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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNER BUILDER DEL(NIATION
<br />I hrby !fftrnr undcr Dcehy oI pcrjury th,l I m.rcqr tmm rh. Conlmclom LtInc kw for lh. lolhwing t e:ln (Sf,c.r031.5
<br />Businc$ md Prolcssion Codc): Aiy Cny or Colnly shicn requircs t Fnir io sisru.r. dr6. imProvc. dcmlhh or EIEi rni
<br />stdctuE. Irior ro irs issumc. alro reqlirc! rh. applicer fo, such p.mir ro iL. si8nc{ stdcmnl lhal h. or rhc ir lic..scd puuuel-
<br />lo rhe ooviqtons of E Comrocloi. Lianscd Lr* (Chsplcr 9. Conmftits wnh Sftrion 7000 ol Division I of lh. Blsitu* atd
<br />Pmac$ions Cod.) or rhar tE or r& h cicrlpr rhdctom lnd rhc t'rsh for rtE alhg.d .x.mprion tuyviolalknofS.tdon7oll.5 by!r,
<br />opplicanrfor!pcrmilslbixr!rhc,pplic,nrrorcivilFmhyolnormorcrhannvchlndrcddollrs(S50O).
<br />-1,
<br />!s owmr of lnc Fmlcry. or dy cmPlortts sirh a{scs !s lh€[ eL conp.ns,tion. viU do tlE lGt ud th€ flanm ir mr
<br />inreidcd or ofisrd lor €lc (Se 7(M4. Bushe$ x.d PrlLssion. Codcr Th. Conlrlclols Litn* Lrw docs nor tpPly lo tr. owmr of
<br />th. poFny vls t[ilis or itrproB rlEEn. sn *ho dG Mh a himsclf 6r h.Mlf or thmt8l his or h.r oM cml'loyc.s.
<br />providcd rhar s&h ihltr*cftn* m mi inrcndal or oned ror $L. lt h.wtd,
<br />'lE
<br />trildin8 or itrpmrcmar is sld wirhi. oft ttw
<br />ol coq,hrion, rh. Owrc. auil,ft pill haE tlE hrdcn or pEvirg rh{ rE or shc dn ml hild or inpmE 0E p&rery for llf, puqr* or
<br />-1,
<br />asowncrolOcFDcny. m. lusiv.lyc.ntu.lin8 wilh licc.s.d conl6loF to.onstruu rhc pnrrt Ise.7044. Busrne$
<br />od EDftrehn Codc: Thc Conrt.clois Lkcnsc L!* d@s mt applyro eo{n r olpmrEny who builds or impn*r lheon.
<br />a.d whd .onitu t. for strch psjccls virn ! Conrrcro(s) liNnscd l,usldtrt ro rl* Conrndoar Lkcn* Lrw).
<br />_l @cxcnpr und.. S*Iion-. B. & P.c' for lhis eeen,
<br />UAf,f,EXI:IAITTENIAITII!
<br />P[CIrrBAIlo!
<br />I hc.cbyaffinnu $pcndhyof pcrjuryorcolthcfollo*ir8dcclur ion\l
<br />Ihrvcddwillmn dinaCcnificolcofcon$nlkrScll-lnsu.cfor*orke^.onFns,lion.os lrovidcd ior l,ySclt,i l7m ofrhc
<br />Lrti* Col., lar rh. Frfommo ofthc wort for qhich rhc p.mi i\ nrucd
<br />!(hN c ,nd wtl ,r$N,m * o*cr' .omrcn.at i,,o rnrurJmc- as rcqui'.d hy sccrion 37m ol rhc rjbot codc. ior lhe ,trrornM.. of
<br />lrcmr n nsucd. MywTlsr compcnsalion inru,atu. cri$ a,xl D.licy nuflrhcr !rc:
<br />.)
<br />-l
<br />eniry fiar in rne lcrfortuft. ol th. *ork l'or whth rhis Frmn h issu.n. I shlll ml tnploy fy Fr$n in 8ny marcr
<br />s Bhh$or biccl ro rh. eod€F' coml.ner ion lawsofculifomb. and,gN lhat if| should hcom suhjcd lollt
<br />mr(cs ompcNllion lmvisiotrsofSerhn 1700 ol rh. tlbot Codc.I qh.ll. aodhwilh om'ty vilh thotlmvhionr.
<br />WARNING: FailuE io src work.* .omF.sdion ovmB. is unhwtul, aId sh3ll clhirr d cmplortt r. aihiMl tEmhis Md
<br />cilil li.ca !p ro oft hundrcd rhou!{nd dolltrs (lloo,fiio). in lddnion .omp.nslion, dame.s as F,vidcd lor rhc
<br />Serio.1076orrn Lrbor Cod.. inr.rci rnd lnomy\ fes.l"c ZA
<br />^w-,,
<br />LICENSFT} CoNTRACTOR
<br />DECI.ABAIION
<br />I hcrhl alftm uklcr p.nrliyoltl.rjury thol I am liccnsn undcr pr,li\ion ofChrrrd 9 (.onnNkinS pirt S.cliu 7u)O) orDivi.n,n:l
<br />ol rhc Blims lnd Pmic$i.n\ Cod.. md n, li.chsc h in rull roruc ut criicr
<br />C (
<br />rcISIaT1:II!,ILISDITIi-^.(iI,ICL
<br />i\\u.d lsc. .10q7. Cn C I
<br />AIPIIIANIDEI;LAAAI,IA!
<br />lltrby!fiinnu crncn!llyotpcritrryondof rhcf{,llowinsd..ltrflrn rs
<br />Ddnhlir,oi I'dnrirs Ash.sos Norific.lton fcdcral RcBulari.ns ('lirlc40. Prn6)
<br />Rcquircd t.dt.rol Nolillclrion
<br />-l
<br />ccnify rhor rhe acdcdl EslhrioN Egndine abclror rcmval m ,or arplicrble lo tnis Pojtl
<br />-l
<br />ccriify rhsr I havc rc.d rhh appliclrion anl sIllc rhlr rne ahow ioromrion is com.l. , agre to oxnply wnh all Cily ond counly
<br />ordituft.s rd st,r. hw* rcl,rins ro buildins omrtucrbn. und hercby aurhoriz. cprcknraiils oi thk Cily ond Counly lo cnlo uF. rlt
<br />uhovc nf,rlioncd pm0.ny for insperion
<br />^,", / -6-?r',
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />Smoke Detectors lnstalled
<br />Rouoh 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 Ducl
<br />Fire Damper
<br />Openings
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rouqh Mech.
<br />Final Test
<br />Meter Release tt I
<br />FINAL tnuQt &illM rr
<br />Notes, Remarks, Etc.
<br />COMMENTS
<br />lnsulation
<br />lnstallation
<br />3 -c-7.0
<br />-71,
<br />rT
<br />i-F-
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