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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS oIINI]R BUII-DDR DI:LCARATIoN <br />I hrtuhy rfln r ! dcr p(m ry ol Frjwy rhnr l an cxcnfl ftum lhc (innrrrtrr l,i.rnsc ll$ nn rhr folloqi.S rcasrn lscc To:11 5 <br />Eusi|c\s ,rrl ltrris\i Cod.): Any Cily or (-(trnrry *hirh rcq tr\ x ncirn i' .oi{nr.i. rhcr. inuorc. d.rnoli\h ot rcnaia rny <br />{flr.iu..- pritr ti irs is{'rn.c. rlso rq!rc\rhc pplicrnr ntr \uch n ann k' filc r silrcd {nl$rcnr that hcor shc is liccn\cd Pur\u nr <br />n, rtu t,n)rnnnN ol rlr (i'nrn.roas l-i.cn*d t.r$ ((hiprcr 9. ('onrnrn.iu wilh Scclion Tlixl ol Dili\nnr .l ol itt Bu\irrc\\, d <br />rt,!lunr hr r |{nnn nrnlcclsrhc atpli.rnr ro ac'vilpemlryolnor morcihrn fivr hutrdrtddolln\ lS5U)) <br />l. !s o*mr of lh. pmFny. or my etrll)loyes *ilh wrscs !s thcn sb .lmpcnsdion. will do lh. wmt and lhc $rerG E er <br />inrcrh oroftcrcd rd sk (Sd.7044, Busimsond ProlcsionsCodq Tnc ConlEcrols Uc.ns ri* do.s nol omly lo owncrof <br />rhc pmp.ny wno hrlds or hpmts thsetu dd whd &6 Mh wlk hi'nslr or hcrclaor lhmrgh hn or her ow. cmployss. <br />prolidcd lnar ruch inlewEnh m ml intcnd.d or ofi€En lor s!. ll hoqckr. lh. lniEing 6. irqrcEmd h $h within orc ru <br />ofon{rLrhr. lh Ower Builds wil naE dE hudcn of prDvinB lnal hc or shc dij ml build or ir{,oE rhc pmFny for tlE purlnE of <br />-1. <br />as o*mr ollhc pmp.ny. am excllsiwly Nrtturi.s wnh licensd .onrrchs io on(dd ltE lror*r (56, 70rll, Btr.m( <br />,d hsltsbn Co&r Th. Controclol s Liccnse Li* do.s ml s0ply lo an oPnc. of pmpcny who builds or imtrcEs llrcrsn- <br />trnd who snrrrcrs for soch Imj.lls wnh a C.nrBro(9 lten*d f6!a lo rlE Conll.admt LianE L.w). <br />I mex.mDt undc, S.d6n , a. & P.c. for lhi! rc&n <br />]vl)ar.E&itraMr[NlArl0N <br />DECLAAAII]N <br />I hcrb, lffir !nd( Fn,x,ofrdjuryotu ofrhc folnrwn'g d.clffilions: <br />-lh.vc <br />n willn$irrrinuC.niiErirol Con\cnr k,s.lfln\urc r.r workcie corycns iofl.as pblidcdlffbysccrionlTmofrhc <br />ti&)r cod..lor rh. tcrrbnnncc ofthc trork f{' *hich lhc pcnir i\ h\Nd <br />45"\c rtr,j{illmninh'n u,dcA cnmn n(rrtr rn\urdtrc!.as rcquirci hy Sccrhn]7m orrh. ljbor c.dc. rfi the lcrt'onMrce of <br />rhc wn'k,'{ *hi,'h,hF'pcnn( r\ A\ucd nlytrorlc^ c" lnc urion in.urJn.c,rnr' {d Fl*, nu $.r r. <br />.,... i, SA "l,n-trrl da-aL *'d.a 1,111dI r /ta /.rq <br />_l dnily rhlr in rrE Frro.nhncc orrhc work for which rnk plrmil is hslcd- I snll nor cnploy a.y lctson ir any fl'umr <br />$ Nto tEsm suhiccl ro rhc *ortc6 oq,ensarion lass ofcrlifodia. ild den. rhil ial sln'uld hccom subjel lo tlt <br />wortdl .om0.nsalhn F$visions o a S€clio. :1700 ol rhc Lator Codc.l sh,U. fonhqnhomply wirn lhos pDlisnric.. <br />WARNIN(;: Failurc lo sccurc sorkcr' oDrcnsarion cowrasc ir lnlawrul, Md sholl subicl an cmllorr ro diniol Ftuxic!.ild.i!il nncs up ro om hundrcd rhousatrd dolh6 ($lm.tuO), io uddnion ro rhc co{ ofcomrrnsalion. drtus* i{ lroridcn ro, ih. <br />inrc,csr lnd anomcr's !!cs <br />DESIA.SAIION <br />I h.*_hy lliirDUndcr |rcn.llyofp-rjury lhll I m lien{d u.dcr I]R*nnri.lChsPrs I (mmnErcins lirh sedion 7000) oiDivision l <br />or rh. ausftrsjtul Prof.si.ns Codc. o.d myli.cnsc h in fulliorcc xl crRr <br />conrncr.. E OoxJl <br />IOISIBUqTONI!!DITj!i.{C!NII <br />I hcrcbyrltnnu cr l].nrlry ol l]trjury rhd rncr. nrcon!'xrli,,n Lndi'is rtc'ky lor rhc pcrfo,nr0ncc ofrhe$o fffwhi.hrhir lcnnir is <br />h\!cd (S.. .10)7, Civ C ) <br />APPI,ICiNT DFCLARA'IION <br />llBrtydflinnundd pctrrlry ni|trjury otrc or rhc rolbwinr ncchrurion\: <br />l)c xilirn Pcrnrirl sbc{os Noiinraiion rcd.,rlRc!uhri(r!(T lc 40. PrrrO <br />R.qtrtcd t..(cr of Norftrrri([ <br />_l rcdiryrhar rhe r.d.alr.8ul iotrs rcSudirB ashcskN rcN,v.l arc nor {rlicatJlt b rhr pmrc.r. <br />jdqdi! Ihur I hl'c rcad rhi. lprrlicrr io. ,Jxl dic rh rh. rb\t inlitrmln'. h.orel.I a$e ro comply wirh 0ll Cny.nd Counry <br />ordind(\ r.d srd. bws rcLxins ro huildn's c.n(rucrion. and ficrchy lurhJria nlrc{ndtcs olthis Cilylnd Co! y b .m$ q$n rhc <br />Appliances <br />Ivletal 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 /-v-/7 D-<-zs I <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranoe <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 />Rouqh Mech. <br />Final Test <br />Meler Release l') -1"7 7?-c-z-7 <br />Notes, Remarks, Etc <br />FINAL <br />K <br />ahovc nrmioncd potcny for frpT *" r, Jur/td <br />--------r------ <br />:-------r-----