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APPROVALS DATE ID/SIG.COMMENTS <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 />Rouqh Ductwork <br />Venls <br />Toilet Room / Clothes Dryer <br />Residential Range <br />Other <br />Hood <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 />Rou gh Mech. <br />Final Test <br />Meter Release <br />FINAL 2-11-2'r' Jr'c't f?% <br />Notes, Remarks, Etc. <br />OWNI'R BU!LDI'N DOI,CARATION <br />I hcrcby rffiln und.r p.nnlry of p.ijuiy rh ldcxcr0r fio6 rhr G r r,N Liccnsc Liw turhc f(rloaing rcrv (S.rl0ll5 <br />Bu\ircss nnd Pnna$rn Onlc) Atry airy or chnry shi.h r.quircs 0 linnn ro .oistrucr. rhq. inuovc. dcnnnnh .r Enrn uny <br />{rucnrc- pri,trh irs is{ n c. il\o tuluncl lhc rfl'li.rnr l'.'r {rh Frnril t, fi1. ! \i8ncd (llcnrnt thrr hcor shc i\ licfl\cd pursurnr <br />ro thc frcvisions of rhc Cotrtrr.lois I-(ctrscd Lr{ (Chilrcr 9. ComnrncinE $irh Scdion ?fix) ol Divhion .] .f rhc BusnN$ rnd <br />tr'fcsionsGde)or lhartEorsh. i\ crcnrl rh.rclnnn Md rh. sn tur rhc rllcscd cxemption A.yviohrionofscdi'n70ll5brrny <br />rrplicant fd antmn \!bj\.'r\rhc amlicani h nci!ilpcnrlrtoinor frnc rhrn lii hundrddollr\ (5500) <br />-1. <br />a owrcr o,Ih€ FlFny. d my.n hyes wilh slgcs a llEn $h anpemaliofl, wil do tlE *orl Ed lL strarE is Dl <br />iftnded 6r o,tccd fd sb (Se.7Ol4. B$iftis end P,of.isbns Cod.: Th. Conrturois Li6n€ tr* dra rcr qDly Io e .sM ol <br />rlE poFny wln hoildi or itrp.ohs tltoi, .td who .Ld sh mlt hiNlf or bcElaor lhou8h his or hd o*n c'nplortcs. <br />prcvid.n thll such inprcwmnB I mt inrorh oroffcEd 16r sL.Il no*k.0E boiHr8 m inptulmr b sld f,ihh oft )qt <br />6r6n9brhr rtc OeM Buit er sill hsr tlE hrdd ot Fsvin8 rh3r lt or slE di, mr h(iiu or in@rc df, po,gi, ior lh. porln* 6l <br />l. !s ow8r or rtE t b,!cny, o rxctur,rcly .onrri.rane sirh lienln .om6.roF to conod rlE poj.d lsa. 7044. ausrffi <br />and Eoeasir Codcr TIE Conlr..lols Liccns. Llw docs nol q,ply lo M o*nd ol I'rorcny *to builds or nryrolrr lhed,n, <br />od eho ontE lr for such ,roj.<lr Bnh . Conu!.1o(3) lien*t poma ro rh. Co rr.ior's Lhens tiw). <br />-l <br />am .xenfl urdfi Scdion- B. & P.C, for rhi. rcen, <br />I rhor Co,l.. lar rhc !.'liinnrr(c ol rlt "o l(tr shi.[ rl'd ,tr'N l i\ \{i.(l <br />rhc \rcrk ktr whi.hrlrs t). n i\ i\nrctl Nlyqorkc* (o ll)c \I otr ltr\ur r.c..iirr rtrxl Nlicy nunk\r rc <br />P.li.yNumbcr Exfncs: <br />-l <br />ccnifythll in lhc Frformmcof ltc wort l stth lnis p.rmil is i$ucd. I sholl not cnfloy an, pc6on in any mmr$ qs ro lEd,ft subFcr ro rhc wo*6 compci{thn laqs .a Crliaornie and aFcc rh,r ifI shduld lE om 3ubi.r ro ltf, <br />*ortcB ohl,cn*rionl)n*ions otSecrio.l70Oofrie ljhtr Codc,I shlll. fonhwirh.on'ply wirh rtb{ povisi.ns.. <br />WARNINC: FailuN lo KUR workctr s'ulEnslion .owmgc is utrtlwlnl. and shall $bjcl !n cmlloyer lo aimiMl rtMtis sn<! <br />civil 6ncs !p to orc htndrcd lhoustrd dollaB ($10:r.0o0), in oddilhn <br />'o <br />lhc cost ol onrperstion. damses as tmvidcd for lhc <br />Sction 3076 of rh. Lator Codc. inr€rcsr ud artomy\ fes. <br />u(JlLsliD_!!)NrxJ1:roa <br />DECLA&II]ON <br />ot ihc n!\inc\srnd l)rotus\in\ Codc. riJ my li.cn\r n in lullk,( rnd.llccr <br />(aNglar](rlaNt[ltltNc-6c[lcr <br />I hcrby rlli nuMorltnrlirol p{rjur} rh{r rhcrc h i.otr{ru.ri,,n lcndirer8cn.} for rhc FcrlonMrcc olthcwork iorsnichrnis pcnnit i( <br />i$ucd ( s\.'. .1097. Civ. C ) <br />acta loomply wirh allCilrlnd Counry <br />ir6 or$h Cirr.nd Counlylo cnrs u,rn <br />'lE <br />z7 /8 <br />MECHANICAL-INSPECTOR RECORD <br />IABf,IBS:.COMEESAIIIIN <br />DECIdSAIIAN <br />I tceby afEm und.. rcnrlry of p€jury om onhc followhs deldlriori: <br />tridcr'\ Addrrss: <br />- <br />lppr rt:,rtrtr trrrr rrn r:rto.',t <br />I hcR.by ultinn u nl.r licDrlry ol t'rrjury oN oarhc lnlniwint dcclmrnnr\: <br />Dcnn'lirbn l,clnils.Ashcdos Norili.arion lcdcrulRcrullrion\ ( litlc,l0. t'rno <br />R.quncd b(cr of Nori[.{i.n <br />I <br />ihc rcd(al e8uhrioN Eg8rdi.8 lstEsros rcfr)vll lrc nor lpplic.hl. lo lhls poj.rl.