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MECHANICAL.INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNER BT'ILDER DELC{f,ATION
<br />I hchb, .flirn nnd.r pcmhy ol pc+ry thll t rn cxcn{tl lron lhe Cof,lEcloB Lhns. ljw for rlE lollosin8 rea$n (Sd ?011 5
<br />Businc$ and Prcfcssioo Codc): Any Cily or Con.ly *hth rcquncs ! IEnit lo @nglrucl. alld. inpht. d.mlhhrt qr{t 3ny
<br />srocrlE. |,hr to ns issudm.. lho rcquiEs lnc q,plicanr aor slch frmi lo filc a iiSftd stllcm lnd h. or sh. h lie.$d pumlni
<br />ro rh. pmvisions of rlf, Conrmrols Li.cn*d t s (Chaflcr 9. C.mtring wnh Sccrion 7000 of Diviion I of tlt Busiftss md
<br />Aofcssiotrs Cod.) or rhlr lE o, sh. b .rcnpt llErcfrom and ln brsis for rhc illcgcd .rcmDlion. Atry liolarion of Sstio. 701 1.5 by 8ny
<br />applicafl fo. . pcmil slbjals lhc applicrnl Io a .ieil !.nalry of nor mrc thM fiv. hudtd dollus ($5u)).
<br />-1,as
<br />o*ftr ofrtE !mD. y, o, myemphFcs wilh was.s !s llEn $t otrp..sion. will do th wod( {n dE slru1w is rct
<br />i.rcdcn or o,IcEd aor eL! (Sc.7lX4, Blsircrs lid Profc.sions Code The Conrdols LtcnE Liq dcr nol a0ply lo an ovner of
<br />rhc In,Fny wtD t{ilds or irproks r,xft( srn w}b dcs luch mrL hims.lf or h.mlr ot rhmlsh his or hc, oM.mplover.
<br />prolitcd rhr! $.h inpmwnls N rcl idsddl dotu lor sh. ll,nww.llE lIiuing o itFowmnt is sld *nnin nnc )ur
<br />of comFtrion. rlE Owrtr Brildc {Ul hsrc ltr hunlc. otplving ttd lE or sh. dn d h{ild ot nlp,!re lhc pmpcn, for tlE p!4Ds of
<br />-1.
<br />as o*rcr otfic popcny. amcrclusircly.onlEclins *irh liccnsd.onrt0ctou ro con{dct thc In.je.r (Sft 7044. Busircs
<br />and P,sreadm Codc: TIE Conlrerol. Lic.n* Lr* dms mr rpply to an oon( or,,op.ny *ho builds or idnbvcs th.rmn.
<br />aod *lb co n rs ror such tmjcch wnh 0 6nrBcd(n lkcMd ,,x,$Ll hrhc(.,y!dr'\ l.icoi\. Lr\')
<br />ui.L, Selioi- 8. &/
<br />I rtrnby r|rtntndM Nnolryolpcrjlryonc oilhc aollowin8 dec
<br />I hdv. dld will roi.t0in s Ccnific cofco.e lo sclr.lh$rc for {otkqs orqxnsrion, ai l,!!!lcd for by S(iidn l7m.l rh.
<br />lfh.r C.dc. ror (hc perrormnce of lhe eorl for *hi.h rhc permil i( ksncd.
<br />-l
<br />hN. and will mi ain worlch .omFn*lion inrur.r.. !s rcqlt d by Sdtion 3'700 of llE Lat$r C6<L, tdt lhc p.rfoMc of
<br />6c vort aor which tnis |J.rmi is irscd. My workds snp.trs.lion insr*c @i$.nd poli.y numbcr de I
<br />-l.cniry
<br />ltur in rhc Frtunun.c r'lthc sork tu uhi.n rhi\ If,nnir i\ i\\uL1l, I \h.ll nor emnloy !.y P.i\on h My nrrtrEr
<br />k, ns t, b..omc su$jLri lo lnc workc.( comr.nsirion lnws ofC,liloari( and asrc lhrr irl sk)uld lEom $hicd t, rh.
<br />wo&crr to.lrcnrrlior fnvni,i\olS totr :l7U) of rhc trlbor Code. l shall. fndh*irh .onlPiy wiln rl[c trovi\io.s
<br />WARNING: F{ilurc to suc wotkcs omtcnsarion mvcmBc
<br />cr.l fincs up h rc hundrcd lhourrnd dolle\ rtl00.0il0r, rn
<br />Sccrion 3076 of rhc kbor Codc, i.r.cs &d 0trormy s fe*
<br />an emplorcr tu dnninrl pcEllics !M
<br />nsolion. datugB !s prcvidcd for thc
<br />I haEbyoffrnunda p. tly of pcrjlry th,r I sm licned uido Dmvision of cnaplf 9lo,lErcilg wirn Scc on 7000) of Divi3bn 3
<br />of rhc Burircs ard PrclcsioE Co.L. !d dy lkcM is in tull foe .id cfcl.
<br />Lie.s Nunbd:
<br />CONSTRU(TIoN I FNDING AGENCV
<br />lhcrchi,alnrnu.rpcnalryo,I,.rjurtrhdrlu.isdco.{ru.riotrlcndinBlscncyaorrh.pcrt'ornrnccolrhc*.IknrahichrhislEnnilh
<br />n$ed (S.c,:1097, Civ. C.)
<br />APILICANLDEIIAE{IIO!
<br />I lmtly,Jlif,n undcr Fnrlry oa,{rjury um ol rhc rollosirg dcclnru'tN:
<br />Dcmolirion Pcnnih Astr{os Norificalion Fcdcral Rc8uhbnslTnt 40. Parl6)
<br />Rcqun L.lrcrof Nolilicalion
<br />-l
<br />ccrrify rh rlE fcdchl E$laiioo. r8!,ning shcsos Emvrl m dn aPPli6bk lo lhis Prci.Tl.
<br />-l
<br />ccnily rhar I havc Ead lhi mlictrriotr {d sr inn rolhn is oEccl I osr loomrly wnh all Cilyrnd Cohry
<br />ordimR.s snd srrrc Llws rcl!fin8 ro lllhorir e0os rarivs oflhb Citylnd ColnlylocnrE utonllE
<br />obvc 'Enln,ncd
<br />pmFnt for inrr,&rio,
<br />Apt,lican' or Aglnt Sismlure:
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rough Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<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.pl9lqft\zxxt4t ,9)
<br />Final Test UJ
<br />Meter Release A.
<br />FINAL t-7\-70 V-\lrr0'\
<br />Notes, Remarks, Etc.
<br />APPROVALS
<br />Furnace
<br />*, 6fe2lt(
<br />"rd
<br />,","4talu
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<br />T
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