|
MECHANICAL.INSPECTOR RECORD
<br />APPROVALS ID/SIG.COMMENTS
<br />Appliances
<br />It/etal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />Insulation
<br />Smoke Detectors lnstalled
<br />Rouqh Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Range
<br />Other
<br />Hood
<br />Tvpe 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 />Rough Mech.
<br />Final Test
<br />Meter Release
<br />FINAL llhlt'l 11,//c,16 )
<br />Notes, Remarks, Etc
<br />(}WNI)T BUILDER I}Et,CARATloN
<br />I hcrby rlnm undcr Enahy,,t pcrjory rh l amcrcnl|l rinm rhc ({'nrr.r.d l-ic.,r\c l-aw for rhc rblk,sing r.rYr (Scc.?0315
<br />ausircs\ rnd Prorc*ion Cldc) Any Ciry or Counry shic[ rcqunc\ Nnnil ro cofl(rucr. ]lr.r. nl]ln,!r' dcmnnh or rcPtir a v
<br />no.turc, f,ritr k, ir\ isu cc. aho rcqunc\ rhc rptrli.rir nt such Fnnir b Ulc n \igmd (dcm.r rhd ,f, or sh. is lna \c tuBUMr
<br />t' lhc linnilion\ ot rht Conk0.r, s Liccnscd tis (ChlPtc! 9- Codm.mrnS sirh Scclion 7(x$ or Div,\ion ll .l rh. Bu\incs and
<br />Pnni$n,n\ Codc)orrh.r hcorsic i\cicnrpr rhcrerioaraiJ rlt h,!,\ ntr rh- Illcs.d crcnrfln,n. ny viol!rionotSccrionT0-ll5 br r.i
<br />nprli. r lnr rtcanir subjcch rhe npplic!irr(, r.ivilI)cfulryofnor nmrc lh!f fivc htrndrcd dollrs($5(U)
<br />-l.
<br />rs ownrrofrtur,r)tidy.{trnrycnDl.yccs wirhrdsc\r\ rhcn a'lcconrB,osllion. *illd. rh- wdA rxl lh. (ure- i\ tror
<br />inr.ndcn or olriNd tu HrL lSLr 7011, ausi'r.ss tnd P('la\sions Cqlc:'lhc Conta.u \ Li.cn\c ti$ docs nor slply ro 3n ounn of
<br />rhc pr,t^-.ny sh, hitis or nnfl ous rh.@n. md sho dcs s!.h qr)* him\clf or hc6cll or rh( 3h his ot hc, orn .'.ployc.\.
<br />|,ov cd lnrr ruch inll'nrrNnrs rn mr ir[cfrlcd or olls cd tbr \i[: l,i h$.\tr. rhc hriklirg or iq,rclc'tunr i\ v,U wnhr tru Fr
<br />orco dcrnr th. owncr Buildn sill hr\t lltr htrrdtn or Imrvirr! rhd hc or shc di.l Rn bt l d nnprovc lhc F)rny r rlr Ptr(ssof
<br />l.rrostrcrolrhctm['.ny.r'!ci.luriYcly.onr..rnrguirhli.cnsn.onrrrtnshrondndrhcpmJcr(Scc71X1.Busns\
<br />d,xl th,l$\i'trCodc'rhcCoirrr.ttr'st-ic.nscLlsdoc\n.lrnplr(,rnou.roflnirnyqhobrildrori'nro\csrhctcon-
<br />r aho contrr. tu su.h prorcd \ w iih r G,nrarkn ( I lkctr{J pur n rr l{,rtuConktktr s LncnscljN)
<br />l,mcxcm/ unds Sccrion- A. & P.C. iorlth rclson.
<br />O*n*
<br />wotu(Els' coMmNsaTl(l
<br />MCLAEAU(A
<br />I hcruby alrtrmundcr pcnulryoapctjuryoncof $. follorin8 dNloolions:
<br />-l
<br />hrv. ard sill nui, rin r Cenifrllc oI Con\enr t, s.lr ln$rc lor wotkni compcn{non. * Fmvincd ir. by S(rion l7m of rhc
<br />L.trr Gxlc, t$ rh. l(lfomumc ol rhc sort lor whi.n $c I'crnn i\ i\eucd.
<br />l lrvc lnd wi ll nr inr s in workers comr.nstr ion insuromc. ts rcq u ncd by Sccl ion :l TuJ of rhe Linor Codc for lhc Pcttorm ncc o f
<br />Dcrmil is h\Ed. My workcB onmnsdnn rn.umncc .rtr r*! r.li( y numhcr mIl-1*6(t"Vt1-
<br />I o0 Leil I lt
<br />-l
<br />ccnifythal ifl lh. !6lormec oltld *ork aor lhich thh pcrmi n hsucd.I shsll ml eryl.y any l.@n nmny m{m.
<br />s N ro becom slblrr ro rlE wo*cF' mqrcnsr ion hwr 6t Cdilomi,. ond !88 fid if I $6tld bc<om subjd lo rl*
<br />eo crr .oqEnsark'n pmvishtr of S(lion 1700 or ih. tibor cod.. I $!ll- fodhanh @nply *nh lhos pmvnioB
<br />Sccri,r lriT6rlrlk l.ilrtr (i!1.. i' crr{ rntlrr(ntu! \ ttc\
<br />L t l9
<br />-
<br />t,,,,*,. (P*tl'e- tnccNTert+
<br />UCEIIILCAN]3ACIA&
<br />DECIJSAIION
<br />I hrcby 0lfirmundcr Fnalyoflcrjuryrhsr I m li.lnYrl und.r Fovision ol Chapr..9 (om,IrncinS wilh Scdtn 70(xJ, naDivhion:l
<br />ot lnc Bnrincs and Ptufc$ions Codc, und nry lic.ne is h tull ror.c 8rn cftccl
<br />.,*"* "r*, 6 Lic.nr No6b.r:7e-417
<br />Slwl tv Ci,hC /*tt. L"^1"- D,+c1T
<br />CONSTRII(:T(TN I r.^IDIIIG AGENI]Y
<br />I hcrhy sfftrm und.r FMlly of pcrjury rhd fiqc is a.unslrucrion Lndiis dscey for rh. p.rfonmncc oflhc work for whhh lhis Frmil is
<br />hsucn (sd. 3097. civ. c.).
<br />l. rl.1 .
<br />^JJ... _
<br />AI]].IIANfDILELATAIITN
<br />I lm't'y u[norunncr |xtrrlry or Pcrjury oN olrh. folloqin3 dcclsarions
<br />Drm'lirtr'tr Pcnnirs^\h.{o( Norincrri Fc (al R.!ulJn,nr lTirl..l0. Pid6)
<br />It.quired lrlrc! ol Norifi cari,)n
<br />-,
<br />ccnify thot rhs fed.El cgrhlions EssnlinB &rbcsbs rcrcwl @ nn .tplictrbl. lo
<br />I ie6 to smply qirh lll City aod CoulyI cdiiy lnd I hsw Ead thh applicabn dd dar. lhd thc ehovc informtion is cd@r.
<br />ordiuN.s trtrd srdc bws nbrnE lo buikli
<br />ry-:
<br />ivcs orthis Cilylnd Counlylo cnrc. ulsn d.
<br />nhovc Nnriul.d pmlcny hr -u'
<br />Amlicont or Ascnr Sirtururcl Ptdt e -la-c-yttTtt*
<br />,*, {fz>ltv
<br />I
<br />DATE
<br />If-------T------
<br />I
<br />[T
<br />I
<br />t--
|