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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.COMMENTS OWNER DI,IILDEN DELCAXATTON
<br />I hcrcby affrm u.rhr Ftully of !.rjury lhd I e .xctlpl lion E Conlra.lor' LirnF L3P fot tlE following'@$n (Sc.?031.5
<br />Business fli Prof.ssi.n Cod.): Any Cny or Co! , ehich Gquircs tr pcrnil lo constdc{. dlct, improv., rlcrmts} d rcpan any
<br />stlcruE. prbr ro ils hsua@. aho .cquiE. rhe .pplicfl for suct Fmir lo fiL o si8tud Bldcftnl th,r lE o. shc is lieiEd t!*uoil
<br />ro rlE pE"hionr of d! Co.h.lols Liccnsd Liq (Cha,tr6 9. Comftrcine *irh S..lion 7000 of Divhio, I of tlE Busircss lnd
<br />Pofc$toosCod.)orthallEorshchcrcmflthercfiodsodlhtbrshforrhcrlhgcdcxcdplior.A.yviobonotselirnT0Sl.5bysny
<br />lpplicant for , !.mir subjers rhc al,plic"fi ro , civil p.nahy or ml mrc lhe fivc hudEd doll&s l$500).
<br />-1.
<br />f,s o*ncr oirhc pmPefly. or my cmplorec. eirh waecs !s rhen $k mmpcnsalion, will do lhc wrk .d tlE e h^ is ml
<br />inrcndcd or oncEd fn sle (Se.7O44. Busin.s lnd kofessiom Codc Th. C..relois Liccnk rjw der iot lplly lo M 6w.cr ot
<br />ttE pDp.ny wtD huilds or iqms rhc@n. &d wh6 dB sh *or* hims.lf or n mlf or lhreush hh or lEr os! .,lployes.
<br />providcd ih,i .uch ir{nrcmils e mr inrcndcn or ofrcrld for sL. la hoEM, d. t ildi.! or inpswmnl is sld wnhin nm ,tu
<br />ofcotr{,lctior thc Owrcr Blildd walt hnE ltc buhn ofprevinS fid lE or shc dii hl trild o, irit oE dE .,nFrty for tlt P!rIN of
<br />-1.asowncrofrhcpmnnr.ancxclu\iv.lycontrc1ingwnhli..nscdco
<br />ucloN ro .dnrlrud the ploFcl (SN. 7044, Busin$r
<br />ud Fofls\ion C6dc: Thc Conlr0crols Licctrsc tjw docs ml lpply lo an ow.6otpropcny who huilds or imlroles lh.tcotr.
<br />and who onlacls aor such Fljecls uirh ! Co.rB.ro(.) li.cns.d l,unuer lo lh. Conlncrols Lien* L,w).
<br />-l
<br />mcxcmfl undcrSsrio.-, B & PC. forlhis rcason
<br />III8trEBSJ:AM8IISAIION
<br />DECI.ASAUQN
<br />I h.rchy afiflr undcr ,.n!lry of Frjury om of rhc lollowin8 dsh.&tiotrl
<br />-l
<br />hlvc and vill minrain a Ccfliferc ot Cttrenr ro S.lfin.un ror wo*s otr{cnerion. I tovidcd lor by Sdliotr 3?00 ol rhc
<br />Lrbo, Codc. for rlE Frfffic of rtu snt lor ehich rhc Fmir 6 i*u.d.
<br />-l hrlc snd sill
<br />'Minrain
<br />workcn comp.Nathn ins!En$, es rcqut€d by Sccrion:1700 of $. bb.r C.de.lot rhc lcrfor,mo of
<br />thc wo for which thn p.mi ir hsucd My
<br />-l
<br />ccrlily rhat in rhc ri.rtd@Nc of rhc for which rhis p.rmil is i$ucn.l shall nor .nPloy any Fson inanrnanicr
<br />$ !r ro &.oft rub.icd ro rh. worleB comFctrsrion h*s of cllirodi!. nod ngtc rhd if I shuld bccom \!$i$ ro rt*
<br />workc^ .omn nsarion t)rovlsions oiScdion ]T0Ooflhc Lihor Codc,l rhaU, fonhwnh.omrly wilh lno* llNvisidtrs..
<br />WARNING: Fdillr. b c.uB rolkcr ompcnsrion svcrsc i\ unlawrul. ,nd shall sut*ct m cq)lotlr ro dininJ Fndri* and
<br />cilil lin.s ut o onc hundrcd lhousad doll6 (Sl in lddnion ro ihc.o$ of comp.relion. dsnslcs as [ovidcd aor th.
<br />Secrt,n 10?6 orrhc trtsr codc, inlcrcn und ullorrc)
<br />-.-=r+'=-'-'-Lx:I:NSIILCONT&I!:I!.f,
<br />DICIJ.B{IIQN
<br />I hcr0hy r{ltn undcr F,nrlly olF-rjury rhxr I rD ln{Mrl utr .r novi\nr oiChlnrs 9 (conntun.ilr8 *irh Sc.rir 7Ux)) ol l)ivni{r,.1
<br />of rhc BusiNs ind Prni\$onsCod.. r nlylicc \. $ i', rull i,r.c md cllacr
<br />.--U
<br />raNsrf,tJrrl0Nr!;NttNc-ati[ltr
<br />I hcnhy alfiiin urln lcnrlryolpc4u.y ihdr rhcrc ir d mnsrudion lcllllrS ng.ncy fn rhe !.rlorrofr. otlhc sort for which lhn Frnrir is
<br />n\ucd (s( l(l)7. crv c l.
<br />I cn'lc''. \rnl'
<br />-
<br />Lxndci\ Addns:
<br />-
<br />APPI rcaii-ifrifiAird-
<br />I lErr-by nfiimr undcr pcnalr, ol p.rjury oft or rhc rolk,wine dc.rurtionr
<br />O. nnion Ponik A.tx** Noriiicoliotr Fcncral ReeularioN (_rilb a0, Pad6)
<br />-Rcqutcd
<br />lxrlcr ol lturifi.,ri.n
<br />-l
<br />ccnify rhll rhc fcdcr.l cgulsrions EEordihS lstE$os Rmvd uc .ol lrpltrblc lo ihls ptuitt
<br />-l
<br />enify thlr I naw rcld rhis rmlicari.n ffd s.rdhd rhc!tx)v. infomlion n cotrd, ! as/c rommplt wilh ull Cily0!d Cou.ry
<br />ordi.0mcs and Srcrc hws Elllins ro tlildins con$rudion. ard h.reby dllxnir rcrrcscnlalilcs oflhis Cir, dd Counryro etrrs u,'o.ltr
<br />$ovc troriomd rruFrly lor
<br />AplliunlorA8cnrSicnal!
<br />14',
<br />Appliances
<br />lvletal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulalion
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer -1 K.\4,tt\
<br />Residential Range
<br />Other
<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 />Rough Mech.
<br />Final Test
<br />Meter Release A
<br />FINAL 0-21-I A"\rrrd
<br />Notes, Remarks, Etc.
<br />Above T-Bar
<br />codE nslion inslBer tui.3,n !olh, numt r @l
<br />^.422//e
<br />?.' 7' -
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