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APPROVALS DATE tD/stG.COMMENTS ONcr BuildF D..h,,lion <br />Ihd.b,t0irnunddp.ohyofplrjurylhrlI! ex.nrpt lorh lh. ConlBcloE Lic.nF ljw aor th. aollo,ins r.en (6 ?0! l.t Bsin6i <br />ud Prof63ion Cod.): Any Ciry or Codry which Equtd s phir lo o$tD.r, !ltq, improG dcNlirh or rcpair &, lttucturc. prior lo its <br />nsunc.. rbo r.qun.r th. rppli@l for ruch Fmil ro lil. . rign d 3tordc thll h. o. 3h. is li..ed p6um ro ft. pDvisioB ofrh. <br />Contnclor's LieB.n lrs (Chlpld 9, Comm€rcins wnh S..lion ro0o ofDivirior I ollh. DurnB..nd Profd3iom Cod.) or rtar h. or <br />!h. i!.r.mfl $@n'on lnd th. b8i! forrnc !ll.s.d .xdption .Any violrion ofs.clion 7031.5 by lny.rplio fo. ! p.mn lubj.clr th. <br />lppliml lo . civil p.Ehy ol nol mor. the ,iv. hlndrcd dolla (1500). <br />I. u o"G ofrh. pop.ny. or oy dployca whh *rsB .s lhcn sok conp.Mrior will do lt sorL .rd rhc irrlcru. it nor inrcnd.d <br />or oaLr.d for gl. ( Se.?o44. Butind3 snd P.oa6r6n! Cod. Thc Co.tE.lol, Lrc.G. Lrw do6 nor.pply t..n omd oa(h. pmpdly <br />who build! or inpbvG lh.r6c and wl'o do6 txh *orr hi@.laor h@lfor rhrcugh hii or ha o*n .mplor6. povid.d lhrt toch <br />ihprcv.i.nlu d. nol inl.tu|d or of.rd lor sl.. lf, ho*.v(, thc buildirg or in!rcv.m.fi i! lold silhi, on yco ofconpldion. th.ol,E Blildr -ill h.v. rh. b!fttcn olprovios rh h. or 3n mr build or ihpov. for $c purDo* ofsk). <br />!(..*"*"r,r,. p,op"ny. <br />"'n .xc lurir.ly ..nrflcrirs snn la.Gn*d.o d.toB to coEltu.t lhc proj.cr ( s.c. ro44, B6in6s sd <br />P,ot$,on Cod.: Th. Conl6cloi! Licctu. L.w do6 nol ipply lo tn o*n.r of prcp.rly who build! o. inDrov6 rh66n . !.d who <br />conlrcB for such proJels wilh. Contrclo(e) liensd p!6u.n' ro rh.Contdol3 Lic.ns€ bw ) <br />_l 6 .xmpl udd Selior _.8. & P,C, tu tth !!ei, <br />Dir.: Oq@: <br />_| h6v. lnd willnlmllio worL.u' snp.n$rion i.!u6n r a r.qun.d by S.dion 3?00 ofrhc bbor Cod., fo.lh. p..foi@n c oflh. <br />eort for whi.h lhE p.rFrl is issu.d My wort..s 6nrp..slion imur.n.. qrcr.nd policy nuhbcr r.l <br />Policy Nu'nb6:____ __Expt6: _ <br />(Thi5 !.clion n .d nol b. compld.rl iflh. pcroir i! for Oi. hundr.d dou6 lS 100) or 16$ <br />_l ccniry thrt in rh. Frfolruc. oalhc wo.k lor qhich lhb pmil ii i.6!cd. I !h!ll not .mploy r., p.u6 i! ay mlnncr so a lo <br />b.camesubFcrrdrh.uor[e6 cofrncnerionl,$ofCahlorn'!,lnd <br />comp.nstionpRnbionsoaSccrion 1700olrhc t borCod.. Ish,ll. <br />J:r-,9 <br />*ARN INC' rlilurc ro !6ur. workds conp.rexon covdB. i urhvful, lml3h.tl subj*t !..mploy.r tosimi.rl p.MhiBlnd civil <br />to6 up to on. hundEd lho!r.!d dolh6 (ll 00.000).ii rddnioi ro th. .o$ of.oep.n ion. damagcs a pblid.d for rh. Sdion 1076 of <br />lh. Lstor Codc, inl.r6l !.d r(om.y 3 a6 <br />tlcEBEED.CqlIEAgrAat iCLAaAIlqA <br />I nr.by.mm und6 p.n.lty ofp.rjury lnrl I m L..tr!.d Ed.r phrilionolch,ptE 9 (onm6cin! wilh S.cion 7000) ofDili3ion I of <br />rh.Bosircsard Prol6sions Codc..nd my li.s. is in tull foic. and .rf(r. <br />9-g- t! <br />g)!$!!cl!ox_tE!D!!G_4c!!c! <br />I hd.b, iflinn trnd.r p.ru]ry or!.rjury rlrt rhdc is a.odrruclion lcndiis as.ncy ror rh. pcrlomd.c€ ofrh. sorl lbr*hich lhis pcnnn is <br />issucd (S.c l0!7. CN. C.) <br />a8&tgAgr.9.Egt a8ar&a <br />D.mlilioa Pmil!-tub.tiN Nolilic ion F.d.6l R.rd ioB Onh a0. Prn 5) <br />_ R.quir.d Lat6 ofNoii,ianio! <br />_l csrify tlrr ln acd6ll rqulations rcE rdin8 abdtN r.novalaB nor.ppli..blc lo rhi! projdr <br />I c.niry rhll I hlvc E d rhis .ppliorioi rh.rrh.abov. ioaomatio. is.otur.l asr.. ro co'nply wilh allCily and Coumy <br />ordidncd and $rt. Llss El.rins ro authoiz.rQ!6.trtali!.solrhisCnyrndComryro..rcruF)n$c <br />.bo!. m.ntion.d prop.ny aor Sr9-"e <br />Appliances <br />llletal Fire Place <br />Evap Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork /04/-(6 z '.2 at 7 <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />lnstallation <br />FlD. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release <br />FINAL iz -3 -/B 6z z,,.,,.1,/ /. A..,D <br />- t--/8 e.7 <br />ical-lospector R6.od doc 03.31 06 <br />MECHANICAL-INSPECTOR RECORD <br />lnsulation <br />IIORXERS COIIIPENSATION DE(-LARATION <br />I hccby rtfi m und.r p.tulty oap.rjury on. ollh. followins del.r.riom <br />Ihav.ind{illmainuinrC.nifl..r.olCoN.nrroS.ll-hslrcaorporlcB comp.nslDn,.s provrdrdforhySecronr700olrh. <br />l,bor(odc. aor lh. p.rfomarc.oflh. wo* ao!qhicn th.p.i,nn is issu.d.