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MECHANICAL-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS (}VNER BUILT'EI DELCARATION
<br />I tercby arm lodo p.ully of Frury $al I d crcnfl fmmln Conlncto* LkeM L,s fot thc follo*ine @sn (Sa.?0.]1.5
<br />Btrsi.css ldl ftoacssiotr Codc)r Any Cily o, County *hth rcquiEs . pemn ro conslrucl, altcr. improvc. dcmlish or Eprlr onv
<br />srrud!rc. pri,r ro ns irsmc, al$ rcquncs thc alplt!fl ror 3eh Fmn b filc ! si8tud sldcmd lhst lE or sh€ is li.cned l,utrudl
<br />ro 0rc prcviriofls ofdE Conlrsi.as LienEd t:w (Ch!!,lcr 9. Cof,tunca.8 wilh Sdlion ?(xlo of Division 3 oflne 8tsin.* a.d
<br />Pbfcssions Codc) or rhlr lE or sh. is cxsmfl rhctclioh od rh. besis for lhc alkscd dcnption. Any viohlionofSdlion 7031.5 bv env
<br />0mlicad for.IEmil srbj*ls lhc applt, roa.ivilp.Mllyofrcl mrcihd nv. hundr.n dolles ($500).
<br />-1.
<br />as owndr ot rhc po|Edy, or my cmplorcca qirh eeget 6 thcn sb mmrcnsation. sill do tlE wot( ad ln smtl@ k mr
<br />inrc .d 6r offcr.d f6r eh tse.ro44. Burhcas and Prcfcsshnr Codc: Tti C.nltutq\ Lienr L3w dcs ml lpplv lo m owmr or
<br />rhe rbFny who tnikk M in DB tlt6.. {n sh des trt mrl hincla6, hcBlf or lhmtsn hk d lEr 6m ctr{,loyces-
<br />povid.d rhar surh inpoEmns m nol i ciid.d ot or.Ed lor $h. ( h.rcE ltE btri}li.g or i,rptuKmn' is sld widii. om )Ea
<br />oaonpkrion. rlr Owmr Build.r vil harc dr hldcn of B)vin8 l}u tE or $c dn d bild or iqmw dE Pml'sl, for rlx purpoe of
<br />-1,.{owrcrof
<br />lhc p,oFny, dctclusivclyco.hding wilh liQtr$d.oolscto6 Io onsrdd EP,si(l(56-tu44 Busim*
<br />&n Ela6siiC.dcr Ttc ConlBlols Lic.nsc Las d@s mt spDly ro owmr of[openy{ho huil& or imPots thc,6..
<br />md wh. snrBtsforsochrftjek wilh ! C.mo.1o(, li..nrcd plM & llE ConlBclo* LiccBc t w).
<br />! ancrcnrpt undcr Sccrn,
<br />EO8&IB5]COMTEIi,SAIION
<br />DECLABAITA!
<br />I hcrcby 0ilirD utrdDr pcMlry of p.rju y otrc oilhc iollosinr dcclrrurnJnsl
<br />Ihrvclrla$illnuinrrinaCcdil{ircoiCofl$nthScliln\urctr*orkclicompcns!'ion.$pn,vdcdforhvSltrion.l7(x).1rhc
<br />tf,bor Lidc.lor rhn rcrlirrus'c r, rl-c nu'[ h1 trhi(h rh( 81trr, i. r.d(l
<br />-:l h cin,l*rllmr rn$r*c^lonrPcnlJlt,ntrFUrJ,r..drruquitdhySccnon.lTmorrhcl-0hltrC c. nn rhc lcrrormncc oi
<br />rh. wort fo! wh'chthE ffim rs issucd. Mt wo*6 .um.qarbn hsurJncccuier, , {af'aliLfirp lac.
<br />izOddA"<oz 2?
<br />-l.cnifylh0!
<br />inrhc pcrfonMncc orrh.wortlor whichlhk Pcrmil is t$.d,I sh,!l.ot cnltlo, any
<br />s 6 ro bcconE slhj.rt to rhc wo cn ompcnsarion hws ofclliromia. trnd larcc lhui irl lhould h.conE sutFct lo 0t
<br />wort6' smpcnsrrioo povisions of S.cl ion ]700 of lhc Lar$r Cddc, I shlll. fonh*nh .onPly wirh rhos Pmriin,nr .
<br />WARNINC Foilurc lo s!,c *ork6 omt[nstion ove r d c'ufl.ycr kr niniml lEtuhi.r B.d
<br />.ivil fims uD ro om hlndrcd lhousld dolhn ISI of comlEnsnon. d,rro86 ss Fovidcn Lr ttE
<br />.f rhc Busnc$ nl Prrc*ionsCodc, nnl nry li.ci\c is i,r lullln...lidclf.tl
<br />L
<br />I h.Ehy rlfirr undcr FcMlryofErJurylhlI lhqc h r
<br />i\\ucd (sc.. l(l97. Ci!. C )
<br />lcnding .Bcmy for it pdrolmmc of th€ sork fo. *hich lnL Pdnn is
<br />-l
<br />rdlil!,rhat I ltrru rcrJ rh^rion iscodr I ogre ro coqrly snh lll Cny and Co!trly
<br />,,,lfrn(.\ x dSr .I.itr1n.r PEsnllrnq olrhir ciryd.d c(,unr,
<br />rh,!c ocnrioncJ tul)|xn, lor
<br />i. {n h.rch, nrrhoriz E
<br />t9 Lo'Lo
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />lVisc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<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 />Rouqh Mech.
<br />Final Test
<br />Meter Release I - /^
<br />FINAL l/'tu //4,rh ff /0Y
<br />Notes,Remarks,'E-[c. I
<br />APPROVALS
<br />I
<br />1
<br />tr k t Nmr-
<br />I.nd.as Addr.{sr
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<br />rppt rcriilrr-ilmixiF
<br />llErbyatnm!nd( Fnrlry oiPcrjury onc ofthc ft'lLsiis dc.l,r,rbns
<br />Drtulnion Pc nireAst sros Norifi.rrion F.dftalRGBUhtions (lirlc40, Pd6)
<br />-RcquiKl
<br />lf, rrcr of Ndili.alion
<br />-l
<br />ccnifyrha! rhor.d*Nl rcaublions Esrdins ast{do\rcmv aE nor !Ppli."t lc ro rhis pmjcl
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