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APPROVALS ID/SIG.COMMENTS
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />lVlisc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />A
<br />Toilet Room / Clothes Dryer l0-z-\.U/.rq)
<br />Residential Ranqe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Fire Damper
<br />Openinqs
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rouqh Mech.
<br />Final Test
<br />Meter Release /A
<br />FINAL t0 -zJ-1tr )f"Wr0l
<br />Notes, Remarks, Etc.
<br />OWNER BUILDER DELCAI'ATION
<br />I lE6by ,mrn und$ Fnrlly of lciury lhal I d.xco{l fmm rhc ConlEctou Lt.ns tt{ for lhe followi.e E!$n (Se.?031.5
<br />B$iness rrd P,oaession Code): Any Ciry or Countt shich rcquiEi n p6mn to .onntud. alts, imptorc, d.mlish or Epln ey
<br />srructft. prior to ns nsstue, also rcquiEs lhe aDlicant ior luch Frmil lo ,ilc 3 siErtd sllrcmnl thot tu or shc h li.cn*d J)ulsdl
<br />ro rh. Imvirioni of tlE Cont ..lols Lisn$d LIw (Cnapl.r 9, Comncing wirh Setion ?000 of Dilish. I of lh. ausin.s and
<br />Pm&sao6 Cod.) or rh lE or shc ii crcnEl lhcrcftof, and lhc teri.. for rtE alk8.d cxcd'Plion. Any viol{io. ol S.dion 7031 5 by lny
<br />lppli.anr for ! F mir $b.i@G rhc ll)llk.ni lo a .ivil !.Mlly of ml mE ltd tivc hudrcd dollafl (15!Ol.
<br />-1.
<br />I owrcr ot lnc l,mFnt. or my crplorrs siih sag.s as lhct slc .onrtinidion, will do llt w.rt {d lh. sml.rE ic rcr
<br />n€ lcd troflcrerl for sl (Sa,7044. Busiftss od PrDfersions Codc: Tnc Cor!@loas Litn* Llq de. not .l)plt to an owtur of
<br />lh.
<br />',oFny
<br />wtp buil& or inpr.B tre[ 6Dd who dcs sh wtt tims.lt or h@lf o. rhmud his or hct oqn .nployccs.
<br />plovid.d rnsr rlch inDmErnlt m ml inrcnd.n or oficd{ fot sb. lt h.*ry. llE building or in{rcta i $ld wilhin orc }le
<br />ofonpLriotr thc O*ncr Buit d wiU ltsE rlE h!d.n of Fving tld lE tr shc dn ml hild or itpros dE pmtEiy for *E porlDs oa
<br />-1,
<br />asowrorft prcrxny. "neicllsiwlyo reti.S wnh lie.s.d conlEdm lo oBrucr (h. pmld (Se. ?OU. Buiifts
<br />lnd hDtusir Codc: Thc Co.tmctoas Liccnsc Llw dcs not aptlr lo oosnn ofPrcPcrly rho bulldr o, inPrcrcs lh.r.oi.
<br />,nd who ontEcls for slch !rcjeds sirh ! Conr&lo(O lic.osd puBuonl lo lh. Cnnracroli Liccnsc tiw).
<br />-l
<br />ancxcmfl u.der Setion- B. & P.C, for lhis ranf,
<br />l)nh
<br />won(F[s' (l()MPFNsaTloN
<br />DECLIBAUOA
<br />I ficeby a,fim under p.mlry of orjury om of lnc fouopins d(lmlions:
<br />-lhirond*illnurinri'ii('.dittrdcofCotr{nrroSclaln\urcr'or*orkcr!.ont'ttrsrrion,!\
<br />Ptrrvidrilfdhys..rior.l,u)01rhc
<br />Lah.r Codc. rorrhcpcrtonun c orrhcv.rk turq[]chlhc pcnnil i\ is{rd
<br />I h,vc.nd will ruintdin *orkcrs conFns ion insurak.. $ nquircd bySsrn'n lTOoofthc bbor Codc. for thc rsformfrc ol
<br />rh. *6rk n, whkhlhG p.rnrir h i\sudl My mpcnsolion insurotrcc cariq and liolicy nunb.r m:
<br />-l
<br />eniiythar in ltc lcrrormnc. of lhc tu*hththt pcnnit i\ issmd,I sln(ll n r cmtloyrnypcBrn in rny rumr
<br />$ &{ to bc.om sublecl lo thc worlcn otqtnsrion lrws of Colitomi0. md a8rc har if I sholld lf,com subhct lo tlr
<br />woltr$ d,mpsration pmvhions ot S€dion l?00 of lbc L!h.r tue. t {hnll. fonh*nh oqtly qirh rhos lmvisiof,s..
<br />WARNING Foilurc lo suc qo*cts .on{xnsrion covcmSc is utrlo*tuI, and {hall subi{i m dnplorr lo dimo,l FslrLs md
<br />ciril fincs ur lo onc hundrcd rhols,nd dollar ($l in lddilion ro $c oir ofcomp.nslion. d!tuger !r ptovkldl for llE
<br />Sccrion 1076 oflhc t tnr Codc. im.r.i and aflomeyt
<br />^,", i)zzrl/a ^*
<br />LlrtNl&lrg]ltraa(fa.B
<br />UEIIAEAIION
<br />I hcehy afifln hdc. pcnrltyolrcrjurl lhrlI ur licctr$d uNlcr tovisi(,n .r Chrpi$ 9 (comntrcins sirh sccri i TuxJ)oiDlvisnnr l
<br />of Ihc Busircss lnn Pnitc\\nnnCodc, o nlr liccnsc h ir tulli(rerftlcic(r
<br />o,//
<br />24 )/r\,--7-
<br />CQISISIICIIONI.INDIICIGEIgI
<br />I hcmby dm.n !nd$ pcnally of Frjuty lhar rhcc ir 6 onsrrudion hndinS !8!ncy for lhc !.itoli11rW or lhc work aor which rhir Frmir is
<br />is&d (Sc. r{D7, Civ C I
<br />Afrl.rc NLDErt. xrullN
<br />t h.rchy afinn hd.r ,. a lry ol Frjury orc of lhc lollowio8 dNhru' i{rnr
<br />DcnFlirion PcrnlnsAshc(os Norificarn,n Fcdcrrl R.Buldrions (l- le 10. Pan6)
<br />-Rcquircd
<br />lxrtcr 6f Norifi carion
<br />rbv. mntioncd lmlxn, for i
<br />Applk.d or Agc.l SiBnorurc a----.t-*,., q/zt/rtt
<br />I
<br />MECHANICAL.INSPECTOR RECORD
<br />DATE
<br />Vents
<br />Grease Duct
<br />lnstallation
<br />-l$nilyrhd
<br />rhc rcd.rd rc-luldn,ns rcsudinsr\h(\to\ rcnn,val m n.r,fllicahlc to rhis pnjccr
<br />-l
<br />ccnifyrhnr I hrlc ral rhi\ ilplic{riotr mn stllclh{r rh.&'rc innnnurion n corccl.l a8ra lo comply snh,ll Ciry and Counly
<br />oftlinrrc$ ind Srorc Lr*s Ehrin8 kr bu ild irB .onsrudion. ,d h.rcby 0 htrtu rcp(sentariv.s ol lhi\ Ciry.nd Counry h ord ulotr thc
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