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APPROVALS DATE ID/SIG.OWNER BUILDER DEITANANON
<br />I lE by .ftm undq F.rlty of Fjury thn I n adF i!6 rh. Cofir.to6 Li(ce t w fot $. follo*iig ,a$i (S< 701 I 5
<br />&!inq !d Proteraon Cod.l: Any Cny or Cou,ry which EquiB r Fri ro edEd, rira. ntrFov.. d.mlil' or rF.i ey
<br />trru<le Fir lo ilt iMe .lo E+iG tlE +dtd for Bh Fni ro 61. ri8n d r.aE il. IE d tr i! li.6.d F,id
<br />ro rll Flitb6 of tlE Codr*rd.r tiqE d t * (clrF6 o, Coffia,3 wnh Scrn.7000 of Dnrb.1of lh. &4iE od
<br />ProfdaoB Co&) m rh.r lE or dE i. ddpr rh-.6!n id rlE lri! for rlE dlcS.d dotrFio.. Any viJLri,n of Sarbn ?01 I t b, oy
<br />.pplicar for . p.rf,i 3ubjd3 rh. .ptlicdr ro . civil p.Dhy .l not moE lh.r liw hun{trd &lld (1500).
<br />.- l. ! otE ofrlE FlFry. d hy olpr,E *ih *re€ 6 {Ei $L @!rF!.aoi. {r[ & rlE rst .d $. r,!Ec ir DrinarE d oftld 6r rl. (Sa .704r. &Bit6 ad PrDftsiE Cd. TlE (odr.rd-i li* le .1,6 ml +tt, to - ow or
<br />l,t FlFry eho hitt d itrp.D6 dE@ .xl who do6 *t Nii hi@lror ha*lf or lhrcusi iL 6lE om 6iploy6.
<br />pDvi& rhar tuch inFn\66l!@Dr ilIdrd.dffolH forrh l[ l$lr!E. tlE tnildiis or irptu@ir i hld eirhin oN Jaof@ipiiri4 llE olm eil& wiu hE d. hldar ofFDti,g $. lE or tE d'd Dt hdd a btllE dE FoFq trr lb. F,F.c ol
<br />l. .s o\ no narlt ti.l6). r.\(lostrel) c..ri(r'nN \irh I'rod n,nh,rnnsn)(f nni.r rh. trordr (Sr tr'l1, aB'6i
<br />rl hrlisiin(i r lh.(inr'nrrorsl'cds.lr\d.6noril't)l\r)an.{trdfal]lpor\(n.hildsortrntr,\csthd.tr.
<br />inJ \h. qn'rdsi4suchF.lRrs(irh0(t!ir&n\ts)li(oxc,lNrstr3rr,rl'c(i. rd!\lkdrln\l
<br />I m.r6F ufllc Sriih lr i\ I ( rr rl,x r.F,r
<br />l).r. Ortr.r \aBEtalll'luflirlllrutu;(l,axarar
<br />I hd.|\ ill'inn un&r p-dr\ f lt-ro^ oh. rfrh. f,nhrrry &(lnr.rk,ns
<br />I t vc od will mior.in ! Cdifrlr. of Conhr ro Sctl- lEuE for wort6 NnFrsrior. B FlviLd for ty Sdrhn 17@ ot rh.ttiu C.d.. for thc Ffolr'e. olrlE mrt for rnich th. panir i! isu.d
<br />I hlt rd will rid.E *qlo Mp.d6 rm... . Gqui.d h, S<rbG ,?!O oftb r-&. Cod.. 6. dE Ftrle of
<br />uE wr b with dri EEi i i'.d Mv *srto @qa.rbo iDIre 6a rn potry o6ba G
<br />rt..,-'h+.LLf h*pfr
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<br />-.rE9.@fa
<br />I c.nit lh.l in
<br />'h. Ffolmtr oath. "ort for shich lhn Frnn B is.rl I 3hall mt dploy by pa$i in uy 0@6
<br />F B ro t en. .uhjd lo llE worl6 mmpoldion Lws of C.liaomii lrd +E rhi it I th.lld tr.om. rubj6t
<br />'o
<br />rtE
<br />mrt4 onl9.nlaion Foriiod of S*rion ! 700 ofllE t E (od..I lhll frrhwirh 6nply r nh rfior FvirioE.
<br />$AL\l]i(; l.rlu. rr suc \10116' cof,thertr)n co\dr!. r unln\ful. inJ \hrll subj(r ?n oll,)\d (, cininrlltr$trs and
<br />(r'l nn.s trt k) n,r. htrndr.d rhoor nd dollin {ll(().(x ). '. !dd'lr)n n) rh. (d oa.ornl.nslr'on, dmm!6 cr p..rid.J itrrh.
<br />sdnrn 1076 oflh. llbor Code inl6.sl d d'onry r fG
<br />[G* fiZZ(11
<br />ll( [\strrr r)\rR\( r(I!
<br />!!1.(-1.\rtu1!^
<br />I ha!6t rfrm un lq pa.ry of Fiuy thr I o li.q!.d 'r.L. Foririlo of Cl'arc a (.offiirt rih S6lin 7m) of Divirb. I
<br />of lt &BiE rd Probir Co<E -d iy ltoE ir n tul 6c -d .lEd
<br />X,.*.."" tan66
<br />K-" ?ltttt4 )c**,",*."-'["]*f\?o+iiY
<br />x"S".?,
<br />(ttNs] RUc (r:l I l.\ntNc acItNCt
<br />Ihs.hydnnrund(Fnlt)oipajo!- rhrrh6.ia.odtudi'nLdins+ ! ntr rh. Ffomnc. of rh.\.rl for shichlhn Fmt b
<br />issu.d(s( 1097, (,r c )
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<br />APPLICANT DTCI 4AAI I(I
<br />I hdd\ rtrm udk Fnrh) of FroD oft of rh. follo{ ins rklfdirn3
<br />oofrrl rn Pmnr- Arl6or Nor,licl nn F.d6rl R+uldi)ns I l tl. {0. Pd6 )
<br />R.qun.J I-drn olNori6.dnrn
<br />I c.tit thi rlE Ldr.l Erllri.B ,laidilB .b.n6 l€Fr.l & rx.r epl..blc ro rhi. Foi<r
<br />.t r. nErioiEd prlFry for inrp<l
<br />Xe-t -^r- t-.,*
<br />\rmi6 o.ft (Fii0:CJ&t
<br />j*.qleprtr
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc.uipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled //-.. -/,M/as
<br />Rough Ductwork
<br />Vents
<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 />Openings
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.t/zz /i4*/r<rt I
<br />Final Test
<br />FINAL //-L-/
<br />'tfu/n
<br />Notes, Remarks, Etc.
<br />MECHANICAL.INSPECTOR RECORD
<br />COMMENTS
<br />Meter Release
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