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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OIf, N!]R AUII,DFJII DTJLCAllA TION
<br />! hcrchy i,lirm und.r |tMliy i'f !.rjury rlrr I n r.rc't! ftJm rlE C.nrfl.ior' Ldn* Lw ntr rhc Inllosirg rcaen, lscc 7r.ll 5
<br />Uusin.s rid ltolcsi(,. (dc): Ant Ciry or (outrly shi.h rclunc\ r p.rnrir ro.on{rucr, rlicr. imnnrvc. dc mlish or rcnrir itry
<br />dnr.ttrc. tnin to n\ i\\urn.c. nls. rcquncs rhc lptl'unr f,r \d(h Fnnir ro lil.a riSncd \rlrcnknr rhd hcor {hc h li.cnsql Pu.{'anr
<br />n, rhe lrr,vi\i()n\ ofrhc CdnnJ.!r's Li(cnscl ltrrw (Clu|]1.r,. G, nnc.in! wirh Scdior 7(XX) ol Divln'n.l orihc Bu\nr\s rnd
<br />I'tuf.\sid1\Cilc).rrhntIEor\hci\cxc'nnllhcrcfromadrhrh$i!ntrrhctrll.gc(lcxcnrPri('n Anyrn,hrn,nofsLrlion?01156, rny
<br />rprlic{N tur r Fnnil n'hjccr\ihc rlpli.i r b dcirilpcnrlryolnor nnrcthun fivc hudreddoll*\ ($5tD).
<br />-t,
<br />as .snq or rh. I,oFny. or my cnllolEs wnh qagcs er thcn ek @op.Ntion, will do llr wdt ud llE llidw t mr
<br />inr.ndcd or oficrcd for sk (56.7044. B!.ircas Nd Phf.$ions Codc: Th. Conrado/3 Licc.c tnv .nB ml arPly lo u oqrcr of
<br />Uc pEFny sho hilds or inpmrcs drmn. !n wtD dc tuh @lt hnBclf or hcr*lf or lhrugt tn m h.r own cn'rloycca.
<br />prcvacd rnlr suclr imrrcwtunis 6 mr hrcddl or ott .rd fo, eh. It hoMwi thc ltuildins o. it{l@B.r ii $ld wilhir orc re
<br />ofmn$hlirn. tlE Owmr Builk will h.!.llt t{dlm oa Foving tld lr or shc did ml lrild or itrqhw da !rcldy for dE lurros of
<br />-1,0so*rcrof
<br />thc rmncny, !mer.lnsiwlyc.ntmdinS wirh liccns.d coorrlclon lo @nnmr rlE pmj.cl (Scc. ?044, Buriocs
<br />.nd Pt.drshn Cod.: Ttu Contaclols Liccnsc li* des nor applyio mowNt otnrcI,cny who huilds ot inF)v.r thcron,
<br />lnd who ontnrcrs ror slch prcr.ck w h a Conrmcto(s) liccnscd pusu.r ro rh. Conrmrm s Lienr bu).
<br />-l
<br />amcxcmpt undcr Sc.lio
<br />Dote:-- Own.r
<br />WITRI(EiS' (XTMPT'NSATI(IN
<br />DECLISAtrTN
<br />I hccby afliro undf p.Mlly ol pcjury onc of lhc follo*in8 del,rarinns
<br />-rfNc
<br />rnl { 'll nEmrum 0 L'cn'rr. c urc.nq roScl trsurc ri,r rorlcrr' .o.D..srr io.. , s lmvidcd i'n by S-ri.n 11700 ofrlr
<br />Lrhtr C.,Jc. nr rh. n ritrrurr of rh. {, k fin $ hi h rh. l).' nrir i! ir'uud
<br />-l hrvc utri siU
<br />'tuinrri.
<br />work$ comFnsorion insumncc. os rcquncd by S(rnJn ,l7ur or I hc Llbor Codc. nn rh. pdrormncc or
<br />rh. sort ror which rhh p.mil is issEn. My uortss tnr insrr, .. .nic. drd Enicynumbcrml
<br />-l
<br />enifylhnr in rhc li..lormncc of rhc work roi which I his pcirnil k issucd.l \hau nor .nl,lo, .., F*otr irlnydunNr
<br />$ asb b..o'm subr.r t' rhc uoltc c.nnctrsit)n hss or ('rlinmir. rnd r!rc hnr ifl (hould 6ccom \ubjcc' ro rh.
<br />so&.r\.onf.nerimfhvni.nsoiS..lionlTll()ofrhcl,}itrGrl.,lrh,ll.hnh*irhcomplysirhrho{pn,v'\nns..
<br />WARNINC: l,nilurc ro sc@ $orkch .onBn\r(i,,n .or.n8c ir unhwtul. rnd \hrllsubFl rrr cil,thlq l. omnalF,rl'E\ Jnd
<br />civil lin.s up ro onc hond,.d rhou\rnd do
<br />Sccrhn 3076 olrhc trhtr C(rlc. imcrcr and
<br />i! h rhc con of.omrcns0liotr. dlDagcs a\ p.oridcd for ihc
<br />-,- 2- Z/-2[Zo
<br />I hdrcby rllirn undcr p.ulryolpcrJury rhrr I uo li.cidrr und.r nhvisiir olChaPlc! 0 (comfttrcin! wnh sc.rio. ?00or oflrni\i,)n l
<br />ol rlD Bu\ir.\t End Ptufcsiors Codc. unn tnyliccn.c is in lull frtro rnlclic.l.
<br />o ?
<br />"n, 2 '2/- Zazz,
<br />caNirxlrcllQNuNDAi!-trcENcr
<br />I l{rhy rilim und.r Ftrllryorprruryrhir rhcrc n a consrdcr6n tndi.s lsci.y r(x rhc lslbrnEnc. otrhc sorr rot which rhn lcmil is
<br />issucd (Scc. :1{)97. Civ. C ).
<br />t ndc.. AdJrc*'-
<br />AftLlt NrIlicL xAllll!
<br />lhr.hytniinrundcr litrrlry or ncrjur y onc oarhc folh*ing &chturhtrr
<br />hnxnni(,n l,crmir$AslE(os Norifi.trrion,td.ral Rceul0ridr\ ( lirlc4). Ptta6l
<br />_Rcqunc l.n.rof Notifi.dion
<br />Z;iry rhd rh. r.dcr.l rc8ll.lions EaodinB asltsros rcmral m .or atplicoblc b lhh peir
<br />ion . srar. rhor tlr !tn,c i.fo@rion i! cotrd. I lrN to ompl t wirhallcir! ond counry
<br />y and Counryb cnrd ullr. rh.
<br />Z-ll/-2cza
<br />ordinarcs ond Srare Llws Ehrin8 b in8 conslrudbn.0dl hcrcbylulnonrr t ,r.*nraiiEs oithisCit
<br />Aptliclnl or AScnr Slsflaoe-
<br />Appliances
<br />Ivletal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<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 />Meter Release I
<br />FINAL 3,/1/z).,Mt1,lr
<br />Notes, Bemarks, Etc.1 |I -rL
<br />lnsulation
<br />Other
<br />L..dd't N@:-
<br />dor mnrion d preFny lq
<br />I
<br />Ilt
<br />I
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