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MECHANICAL-INSPECTOR RECORD
<br />APPHOVALS DATE ID/SIG.COMMENTS trlvNnll BULDUll Dt),caRAT()N
<br />I hcr.ht llrnn' rn,l(r Ilrfuht ol p.rjory rhri Irnorcnrd lion rh. (,nrr crnf l-icc rc law hrrhc nilbwins.cr{ rscc70ll5.
<br />Btr\n(\\ rxl Profcs\nr Co(lr)r iy Cnt or Coxhry ahi.h tuqtrrcr r IbN n) c.n!ru.t. rllcr. nnlnnc, dcnvni\h or rc,nn nny
<br />n'!rror., !flor r, i\ i\$riec, rlso rcquircsrlr rpflrntrr tor \u.h tcrnrirtu illc a ngncd {lrdNnr ihrr h:or nr i\ li.rtr{d Nr.un';
<br />ki rhc prcvi\i,,n\ ol rhe C.ntrrr(tr'\ t-itn\rd ljw (Chrtrrr 9. Cotrn cnclng qnh Sc.rio. 7(lxr ol Divnnnr I ol rhc tlu\i',cs ind .
<br />/liirt,..,nrr,,"muur.ut.r.r.rnrJFl,(rnrrni.tr'lncn.,lrirlr{nnr(rr.'l churr' .t,llJ'.'1:o"
<br />Q) ,:..,,,.n,,*,,.,,,,,,r.,,,n,,,,..,*,,n*,r".,,.rh.nn,tu.o,rrrrnttrr.wirdorh.$orkmdrhc(Br,trci\nor
<br />inc..|.d or or.rcd ftr sL (Se.7044. Ausin6s .nd Pmf.ssbn. Codci Thc Oo .ftroas Lietr* L.w dcs nor q,ply Io owmr of
<br />rhc nqEry shd hildr or iqrcE dEE.. dn who dc ckt w!* hims.lf or ltRlfor llmlsh nis o, hd owo .,ployss.
<br />providcd rh.r such nnprokm s c nor hrcnded or otu for sL, lf. lbu.Er, fte hualdin8 or irpsEm.l h $ld ehhin onc ,Es
<br />6f@rmLtio!. {E O*M Boiltr will hlrc tlx tuda ofFovi.e 0d hc d dE dil ml hil tr inprDE dE |'tliny fot dE pupo$ of
<br />_1. sr o*m, of rhc l)tul.ny, am .rclusiRly con[scrin8 wnh li.cnscd contncr.r ro onsrtucr rh. ptoif,r (S&. 7044. Bu\ir{e
<br />Md Profssitr Codc Tnc Contmctol s Liccn* l"a* docs nor Drrly lo un oon.r ol lrcpcny who builds or impovcs lhcrcofl,
<br />rnd *h. $rrrdcrs for iuch ltr+.k wirha 9li.cn$d txnu0hr b rhcCont.clois Licensc L3N).
<br />DECI.AMIION
<br />I hcrcby afirn uMcr ,.mlly of p.rjury om of lhc follo*ing dcclellions:
<br />I hrrc md sill nri'nrhnCcdill.rtcol C.n\rtrrlo S.lilr\urc lur Lc rkcF coarn.nsri,,n. J\ pnrvid.dturbySccrro..l7(xrolrhc
<br />Lrkn Cldc. f(trrtu FnnnnM.c ollfu work iir whi.h thc ltnnir i\ isskd
<br />-l h.E and will msinloin wo&cu Nmpensalhn insrrsrce. s rcquircn B S.crion 1700 orlh. Llhor Codc. for lh. pcafmrce of
<br />thc Nork for *hich $n pmil is k$cd. My vortes smpcnstrlion inslnftc ceicr drd polky nomb.r ael
<br />P.li.vx mlE: Erdl,..
<br />-l
<br />cdiry fiar in rhc p..fornErc of lhc wort for whichrhk pcmil n hslcd,l rnD! ndr.ntloy dny FNn in lny mmmr
<br />s &sro t$om subicr lo rhc wolt6 orpcnslridn hws ofcdiaomid, add aSEc rhlt if I snout tE om subjNl lo thc
<br />wo cs o'npensariotr pNvisionr.r S.dio. 1700.r rh. l-rh.r Gdq I shall. ibnh*ith omply eith ltFrc pmrisionr
<br />WARNNG: FailuE b surc *orke^ omrEnstio c.vcFsc is lnlastul. n.d shall subF.i m .mllortr lo aiminal Il.eltis aftd
<br />civil fincs up lo om hutrdrcd lhousnd dollus (5100
<br />Ss_rion 1016 ol rhc Lltor Con€. i.rcred snd afloftr\
<br />o rh..6i orcomr.relion, da'Egcs as providcd for rhe
<br />6
<br />uc}:lsEutoNrBrttlln
<br />DErlA.U IA!
<br />I h.rhlalllr und.r lcnrkyofpcrjuryrhd Iinr lir.{d urdfi lmvirion olChilncr g (conrmrcing qirh Sccrion T[XX)) dfOirilon.l
<br />of rh. Bu\im$and PdisnnrCodc, rxl my licn\r i\ i full tnr.r i'kltflc.r.
<br />l,i.cn\c CIJ\S LNnlc Nutr$rr
<br />I)Bte Conlrs.lor
<br />COXiIf,UCIITNIENDINGIGENq
<br />I hcreby aflirm undcr Fnoh, of pcdury thar rh.rc h a .onsrGrion hoding .8cncy aor lhc pcrfortuncc of rhc work for shich tht lxmil i!
<br />Gsucd lse. .t(]97- Civ. C.)
<br />APIJ.ICANLIIECI,AMIIO!
<br />I h'rny Iimundcr |xfuhy orp.rjDry onc oithc lol,owinS d(lr,rions:
<br />DcnDlirion Pcrnis.Ash.(os Norili.urnD rtdcftlRcsuhlions (lirlc 40. Pa 6)
<br />-Rcqutcd
<br />l,crrc. ot Norifi.ari,tr'
<br />mllt wirh nllCiryand Counr,
<br />nhrvr ir ri,tri.d tmprny i(tr
<br />Atllicanl or Agcnt SiSmrurc
<br />Cny dd Couoryro cnls ulbn rh.
<br />Appliances
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouoh 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 />Rough Mech.
<br />Final Tesl
<br />Meter Release
<br />FINAL vn '/// a*rydl
<br />Notes, Remarks, Etc.
<br />Metal Fire Place
<br />"""12./472
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