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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS owN!lR BtrlLIlEr Dul,cARA'l loN
<br />I hc!.hy rmm undc cnnry ol pcrju'y rhar Iar.x.nrt rnnn rhc Conrrlorr !,ic.n\c lnw nn rhc rolk,si'rg rc!$n (Sc.70315
<br />Bu\in.ss ! Prnlsst,n Corer: Arl ( iry.r Cunrrt whi(h ..nutc\ r Itnni n) o (rud. rlrcr. nnlr^t. dc.nli\h.r rcIr'n.niy
<br />ntucrurr, pnor ro ir\ r\uli... l{, rcttuncs rhc rppli.rd tur such peirnil k' llc a \igncd n r. Mr rhd hcor shc n liccnscd purulnl
<br />h rhc prcvistnN ol rlx Cotrrracln\ l-icco{d li$ rchrprcr 9, Cotri cming snh Scdion'70(x) ol l)iri\nn, .r orrhc 8u\irrcrs r d
<br />rlfli.atrrld r ltnnir *hlccr(rhc rIpli.!nt b..ivilr'cnalttolror Btrcrhrtr firc hundrcd rlollu\ (S5(X)).
<br />_1, a1 owrc! 6f rhe prcFny. or ny .mployes siln waScs .s thcn sh drfrpcnrrr,on. siu do llE vdt trrd liE sftxr@ k hl
<br />i cnd.d o. or.rcd ftr slc (Se.?044. Busiftss and Pmfe$ionr Codc: Thc C.nrebr's Licens kw dfts nol anply ro an owmr ol
<br />rh.0oFny *ho hlilds or iopmr.s rlEon, ed vho do6 sch wlk hihslf or hesclror lhfru8h lrk or hd own edplorccs.
<br />pmtidcd lh.r such inqmwrnls e mt ior.nd€d 6rolIc(n fo. slc. Il lrwE.llrc hrilditrs o, intll*m Lr $ld sthin on. )te
<br />ofompbrion. tlE OM* Buildfi *ill h!rc ih burdcn ofFovinB lhd hc or dE did tul bild n in{'mrc thc pm,Ely ftr lh. PurtDs ol
<br />I. ns owmr of lhc prcFny. am cxclusilcly conlractins wilh liccn*d contador ro mnsM l,E l,mrcl (Scc. 7(}14, BBies
<br />rlxl PrDfcsbtr Cder Thc Conrtur.r's Liccnsc Llw doca nol0rplylo tnowncroflrcpcnywho boildr or iq)rov.s lncron,
<br />rnd who snrru.rsfor such pmrcB with s Cnntndod, lt.nEn !!rs@r roficConr.dor's Liccns ti*).
<br />SISTEEII:.gOMIENIAIQ!
<br />DECI.AXAIIOB
<br />I hce-by a,nm !nd.r I'Elrl or p..iury oE of llE follosi.s d..bDrions:
<br />,l h.vc lrn will Einllh ! Clniii6tc of C.n* ro Sclf-lnrur tor erk6a omFnsrhn, &s Imli(lcd for lry Sccrion 1700 ot rhc
<br />Lrbn Cod.. fd lhc p.rtolrucc of lhc qort aor whi.h thc l,cflh G isslcd.
<br />_l huve lid will msirlaln workcR comp€nsarion insuruncc, as Ertuired by Section 1700 6f rhc tiho. Codc. iot thc Frfomoce of
<br />r6[J \aqlsC\\Ll Ir
<br />nor cnrnlot Jn, n h'n inany unncr
<br />ill should tco.t \!$F.r rartf,
<br />com[ly wirh iln* ptuvisiotr1
<br />_l ccnityrhnt inrhc p.rrornDncc.rihcwort ror wnicnrhh p.rmir is isslcd.l rhnll
<br />$ usro bccom suhicr ro rhc qortcr' compcnsiian l,ws ofCdit rni,. ind 4rcc lhit
<br />*ofttri conrl)cnslrion ,rrovhion\ oi Sccrio. 1700 of lhc Labr Colc, I stull. fonh*nh
<br />WARNINC: tuihrc ri {.urc worlc coryrcnern,n c.vcrasc
<br />rnolsnd dolhu ($l0o.m0). in
<br />ir crcsl otrd ultomy\ rccs.
<br />I
<br />I hcEby arlm undd Fmi, of !.lFy lhd I .m lieiscd u.dd pDvBion of Cha[lo 9 (ohmftins wiln Serbn 7Cm) of Division 3
<br />of thc Blsimss and Prcfcssions Codc. dd oy liccns is in lull i6re dd elfsl.
<br />q
<br />N
<br />I hcrbJ- afitmnndcr pclalry oipcrjtrry rhd rh.r. n n.on{n,.ihtr lcndirS iscncy f.r lhc pcrao.riumc orrhc *oik nn shich rhis pcnnil is
<br />n$c'l lsc. :1(D7, Civ C.)
<br />rru.lc Nfllrta.BArraN
<br />I [nb).ltnnundcr Fnrhyripcrjryonc orihc,hllowinsd.chrJrn,n\
<br />l)cNliri()n trdmirs Ashc{o\ Nonncnrn,i lrrdctul R.tuluri,rs (Tirlc 10. PrnO
<br />Rtqrrr tr(rrolNorifi.didr
<br />-l
<br />c.nify lnal I havc rcld this ion Md iur. rhd ihc rh,vc inlnrmrrnrn ir concd. lngre k,&rnply sirh rll Ciryr Counry
<br />ordind..\ rtrd Srrrc bwr nlniry b
<br />ih,vc f,dnNd |)lop.nytnr insp(l
<br />of rhis Ciry ond Cour, ro coro uBr llE
<br />Aprlicrnl or Arsnl Stflat!rc:-
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Fu rnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />Smoke Detectors lnstalled R
<br />Rouqh Ductwork |-btb z t*4tno ufJ/
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe ,4:\
<br />Other 4ril/#.?-a rB /a ''Zo-zz ga:!/
<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 q 20 -/6 4/-rvez d?2)
<br />Notes, Remarks, Etc
<br />lnsulation _l xncr.nrlrrD{lcr Sr.ri,nr .ll &P( inrrhi\rcr{lr
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<br />_l ccnifr rh0r rhe rcdetul rclnldions 6g,rdin8,sb.io! rcmvrl uc mr applicll,lc ro rhis F)jd
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