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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OIVNDR IIT]I I,DT:R DI:I,('A RATION
<br />nnkrurc. tir.rtJ ir\ i\{rn.c. ni$ toquh\ rh. ntPli.rnr lnr {i.h nc n[ tu lilc] \iEn.d {ncnr.r rhnr ltor sh. is li.cn!.d Puisurnr
<br />Polt\\i{nN Codo ) .r rhd lr orshd iscxc rU rhcrcliom klrhch!\isforrhtrllcgcdc\cnrPioi AiyvioldlidrolS.cronT(rll5hvrny
<br />rppli.rtrt turnNnnirsuhj..r\rhc ll)flrrtrl lo icivilp.Dnlryolmi nnrcrIrn li!c hLnJrcd d.ll s(S5(x))
<br />-1.
<br />ar oe*. of tlE nmFny. or my orployss wiln w!8.s !s lhcn eb omFnslrion. wil do {r vort .d tlt {tuifr k tur
<br />iir.d.d or of,.E.d f; sh {5<.?044, BBirc$ ud PtnfcsrioB Cod.: Tn Conlr&lot s Lhns La* des rcl .p v lo !n oeM ol
<br />rlr rftFn, wh. r iBs ff in{mh tlxftn. tnd vno dB trh *oI hinscllor hcrslf o. rhou&t hk or n r om cqrlov.e.
<br />pmvi/:hd rhur s!.h id\roEBrrsE ml i cidcd or offcBl aor sk. li hok@.ltr hildin8 or inPtDEEnt ic sB wntin nm )ut
<br />;fonpLrion. rh. Owncr BuiLc. wil havc ltf, budcn of povins lhrl hc or stc did ht hoild ot isp.ow dt popelv lor th. !u{he of
<br />l. asowncroflhc lropcnr. rmcrclusivclyconrEcrios *irh li..ns.d co,rBcloA ro.onirud tlE Imje{r (S.c.7044. Bulncs\
<br />ond Pnr6si,nCodc:ThcConlrocror'\Li.cnscL.wdocsnotaDnlylo own.r ofPqrcny who builds o. imProvc. rhcr.on
<br />dM who otuucrs tor slch t rcjcct vilt ! Conl6cro(s) li..oscd l,ursuont l. rhc C.nrrcror's Liccn$ l,uw).
<br />-l
<br />af, ercmrr unds S(l
<br />l)!tc ()$mr
<br />W(rRk Ir'RS' COM PlrNSA f()N
<br />OECI.ANAIION
<br />I hcrcbyrffn undcr pcnllry oapcrjuryonc ol thc lbllonins dcclr i.nr
<br />-lhrlcul\illnuitrir{CcniL{!colCoDscnrroScllln\urcinworkcFconrPcn\rrbnd*lmridcdlorbysccrn)nlTlni''rhcL!ho. Codc- lbr r h. Fdninuncc oi rnc aork tu shi.h rhc |tmrir n iss!.d
<br />I h.r rnd willnuinrrir workcr{ conrlcrsrlion insu.rncc.tr\ rcqurcdLtScclion.17(X)olrh.L1ho.CoJc fut rhc pdi$utuc'l
<br />rh. work ld qhiuhrhis p.,nir is iskt. My sotkcr' co,np(n\,tion insufuncc cldcr dxl Flicy numhcr {rc
<br />Aco",
<br />?cott r zTtE t8/
<br />l.c'iil!rhdirrhcpcrt)olnr.cofrhc*orkn,qhichrhnP-nninn\uc(|.Innllnrcnrllov.nvPcrrrnimnyenncr
<br />i)islobco*subj..tror,trtr.rkcsconrpcn\rri.il,wr.lColiti,Irrir.rd4crhdtiilshouldtxc.mcru$iLtlloih'
<br />workcrs..!rr^-n\di,,rpnivirhtrsolSccrtrn]T0oofrhcLlltrOdc.l\rrlr('nhqirhcotrrrlvsirhrhorln)risnn*
<br />IVARNIN(;] Frihtrc Io {cur. *.rkcr( .omn nsdion cokrrlt i\ unh$lul. trfrI \hrll \uhirfl rrr c DloFr b oitrriMl fnrhic\ and
<br />ciril finc\ up b.N hundrcd rhou\did dollMs (Slu)-o(lr). in rddiri( r rr rhc co{.f.urPcns.tion. drrt!*,s lr'vi'l'd ftn rhc
<br />,,.,,, t"f/n r,r,ri,,,,, X Z
<br />uclNsl:lz-cQlil&rguBl)l:ct {tutrl()N
<br />IhcrDhyrllnDn.rlrnrll,otprturyrhirIrnliccnsnuDdcrlr,rnnnrofChaPrcr9(.otuMniD8uirhSc.rirmTUx)ror!)ivi\nrn]
<br />oi lnc llurirc$lnd Pnn.$.rrCodc. rBt n! h.c.\c is ir tullli)rcc tlcl)i.r
<br />1 6/i
<br />I b
<br />!:oNirEuElrcN.L};dlllEc-lc[ril.I
<br />I lrcrcby !lrt r utrd.r tE.!h, o{ pcq!ry rhir rhcrc h a.on(rucriD Lodir! rScrcr aot rh. t.rLnmftc ofrhc qork for whi.h lhis Ii{rntir i\
<br />i$ncd (Scc.liD?, Ci! C I
<br />Lrndn\ Ndm:
<br />-
<br />L.rlder'r AddFsi:
<br />-
<br />AIELICANLDSCIASAIIN
<br />I lErch, llll-rnr u lx.lcr Fnnlry ol tErjlry onc olrlE n)llowir8 dcclarrrn nsl
<br />D.ni,hn,n Pcnnih.As6c(o\ Norilicnrion ltdcral RcSul i(,n\ (Ttrlc4). t'mo
<br />-Rquir.d,rtrcr
<br />of Norilj.ltion
<br />-t
<br />ccrr ity rhal rh. fcdcrd rcgul ionroSodinS $bcslos rcnolddr. nol rytlic.blc lo rhis lmitl.
<br />#-:nl';:tlr;;:'.'ffim;otud arc lh.r lhc.h,vc intomtio. hcomcr.I dg@ roomply*ilh{ll Cnyand Counl,
<br />hn. rnd hcrcbyaurhorir. Erft*nlnriv.s oflhis Cny and Coutrlr ro c.rd ulsn LtE
<br />F
<br />Applicanr or lcnr SiAnorurc
<br />,*,*^*,n *,, )1- ( -lrt*u Y*ff^rJ
<br />r{r/t
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Ivlisc. Equipment
<br />Duct Work
<br />Pre-lnsulation LP Vxn,r..,,dtry)
<br />lnsulation u\
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />Vents
<br />Toilet Boom / Clothes Dryer
<br />Residential Ranqe
<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 l
<br />Above T-Bar Orlrl--It r<(|l
<br />l0 )),t t
<br />Rouqh Mech.
<br />Final Test
<br />Meler Release I
<br />FINAL ru'at,tA d.>u)
<br />No1es, Remarks, Etc I U
<br />u/altf aa.l . i- b-.r @t
<br />l-l I
<br />tn(
<br />I t,t
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