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MECHANICAL.INSPECTOR BECORD
<br />COMMENTSAPPROVALSDATE
<br />Appliances
<br />h/etal 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 />Rouqh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<br />Other
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinqs
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />l&-.Rouqh Mech.I hllt q h4/1ifk
<br />(Final Test
<br />Meter Release
<br />dtur(k
<br />'
<br />,10--..FINAL 4lt.lti
<br />-Mles, Remarks, Etc
<br />,-.rct trtrt / a-bua d)h)L,o P C.tn,wilJ crv)- wr tl&rh€{*!
<br />ottNttR Irull,t)t:R Dr]l,cARA l l()N
<br />I hcrchy rtllrnr undcr pcnllry (,r Frjury rhrl I am crc'nnr tiofl rhc O,nlmcntr' Li.cnsc tis n)r lhc nnLrsnrs rclsnn rsq-7nll5
<br />Bu\in.s rnd Plorcssion Codc)r Afl] Cily nr G,lnry whi.h rqntcs I Pctnir r, .oNru.r' llrcr. impr.v.. dc Eli\h or dprt ntrv
<br />(rucnrc. dor lo ns (u c, .ho rcqondr rhc ,tpli.anr rbr srh pc,nir k, lilc r sisncd sl cntir rhd( ls or shc is liccn*d N,suur
<br />k)rh.pn nnnrs ofIhc Co.ricror's Licenscd ljs lchrlrcr 9 ClmnNNirrg sirh sc.ri('n 70ln ol Dilirnrn 3 ol'lhc au!in'{s ind
<br />Pnrt$ions Codc) or ihrr hc orshc hcxcnfr rhcrcriomand rhc hrsis itrrhc.llclcdcrcDDri.n A.y viohr im oi Sccr ion 70ll'5 hvonv
<br />rfnli.anr ruroNirnil n,hj(ls rh. ipplic0nrto {civillcnalry.rnor nnrclhu fivc htndrcd dollG (S5(x))
<br />L as owncr oi lhe polcny. or my empl.yc.s *nh saBcs $ I hct $lL co'nPc.srrion. sill d. rh. sork .fr! lhc (urm n mr
<br />inrcnd.d or otrcrcd fd elc I SN 7(Ert, Buqims\ ntrd Proltsiors C.dc Thc (ln r0do \ l-kdnsc lrw doc\ nor rrljy ro !n ovNr ol
<br />rhc pn,pcd, qb ttrilds or impr.vcs rhcmtr..tu who d(E\ stch rod( hir{ilor hcr\.ll.i rhou8h hn ot h.r orncmflo}er.
<br />lrolidcd rhal u.h i'npmt'mnr s nor ioreftlcd d oltmd f{tr sL ll lmwckr. rlE h{i[ling or i'nProvcm n {rkl $irhin um rtJr
<br />ofcon{h(ion. rhcOwncr Buind will hrvc lhc burdcn olp(liiB ihd h- or \h( did rn huild or inrlrmrc rhc Pnrlcny Ibr llE ptrrF'*uf
<br />l. ss owner of rhc nropcny, am cxchsivcly conmcriog wirh li.ensd co.rhclor to omldd th. prorcl lsa. 7014. Busimr!
<br />a.d ADassim Codc: The Co.imior's Liccnsc Law d@s.or dnply io ano*rct otlhFrly rho builds or i.Vrovc,lhcr@n
<br />md ,ho onm* ror such pojctl.s qith r Co Rlo(, tia.sd lu*udt lo llE Conrkrd . LiNn* Las)
<br />l s cxcmpr tndd Se'io B & P C. nnlh( r.asn.
<br />}ASTDIN]SJIITENIAIIQN
<br />DECIAEAUI.IN
<br />I hcrchy ltlirmond$ r.n,llyof lrcrjuryoncorrhc rollowing dccl lrions:
<br />I h.rcadwill minrainaccnificalcofCoo\cnrro sclrln\urc for *orkd( smPcnsarion. as F(,vidcd lbr bvSccrirn.rTtD olrhc
<br />l:hr C.dc. ror lhe pcrfolruft of lhc worl for $hich rhe Pcmir i( hsucd
<br />I havc and will mainhii sorkcF co.rrcnrar ioo in\u.,R.. ,s tcquncd hy Sariotr 1700 olrhc LtrhiJr Codc for lh{ l.rrormncc ot-t{ii ,.mir ir isscd. My work6 mnlFtr$lion in$roec .ri.r .,n tnficy .umbcr m:
<br />.lrl Cr - F.<-s2
<br />(c.\5' l?I ,-1 ,-Cn{?BoS
<br />-l
<br />enilyrhnr in rh. l.rfornErcc ot lic w.rk for $hi.hrhi\ P.trnir is i\{rcd.l shrll.or rnfloyinv |Eron ii iny tn nncr
<br />$ a\ b lF.otrr suh]ccr ro rhc $(,kd ompctrslrion hs1 dr Crli{ flil. lndxstc rhrr irI \houll hc$nf, subi.tl h|tr
<br />sork.^.onlcnqriontmvi\bnsorScclionlTl)Oolrhcllhn(:odc.lsttrll.n,nh$nhc.nrlveirhrno{lff)vision{
<br />W]!SNIN(;: Fiilxto b scurc qorkfis .omFtrs0rnn co!cr,8c ,\ unllqtu|. rnd \hrll uhj.cr otr cmPloy$ i, nair F-'rlri's'nr'
<br />civil finca !p lo orc hlndEd lhoueod dotl&s 1$1m.000). in addirnJn lo Nrion. ddmgd as lrmvij.d for lh.
<br />Scction 3076 .l ihc t$or Codc. inr.cs ed 0trormy s fes.
<br />Dr",. lt .zr.\*
<br />LICIINSEI) C( |NTR C l()R
<br />DEOAEAIIAN
<br />I h.rby,fii.n undcr penlhy.rp.rjur] lhar I an lian*d undd r()vnnnr otChU.r e (omBncing wirh scdion 7fi)()) 'rDivtion:1ol rhr Busitusmd PmLsionsCodt. d nrr licnsc is in allltur.c r{lcr'is-.r.
<br />. Ct-o zo7t1
<br />e lL2<. lU conrmcro.)4 u-
<br />c()NsTRflclloN ! Fr\DlN(i acFN(lv
<br />I hcr.by rfln'nundcr pcmlryorp.iury rhd rhcrc i\ a co.qfl.rk)n hnirs lscicy k)r lhc l,crforroncc.f lh. work rbr shich rhis lEmil is
<br />ksucd lscc 1097. Civ. C.).
<br />L.rd.r's Nam
<br />-
<br />rhar I hd! rcnd lhis appli.lrio. a.d {alc lh0l lhc !t vcint tur ktn is corer' I agG ro complv *irh Dlt cirv aod counry
<br />odindr.s Md sralc&*srchringb huildins co luthorft icrrc*ntlrivci oathn cirymd Coonry ro cnld upon
<br />abvc m ioncd pmrcn, for insp..li.r
<br />Amli.nrorAg. Si8nrrurc:x
<br />X $l---'-€).':rct-
<br />/(.2<.t(
<br />ID/SIG.
<br />Hood
<br />m
<br />Dlt€ -.
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<br />o*n..
<br />Llndcis Addres: _-
<br />r ppr-rc,riiliiiir iiiru--
<br />I Hry ufim undcqcnalt, of tc{ury onc of lhc l'ollowing dccl0rar ions
<br />D.mliriotr Pcirnih Asb.slos Noliiicotion Fcdcial R.gul,riotrs Oillc4l) Pd6)
<br />-Rcgnircd
<br />Lclrcr of Noliarcarion
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<br />ccnityrh lhc lcdcral reBlhri.ns rc80idin8 osbcslor r€n,vd dc trot lnnliclhlc ro rhis Imlccl
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