. Cie C )
<br />lccdilith,I lh.lcdcnl rcguhlions ESardin8 ashc$s rcmvrl rc nor applrabh ro thh pmitr
<br />ft'fi*t I hnk ead rhh rttlkaiion ond shlc lha. th.,tsv. nrloirmrion iscorel. I as.e to cotr{ y wnh all Cn, and Counl,
<br />rrc tiss El0rins ro b!ildina con(tucrion.aothorirc rcFc*nr{iv.s olthis Cnyad Colilyro cor$ up.n rh.
<br />*,", /la?/Y
<br />LAtplicJnrorAEcdSiln uE
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />lnsulation
<br />Smoke Detectors lnstalled
<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 />Rouqh Mech.bht lq,1 '/ndfi4,
<br />Final Tesl \
<br />Meter Release I
<br />FINAL 3 tI l\I.),il//A I p[4
<br />Notes, Remarks, Etc.tl
<br />APPROVALS
<br />Furnace
<br />Pre-lnsulation
<br />lxidcr\ Addrcs
<br />lppLrc,r-lrt ot curna
<br />I ltn$y finnundcr pcnrlty olprrjury.m orrhc roll{]wn,E d(hEri,)n\:
<br />Dcnxniri{nr Pcnnir{ A\hcsro\ Norif'.di({ Fcd.nl R.lulli(,n\{lrlc40,P.n6l
<br />Rcquircd lrrrcr of Norill.rrk,n
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