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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE COMMENTS olyNtlr Iru ,t)ER t)t l_('ARAlt(,N <br />rtpli.d larrI]cnni srhjcth rhr it),rictrrr!) rcivilfc rlrtfl ornrncrhltr rivc hunnrcl dolh^ (St(xr) <br />-1. <br />{c o*rcr oarlE pruFny. or ny cmplorrcs wirh uuBcs as $cn sb $qEnsdion. will do ltE wort $d th slnldft n ml <br />inlcftLd orotfcEd for slc (Se.1r44. Busircss d Pma.ssions Codc: Thc Conr,acror's Lic.ns llw do.. mt applylo uowffiof <br />rhc t,bp.ny who t{ildr or nr{eB ir@.. ad *ho d@s sh trrl hinr.lt or h.r$lf or thmuSl nis or ncr owi cmployccs. <br />p.ovidcd rhd such iq,Dvemnls m nor in'.nd.n or otu td $lt. ll hoMB.lh. buildine tr ntpmEmnl i3 $ld withh ot Fe <br />of.otrpLrion. E Ostur Builc. wiu haK lh. bmLn ortbvine lhd hc or shc dil mr hnild o, ininoE !h. FDpsiy for tlf lurpo$ of <br />-1. <br />asowncrofrh. nmrEny. amcxcturircly.onradirg *irh licc.sed.o ddoN lo con(rud rlE Fojccl lSN. ?(x4. Blsincs <br />!,n hD(ssbn Codc: Thc Contrrcrols Liccnse Lj* doca nor apply ro in ound or pmpcny wlo builds or i provcs rhcrcon. <br />Nnd who onrEcrl tor ruch !mr..( *ilh a Co mrorls) Iicc.$d Ntruutrl to rhc C.nra.'ols Lisn* L!w). <br />-l <br />ancxcnfl lndo S@rio B &PC lirrhisrcawtr. <br />UO8f,E&LCOMEDNSAIION <br />PECLTSAIPN <br />I herby lifirm undcr p.tulry of pcrjury om otfic fouowing rl&l@rionl: <br />-l <br />h!v. &d will tuinr.in r Ccnifr,rcof Con* ro Scll-lns!rc for wts @mp.nrdion.&s povidcd for 6ySedon 3700 ofrhc <br />ldor Codc. for lhc pcrfomnc of $c turt fm drkn ifi. Fmil is islcd. <br />_lhlrand*il!nai.inworkcr.onp.nlstioniBuiosc.6,.quircdb,Sdion3700oathcbtorCodc.forth.p..to@ftcof <br />rhc aork tor ehkh ihi. Fmii ir isrcd. My workds compcnsion insurmcc wicr ojn IrIcy nlnbct @: <br />q <br />l.cniry rhrt in rhc pcrrornuftc ofrh. wo.k tor whhh rhir r.rdir h hsucd.l shlll nol cnployoyp€r$n in any oMn.r <br />$ as to tEom subj.{r to rh€ wDrtcG'comFn ion hws ofcolifomi& dd lg@ rhdt itl riould b.com sublccl tolnc <br />so*ql smpcnsllionpmvhions of Sdion:l7mof rhc Llhor Codc.I stuu. fonhwnh con?ly wilh rs,,ovisions <br />WARNNG: ltilurc to surc wortcm sdpenillion ov.Bre is unl,wtul. ,nd shall subjccl !n mplors to sihiial FlEXts ,id <br />civil liflcs up to onc hundrcd rholsond douaB (S100-000), in lddnion ro rhc co{ of con{*6alio.. damScs !s lrolidcd for llE <br />ljh)r Cdq inrcren 0d ,rruncy r <br />ucllltLcoNrxa(rat <br />DECIdf,AITON <br />I tf,rch, allirn und.r rEtulr,orp.riry rh{ I sii li.rtrwlund.r tii'visi.norcnap'cr 9 (omflEncins wnh Sccrion 7(xX)) ofDilnioo.r <br />ol Ihc Bu\imss irrd Pmlc$iorF Codc. od nry li.cn{ is in alll ar,( $J cffc.r2 <br />o?.l <br />t <br />IQNIIAUCUANI.IIDIIIG-IAEN(I <br />I hrrhy rr,,nn oM.r lEnrhy of p.rjry lhd thcc is a $Nrru.li,n lcndiu trs.E-^y 6r rhc p.dnnu0.c olrhc Mrk ntr shi.h rhk Fn.ir n <br />i\nNl(S.c :1097. Civ C ) <br />IIILX;/INI.IIECIUAIIO! <br />I tf,{by sflinn undrr Fnrhyol lxrjLn, otrc ofrhc tnll.qirg dc.hmriotrs <br />Dcrmririor PcirniNAslicslos Noliric0rnrn k.lcrulRcsulrrion\ (Tirlc'r0. Pda, <br />Rrquncd Lc cr ofNolili.drirr <br />_l enily $.1 rh. fedc..l cgrlirions EgsdinS $b$ros rcfr)vll oc nor qrpliqblc lo rnii poj(l <br />-l <br />ccn ily rhlt I h!v. rcad rhh applkarion and star. rhll th. abor infnfrrion h c6cl I alc lo oftply wilh all Cily Md Couory <br />ordi.rftcs and Siar.l,ws Ehli,S ro blilditrg conshctiotr &d hcrcby lurlDda rcprc*nhrives otrhisCny md Counlyto cnld upon dr <br />.bovc mnliomd l,rcFny for <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />ltilisc. Equipment <br />Duct Work /?-- -11 M/o; <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer / > -4r-lq A4.bl/6t <br />Residential Ranoe <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. <br />Final Test <br />Meter Release <br />FINAL lZ-tt -t I .lH,flo <br />Notes, Remarks, Etc. <br />ID/SIG. <br />Dole: Osner: <br />^, t? <br />L.d.l! Mm: <br />- <br />t ndd'3 AddEs: <br />- <br />-".q (t")c( <br />I <br />I <br />II <br />=