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MECHANICAL-INSPECTOR RECORD <br />Ownr-B!ild., D.cbntion <br />I h.r.6y.m.n undd p.rhy ofpdrlry ihd l.n.r.npr aorn t. Conrc.roB Lr.n* trw forlh.lollov.ng @sn(r470!1,5 Buin6i <br />ud Prot6sion Cod.)r Any aily or Cou,ly which r.qutd . pmn to @Nrtuc1, .ltd, inprorc, ddoli3h or rcplk &y sttuct@. prior lo its <br />iriun ., .bo r.qun6 lh. rppli.rnl lor $ch pmir ro filc r sign d 3tlrcm.or rh.r hc or ih. i! liccBcd p6@r ro rhc tDvisioc oa th. <br />Conldctois Li..B.d Liw (Chrptd ,. Codh.rchs wirh S*tio. ,0oo of Divisron I oa th. ABinds ind ProfGrDB Cod.) or rhlt h. or <br />rh. i! cr.mpt lh.rctoo .nd lh. bair ao. thc rllcg.d .r.option .Ao, viohtion of Sdio. 701I .5 b, &y lpplicer fo! r pcmh lubj.crs thc <br />apDli.! lo..iyi!pc lyofnor dorc rhtn 6v.hu r.d dolhE (1500). <br />__1. a ow.d of rh. popdy, or $y .mploy.6 wth u!36 r. ttcir !ol. @np..r i.n. will do th. work ud lh. !mcr@ ! .ol intmdcd <br />or olf.r.d for $1. ( sF ?o44. B8in6i ind Proldnonr Codc Th. Conr..ro* Lic.N. Law do6 mr .pply ro d osns ol rh. pop.tt, <br />who build! or ir prcv6 I h.r.on. .nd who do.s such sork hiaclf o, h6clf or thrcugh his or hcr own.nplorc6. provid.d rhll luch <br />impbvm.nls r. nor in'ad.d or oftd.rl ror sl.. I I howcrn. th. buildins or improvd.at n $b silhi! onc yd ofcooplaion. tilc <br />Ownd- Build.r will h,v. rh. bnrd.n olprovin3 rh, hc or rh. oot build or inpo!. for th. purpos of $lc). <br />_1. a own.r ollh. prcp.ny. am cxcluriv.ly conrracli.s sirh lic.@d cont6cro6 ro @Blrus rh! pmjd ( Sc. ?044. Bai.6r md <br />Proa63io. cod. Th. Conh.dor'! LiccN. t w do6 .ot rpply to e o{a ol prop.dy who buil& or ihprcvd fi.@n . ed wno <br />@nhc lor $ch proj*ls wilh ! Contrclo(r) lic.G.! putu.r ro th. cont.dor'r LE.nsc L.* ) <br />I m.xcnfl @drsccrion .8. & P.C. forrhis r.aon <br />IAA5EAIqAMIENAIIA,N.DECIASAIISN <br />I hGby ltlid @d6 p.olty ofFrjlry o.. of lh. follo*il8 dcle.rioa: <br />_ I h,rc and will robtain r Ccnific . ol Coc.nt to S.lf-16!r. fo. worl.u .omplMrotr a providcd 16r by Seton 3700 of rh. <br />l,bor Cod.. for rh. p.rlom.!.. of lh. wor! fo. which rhc pcrnit i! i3!ucd. <br />I ha!..nd *illm.inr.in *orl.ri onrp.Mrionrnsu6.@,as,cqu&dhyserionr?0oofrh.rrborCodaforlh.D.rlorrubc.olrh. <br />worl aorrhich thn p.rntr is is!.d M, wort.u rbn rnsu.lnc. qnt€. Md polrcy nomb.rarr: <br />q 2 g <br />(ThL *crion N.d oot b. .of,pLr.d if rh. <br />-_l ccniayth.r in rhc p.rfoflMnc. o[ lh. wolk for whi.h rhis p.m,t i! i$o.d,I sh.ll not .nploy .ny p.son in rny tBnn( so !s ro <br />h..rm. slbjcd io rh. *o .ts 6mp.nsrion hws olCrlilorn'r. rhd asra $ri 'l b@h. rubJd b Ih. worr.u <br />co'rp.n$lion prcvisionr olS.clion 1700 oathc <br />WARNING Flilue lo s6ur. work.B cooFNtion @v.Esc is unla*,ful, ..d ih.ll subj.cl an .nploy.r lo sr ul pdln6 .nd cryil <br />fiod !p lo on h@dr.d $ousd dolla {$100.000).in .dditioi ro rhc cosl of conpcns.lion. dMg6 a provid.d ,b. rhc Sclio! 1076 of <br />rh. trhor Cod.. inr.r6t lnd rnorncyi f@i <br />llcE!$Le9draAcroBtoEq4aarlQ! <br />I hdcby amrd uodd p.tuhy orp.rjury rhal I m licco*d uddpovisiotroichipr.r 9 (comntcncins $ilh Srt ion ?000) otDivisioo l of <br />\"*"rH'.;"lic.N. is in lull forcc and.fi(r <br />I hcrcby arfirn und.rpc.lhyorr.rju.yrhll rh.re ira co.srtucrion Lndinsa!.n y roilh.p.domin..orthc wo* ror*hich rhispcflnit is <br />issu.d (S.c. 1097, Civ. C.). <br />ac[&!c44L!.EC! 8 IION <br />Dffilirion Pmits.Asb6t6 Noriliclion F.dsrl LglhtioB(Th1.40. Prn 6) <br />Rcqubcd t 16 of Nodfr.rlioa <br />I c.nify lhlt rh. f.dq ..guhlioB ieudi.g Bbctos roord e nor lpplic.bl. lo rhi! prcjcr, <br />__ I c.dit rh8r I hav. Md this.pplication and narr rnnt rh. abov. inaom.rion i. con..t- I ase. ro comply wirh.ll Cty rtrd Coutrry <br />to buildi.g oDlrur,on. rnd hftby authoria !.prc.rl!liv6 <br />ID/SIG.COMMENTS <br />Appliances <br />Ir4etal Fire Place <br />Evap Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents .K\ <br />Toilet Room / Clothes Dryer 5-{-tg a <br />Residential Range \) <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 Test <br />Meter Release <br />FINAL //tcln ? Ivrrv.t6'12>)UI <br />vM&) <br />M \WP51\P€mil.lnspsclion F doc 03.31.06 <br />of l!i! Cily @d Coufl, ro al6 !po. lic <br />APPROVALS DATE <br />VLtr' <br />I <br />I