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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE IDiSIG.COMMENTS OWNER BUILDER DELCARATION <br />I h@by lrm und.r pd,ly of pajury lt! I m crdp tln rh. Conhcldr Lic.M Llw for lh. bUowing l@fl (5€.7011.5 <br />Buin* ad Prcf<ior Co<L): A.y Cny or Cou y which Equid r p6tnn ro @n:(tu.r. .lrd. in$.ovc. <boolit o. rtr& e, <br />srtudE . Fbr lo it! i.sec.. r&o ..quna rh Fpli.an fo. $cn pdnl <br />'o <br />frlc . ligdcd !td66i lhd lE or Ct b li.d!.d p@r <br />lo fi. Fovnio of tll ConlrEtd r Licn&d L.w (Chtpr6 9, Commins wirh Sdion 7000 of Divilio! 3 olrh. 8uir6 dd <br />Pmfdio co&) orrh.r h.orsh. b qcmpr th6<fon Md tLbalG for $c dLs.d ddFili. A.y viohion oas*lio. ,031.5 by my <br />lpplicer for ! p6ml $bjd. th. ippli.et lo 3 cilil pc.dry of mt noa th& fivc nudr.d &116 (1500), <br />-1. <br />s oMs of lh. FoFrry, or my.EphlE wilh f,!96 s ltcir $L smF!.Iion. will do lhc wDll &d $. nrl(r@ i rcr <br />inlod.l or ofrd.d fo. slc (Sc,7044, BEilB ed irof<io6 Cod.: Th. Conlnclor'r Lt6* t * do6 mt .prly lo e o*n6 of <br />tncFoFry who hrilrhor ifFov6rEoa ed vho <bd ech m* hn clf or hfi.lfor thhu8h tln o. na om dploy6, <br />previd.d rhar Mh inlrworEt! e mr it od.d orofiEd for hL. lf, howN,tn. U,iE!C o. iipr@dEt t 5ld wihjn o.. yd <br />ofcotrpkiol! rlE 0$!6 Builk willhrE tlE hnk ofFoviig rh, h. or sh. drd @r hild or nqr.v. dt FDpGly for tlE F4oe of <br />l, d ow ofrh. prop6ry, e dcluriv.ly .onlrdif,3 wnh li.oej co,nEdoB to connnd llE Foj.cl lsd. 70.14, &Bin< <br />and PBfrsix Cod.: 'l h. Conlretol ! Licc. L& do6 not rrply ro d omd of Fopdl, *ho buildt or inpmv6 lhdmn. <br />sd sho corrEcr. for ch pm.i..rr wirh ! CodEclo(r) lica!.d paMr ro th. Conmdort Lk.e L.v). <br />-l <br />m .r@F ur<td S<don-, B & P.C. lor rhn r@n <br />D.r.: 0r!6: <br />.uaaa[ll]courrliarra! <br />DESAAAIIq! <br />I hE!h, amm !od6 p@!h, oaFjury oi. offi. follo*i.g ddl0!tio6: <br />-l <br />h&. lrl will uinlh . Cdliiclr. olcoBa|r ro S.lf-lM for wrkda onrp.ulion d Flvid.d li,r by Sdlior ]700 of lh. <br />hhor cod.. lor tbc FfonMcc of lh. e* for whkh thc pdrir h b!u.d <br />_l havc .nd will nai.lain wotlsi conFG.liotr iNu.mc., a rcqun.d by SEI ion l7O0 of th. L5bor Cod€. fo, rh. Faoll1r@ of <br />th. porl for which thii pcmil i Ls.d My vorlgr onlpos.lior iMc. ceiq dn policy nmbd a.: <br />PolicyN!mbd:_Expn6: <br />-l <br />cdlifyrhd <br />'n <br />fic p.rlirtuc. of $. wo* for whth rhis p6nn is bsu.d. l3hau mr @ploy &, FMn ir my bM <br />o a lo b..oE. subjet to ti. M 6'oopas.tion ln*. oac.lifomir ud daE lfid il| should b..orc tubjcn lodt <br />wotld'renp65lionlovisioEofsglionl?00oflh.t bor Code l Jull. fo.lhf,ilh empry vnh thoe po,ilioa . <br />WARNINGT Flilu. to ffi wl6' .onpcaion o!d.8. i! MLwtul. !d shll !!bja1 a dploF lo aiEin l FEhi: ed <br />.ivn fsBoproon nwdr.d $o@d don4 (1100,000), i!.ddnion lofi..or of .omp.Nlion. ddDlsB a provid.d lor lh. <br />Serion 3076 oarh. tdor Codc ima.3 @d filruy ! 46. <br />ug,!$lrou&tcronlllctAEalIo! <br />I h.r.by amrm unds p.nahy ol psjury lh.l I m liccascd und6 rrov!'on olchapl6 9 (&nndcrs wirh sdb. 7000) of Di! ision l <br />ol lh. susi.seJ ProlaioBaod., od mylicm. is in lullforc.mdcn*-r <br />coltrBucrloNtElltlc-Acllcr <br />I h@b, lllm onda parry olFjo.y rnd $s! is r @Nti*lio! kodiDs lscy ror dE Ffodrr*c ohlE m 6t whth thit Fai h <br />i$u.d (Sd. 1097. Cir. C,). <br />AIIIJCAII.DECIAAAIIA! <br />I b.!t /.6m undd p6dty of Fiuy oo. of tb. tolbwnU .LrlmlioNl <br />D.mohion PmittsAlbdor Norificdion F.ddl RceutdioE (Tirlc ,l!. Per6) <br />-R.qun <br />d Lat6 of rtud6erin <br />-l <br />cdiry lh.l lh. f.ddel r.srhtioc rcsedirs shGlos ronoval r€ nol E0plicabL lo thi! projc.l <br />-l <br />cdiry rhlt I h.vc Ed thL .pplic.rion c.d srllc lhd rh€ abo\c inaonndioi is .orccl. I lsre kr cosply *irt rll Cily ind Coul, -ordimcd d Srd. ttM ELltrU ro boildi.g .oGrndiotr ald hftbyrufioriz.r.F6. rivd o tuhis airy dd Coury ro dtd ulon rh. <br />dbov. Mrion d pbpdly aor irep<rion prro!6. <br />Apllicol or A8d Srgnarur.: <br />r'mrR noc rFn,r <br />Appliances <br />Metal Fire Place <br />Evaporative 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 <br />Toilet Room / Clothes Dryer <br />Residential Range <br />Olher <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />FINAL <br />Notes, Remarks, Etc <br />lnstallation <br />Meter Release <br />Drrc: Applldnr: <br />Lic.B. Cl!*:-Lic.B. Nmbd: <br />- <br />D.t.: Contr..tor <br />f-------T------ <br />--+-