|
MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNi]R BUX-DI'R DI.]LCARATION ,
<br />Inrs rc$ rNl I'rolts{.r Coic) Any Cir! or Cotrr, $hi.h rcquin\ r t i,nir r, (otrdflci- rlr.r. nnf(,!c. C*n'li\h or r.!ir t
<br />{n'crurc. pnor (, ir\ tnrm.c.ahorcrNtcsrhcufrlr.rnrn)rsuchJNDilt)iilcasiSnrJnrictn(rhrrhc r sic i\ i-:dnscd nu^omr
<br />h,'li\\n)n\(idc)orrhar ltr.shc i\ crcnrlr rhcrclio Jtr.l rhc hlst lnrrhc rllc!.d.rcnPri(0 Anyrio[ri,,,ofScdi(tr701l5hyr y -
<br />nmli.itrr t)r iF_nnir {rhr.rs rhc ippli.rnr t' rci!iltcDrlryolnor xtrc rhu lnc hundrc(l olhs(S5(x))
<br />-1.
<br />as op.cr of rh. AbFny. or my .nDlores vith wr8cs as then sb comteoe'bn. will do rhc wk !d tlrc srsrle ii dn
<br />inr.d.n or ofercd lo. sk (58.7044. Busircss lnd Pn',csrions Codg Th. C.ntmlols LtcNc L.w des rcl q,ply t, e owmr .f
<br />rhc pDpcny wtr tiiild\ or iqmB rhcmn. ad who des sRh wott hins.ll or tcrslt or rhmuBh hi. tr h.r own.trll)hyccs.
<br />,rovid.d rh.r such imtmrcmnts m ml inrcdcd n olicd tor slc. lt homvcr, ttP buiHi.S .r imProwmnr is Du eilhin oft )ttr
<br />ol co"pldio.. rh Owmr Buildcr will haE tlrc b'ndcn of pmvins lh"l hc or sh. dt mr b'i]d ot iqmw lhc ptqEry fol rtE lurpos oa
<br />-1,
<br />us oBncr of lfic DnrDcrry. rn .xclu.iv.ly .onrDclue sirh lic.nscd co lr.croh ro consmcl rh. pD.,ccl (Se. ?O14. Bu\insr
<br />.r! Pbfi:xsbi C.d.: Thc Conlr.clols Liccnsc &s dcs nol atply 16 ro osrcr olpfl,Perlywho builds or improv.r lh.r.on.
<br />and *ho conlncrs fd rsh lrnirr3 wirh r CoorDdorl3) lier€d purulnl to thc Cnnieror'. Lk.n* Liw).
<br />-l
<br />omcienrpr under Sccri6n-. B &P.C.torlhisEa\on
<br />lhl., O*..r
<br />WORXE{S' COMPT'NSAT!(IN
<br />DEII,AIA.IION
<br />I lErcby atfin!.dcr Fnahyof pdjuryonc of th. lollowing dc.laralionE
<br />-l
<br />haE ad *iU nrimrn, e C.nii..rc ol Conrnr lo Sclil Nurc for workcF co r!.nsarion. 0r tovidcd lor hr S*r ion lT00 or rhc
<br />{^*".",,
<br />lor rlE lrc onnMc..fuhc work f(r whi.hrhc l).nnt is issucd.
<br />w ill m.i.l!in *orkcr' colnFcnsarion ins!ru.cc. as Eqoncd by sccriotr l?m of rhc Lah, Codc, fo. rh. !.nomtre ol
<br />P4.rf-r su.{ MyworkcB .omn n\arion insutun.c .aricr oM Flicy nlmbere:
<br />c--
<br />LU *adc9ToZ-
<br />-l
<br />ccnify llut in rh. lcrformrc. orthc wo* for which rhis lc.oi i\ nsucd. I rhNU.or cnlloy.ny pcMn ii any odner
<br />s i. ro txm,E *ubicl ro rhc wrksl conrEnsrion lass of Cllilonis, dnd a8ec lhal if I shorld lt<oft subjecl to lh.
<br />w.rkqs conrcns.lt,n rfl'visionsofScclion 3T00 oflhc hbor Codc.l
<br />"hall,
<br />fonhPithcoMply wilh rhot povhions.
<br />WARNINC: ljlil!rc ro scue {orkc^ corqxneri.n $vcmec is !trh*liil. s.d shall qubr.cl M cmPloFr lo dimi.ll Falriis on<t
<br />civil rircs up ro one hunde.d rh.u{nd dolls l$lm.0oo,. in oddition lo rhc..$ ofcotr{Ens0lior, damses as p.ovid.d tor llr
<br />sc.rt,n rn76 rrh!:trhtrGrlA i crc{ tr.Iou,tri(!'
<br />o,", 4?=tb noo,,-",,
<br />DECLAXAIION
<br />Ih.rhyrll]nnuklcrtcnrlryolncrjltrrrhrrIrnili($dtrtulcrt)nni\n ol Ctufcr 9 lconrttinS $irh Sccrhr Tlxl) r of Dn 'not l
<br />.r rh. Rr{,r\\r Pnn $ions(tdc d
<br />'nv
<br />liccnrc is tull f('R{ ..d cl l(r
<br />7 c ezo CZ
<br />Z
<br />IOIIIIBICITONIINIIINC.trCEI(I
<br />I hcrchy arftrm undcr pcn.lry n, ,crjury lhal Ihft i3 e conslru.liotr lcnditr8 r8cn , lor lh. p..aorromc ot thc work for qhich lhis pcmn n
<br />tr{rd lsN .10qr. civ c.)
<br />AIILUANLDISJN.LTA!
<br />I hcrl$_\ rllinntrndcr Irnrlry oft'crrrt otrc ol r1r lall,iwi'r!,iccIrxri(trr
<br />D. xihri( lI.rnril\ A(r\1.\ No(ili.rri li,lrrul Rc!ul,trtrt (Tirlc Jo. Pin6)
<br />Rqunrd l.n.rof Nordi.rroi
<br />I.driryrh rhc ,id$nl rc8uhrions EgordinE ash€sro\.c Dvnl ar. nor applicablc k' thn pmjccl
<br />-l.cnify
<br />rhnr I hlw rcrd lhh,pplicrlion ord slal.lhal tlE.bvc infixndidn isco,Br.l nSre locomply*irh rI Cny nnd Counry
<br />ordimnccsondSllrcliw\mhringbhuildin8..trslru.rion. d lrrchy!ulhorizcrctrcr.rarirc\
<br />trhoe. nrnrnn'cd nioFnt lnr '.x-'*
<br />Afplic!nr o, Asc i siEixrurc
<br />ofrhk Cirysid Cou.ty lo cnrd xpon dE
<br />^,. z/*-/r {
<br />Appliances
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residenlial Ranqe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinos
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />Notes, Remarks, Etc
<br />Metal Fire Place
<br />Meter Release
<br />FINAL
<br />PclnrirN nuE (|ni ):
<br />I
|