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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS oWNER BT'II,D!]R DFJLCARATION
<br />I tumhy rntn undcr Fciilly or Fdury rhir I r'n cxcnU riinn rhc (i,nrrdr l,i.cns. llw a{n rtu i,lk,wbg N/\'n (s:.7n:11 5
<br />l]tr\ircs aftl Ploli$ion Co.lc) Any Ciry.r Cornr, whi.h rcqtrms r tr n tu .ufnru.r. rcr. iD|rn.. dcnrulnh or rrprn rny
<br />{ncruru. lri(t h ns $\urt.., ,l$ rLapt$ rhc qrplrr tr nrh lr:iiniru ill. r \i8D.{l nrtnrir rh lt or shc is li.cttd Putsurnl
<br />n,rhctn,vi\i{vNolrhcCoitr.nr\I-i.rtrscdl.dw(Chrprrr9.(lnnnrn.in!EilhSccrion7(xX)olDivi\i(.1ofrltBu\lncsr.d
<br />Pnri\\i,nr\(int.).rrhrrh.orsh.i\cxcnDrrhc.clionr{ndrhctxr\isiorrhcrllcgddcxcnrnrn,n.Anyvk)hiiunofSccrion?0315hyany-
<br />rnrli.r nn Fnnir \uhJ..B rhc rlfli.rnl h i civil Nnrlrt oi Nl nnrc I hon fix hutulrcd d.llar\ (stfir.
<br />-1.
<br />us ownd of th€ Im,Edy. oi my enployss wirh srSc$ a{ rh.! el. compcnsdri. sil do tnc sol a&i hc srMm is mt
<br />inrcnd.n or oncrcd for srlc (Se 7044. Busimss lnd ftolb$ionr Codq Thc Conta.ror'r Licc.sc lfw do.s .or lpply lo an oencr of
<br />rhc pn'Ffly who tiikls or irltloa lltmn, dd wh. dm trh ml* hinsclf or h.r.lf or llvoqh his or her ov. .nploltcs.
<br />pmvid.d rhal such i,pmvtmnts @ n htcndcd or ofl'sld lor sL. li lsmw tlE lDildins or iqewD.r is $ld whhinonc )tu
<br />ofsrglcrii,r. rh. Owmr Build.r wiI hrv. lhc bodm of pmvi.E rhd hc or shc dil nol blild or nrpEw thc pmFny fo. ilE puqDs ol
<br />-1.
<br />N o*rc, of rhc ImFiy, am cxclusivcly mtrlract in8 wilh liccuscrl contEcl{rh lo .oniroct ttE pmrcd (Scc. 7044. Buincr'
<br />ud Eoltssbfl Co{h Thc Contracr.i s Licco* llw docs nor !ppl, ro qo owncr of pml.ny eho builds or imDrov.r rh.rc6n,
<br />rnd who $nrrd'i ftr such Eoirrs with ! ConIncto4o licn$d ,usurnr ro rhe Conrrucrois Li..n€ L!w).
<br />-l
<br />a6 crcmpt und.r SNrio
<br />l,rr' ()1' .r
<br />ill)f,f,E85_C(rMtrNtAlJlr!
<br />I}&CIAMIION
<br />I hcrcby ltfun u.dcr F.alry of pcrj!ry onc of thc folloqirS d.ctdll n'.s:
<br />-lharcadsillnxri'nri',rCcnilicarcofCon\ctrrk,Sclll,rnmli'rtrorkc^.or.pcn$rior.r\
<br />ptr,vidcd r(t hy Sc.llr :t7lD tl rhc
<br />lihor Cod..lin ihc |ErtunnNc ofrh. *ork aor which rl( Fcrnir is is{rd
<br />lhrknnd sill rn iinwo crl conDcnsrlioD nsumncc. !s rcqutcd by Sccti{'n -17{X) ofrhc tiho. Codc,lor lhc Perlnrron.col
<br />rhr work for whi.hrhi{rfimit is rsucd. Myqolkcs comFctrsrtnr irsuarcccrricr el f.licy nnmbct dc:
<br />xI ccnrfy rh!' in rhc Frlormmc nfrhc worl fm *hKh rhis !$mil n assu.d.l stull nor.mploy rfly p€r$n in lny tunmr
<br />/*). r" *mm,utricr r, rtrc wor*c'Lcomacntatnn hw\.t Cdlrlor r.ond asRtha! il I.hould hc.otr {bryrrorhc
<br />wo&dr comF.rdion tmva\ioN ol Sccrion 37m or rnc l,tor Cdlc. I shall. fonhwnh onrly {irh rh.s tmvirio.s .
<br />s..rnr 1076olrhc Lrtfl (-1xt. inrcrderfd rrron.y \ 1..!
<br />(
<br />Lll:ErS[lLgJNlrdCr0e
<br />DECI,AIAIION
<br />I hcnhy rnirm undc, l.n,hrolperrury lhnl l,D li.cnrn utrdcr provhion oICnlprcr 9 ($m,tun.nrB *rh sNtion ?000) otl)ivisio..l
<br />ol lhc Busimss and Pmfc$ions Csic, dxl ny li.cn* ir ir lul, r.m dII criacr
<br />R b(Lu o4
<br />caNliISlguQNfflDINC-dCXllI
<br />I hcmhyrfln'!dtulcr rf,irllyorrcrjur],thi( rhcrc hr. n(ru.ri( r lcRlirs a8cn.y f{n rhc p.rinnrtr..c orrhce.rk hr$hich lhnplrnrl n
<br />i\\ucJ rsr. 1(I)? Ci! C I
<br />AITUIANLDECLAEAIAN
<br />I hcr.t, dnnn undcr Nndrry orp.rjury.ft ofrhc tallowinS delardrions:
<br />D.nblrion PcirnirsAshc{os Nolific ion ltdcml Rcsuhr ions lTnt .(). Prn6)
<br />-Rcquircd
<br />ldtcr of Ndifrarion
<br />_l .cnily rh i rhc l.dcrul rcBxld ions rcSdding r\h(ros rc xrvil ffc nor lnlli.$lc b rhir Itu,L{L
<br />U4&iiyrhll I hrrc '.rd rhis rnllicrrtrn Ml narcrhrrrhcrh,!c 'ntunnari( i\.oftcr I (aie ro .onDly tr ith ru ciry rnd coxtrrJ_
<br />ordifun dsnndSrlrr Lrssrclnrn8tu huildir8.on{nrchon..nLl hcr.h} urhrirr rctrc.cnr rcsofrhisCityMdCoutrlyroclrcrup.nth.
<br />lhow mntioncd pmFny for
<br />Apnlirxnr or Agcnr sr8nrr
<br />Appliances
<br />l\4etal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouoh Ductwork
<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 /A\
<br />Rough Mech.qcltq17".ilr/pv
<br />Final Test rl L
<br />Meter Release
<br />FINAL llult.4 fr Arqad1 .)
<br />Notes, Remarks, Etc.JI
<br />-,
<br />,"'.,r tt [1?.1 te ..".*,*t4 .\t L- Bai',rr
<br />*. ' rrt'gt [t'
<br />Duct Work
<br />Vents
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