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MECHANICAL-INSPECTOR RECORD <br />OIf,NER BUIII)ER DEI,CARATION <br />I heby amm uda poalty orFjury rh.I I u dcbpr iion rh. col,lraclos Licce trp for$.lonowins @in (Se.iolls <br />BuinB d P.olBion codc)r A., Ciry or Coonly whi.h ..quiB r Fmn lo oturru.t !16, ihptol(. &nolhh ot Ep.n oy I <br />sttucrur., prior ro ils isuec. .lso Equird rh. dpplicer for such Fn n b 6h 6 .ign.d $'l@ol thal n or 3h. ie licdts€d purudl <br />lo rh. FovisioB oftlE Codret is Lic.n*d L3w (ChlFd 9, Com6.ins wnh Selion ?000 of Divaiotr I oflh. Bsird dd <br />Pof.siotrs Cod.) or rnlt h. or sh. i! .imo lhd.fiom &d lh. to.i3 for lh. alLg.d doptio[ Ary vioLton ols..1ion 703 Lt by dy <br />.ppli6l for6Fnh subjd! tn lrplic..t lo !.ivil p.mty 6f nol mE lhe fiv. hu lrcd doll4 (1500). <br />-1. <br />a osd ofrh. Fopdty. o. n,.n9lor6 wih wrg6 6 rh.i, eL @opar.liotr. wiil.to th. M* ad Esrnrd@i @l <br />iit nd.d or olErcd for s.l. (Sc.?044. Blsi.s sd PorsioB Co.L: TIE conrturois Li(t@ Lae do6 nor rrply to e oMd or <br />rh.PloFry vho hi!{b or idF.c thoel! @d vho do6 sch s* hn8.ror hq&lfor lhmugi his or h6 os hPlolt6. <br />povid.d rhd ruch inF!ffi e mr n 6d.d dofiGld for sL. I[ twM. rt buiEi'e or iiErovaE i. eld wirhin oE ta <br />oforptrio., tlE O,Da BoldE win blvc 6. hr&o oaFovin8 tlr, h. or stc dil tul buits or iftpro( {i. prnpqty for dE ltEpos ol <br />l.dostrioflt Fopqry, m.rclNiv€lyco r&ling wirh li.os.d conllcroslo orsru.l tlE pljct (Se. ?044, BciB <br />&d PDtsid Co{.: TIE Co 6cror's Lic@. Lae do6 nor amly ro o ow.6 oaprcr..ly Bho builds or ihProv6 lhdo.. <br />,id trno o.flcrs aor 3uct Fljdil with a ConrE ro(t licd.d pBu,n lo lhc Conrado.3 Ucog t v). <br />I .rmF ond6 S.rlion , B. & P.C. forlhis r.&o <br />D.rq onn4: <br />tuorsrxl:.coMrElsAra! <br />DECI,ABAIIO! <br />I td.bydfmuodd pallyof pEjfyoEof th. followiq<,!.l,r ioB: <br />-l <br />h.v. ad will ui ajn s Cdrific.rc of Co@l ro Sclf-ls@ for wo(6 onpo!.lioE B Ftrrid€{l for by Sddon l70O of lh. <br />L.bor Cod., lor th. Ddfol:Mc of lhc rclt for which rn pdhh b i$u.d. <br />I ha!. dd sill nli.tain worl6 co'rp.Mtion iNurocc. 6 Eqlir.d by Sclioo 1700 ollh. t bor Cod.. fot lh. FlorlMc. ol <br />rh. work atr wnich rhis pmit is issu.d My work6 conpmalion idurec. .elr rnd policy numbcr e.: <br />PolicyNudbo: Expnd <br />-l <br />cdit rhat in lh. pdfomdc ol$. worl aor which thi! pcmir i! isru.d. I shall nol @ploy ey F.on i. ey oo.o <br />s 6 ro b€om. 3ubjd ro rlE wo*d' co,rpsssriof, l.s or c'liromi4 and asr rhar if I dDuld b6ooc .ubjsr ro th€ <br />wort6 @oFqrion pro$i3ioN ofserio. lT00 of th. t t r Code l shaU. foflhwith compv ,irh Oo* FolBioB.. <br />\'VARNING: Failurc ro $u. ro,k6' omFMlion covFasc is unla$tuI. ed shall m mdoy6 ro oidinal ,aelts dd <br />civil lind up ro onc lurdEd rhoMd dou6 (5100.000). in additio. ro rh..ost ion. d.m.gd s provid.d lo! thc <br />SN'n,n !076 !lrhc lrh,r CuJ.. in'6d ullatnm6' <br />,,.,e q/ay'z <br />^pp,rori: <br />l,t ( tiNst.p (1)\l R1( t(rt <br />DESdAAIIO! <br />I fiftby rfEnn undcr pd.lry ol pdjury rhal I d ltdsqi 6dq provision ofchaprd 9 (omddrg wilt S..lion 7000J of Divtt'n l <br />of fi. BBind md F ofsioB Cod., ed my licsc b in tull lorc. dd ctr61. <br />-={sz/ <br />( ()NS',t RU(',t t()N l,llNOtN(; /\(;[^( t <br />I t@by a,Im ud.r Fnrlty of Fjury lhd lh@ is d connrudioi Lndi!8 asa.y for th. FfmEcc offi. worl aor *tict lhb Fdil is <br />i.su.d (S*. 1097. Ci!. C ). <br />I cdiry rhar ih. t d6rl r.gutlrioN r.Sddins sberos moval se mr appltablc ro $i5 prcjc.r. <br />I csliay rhar I hlvc r6J lhie rprlicalion ad slalc lhal fic abov.rf,6rion a cotrd. I a8c lo omply wirh au Cny Dd coudry <br />osnnan..s and Shre l-n\s.clari'l8 h buil{lin!.onstrudion. dd ivB ofrhir Cityod Counrylo ord upon fi. <br />ah\'e nMrioncd poD.ny aor <br />Applic l or Asol Si8nalu.. <br />APPROVALS DATE ID/SIG. <br />Appliances <br />hrletal Fire Place <br />Evaporative Cooler <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnslalled <br />Rough Duchvork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranoe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release <br />FINAL 4l?.0/lr 5l\*7 <br />Notes, Remarks Etc. <br />7 <br />COMMENTS <br />Furnace <br />-Lic@. <br />NlEbq: <br />lldd s AddrN: <br />- <br />appr-rci i orcr-aqlrroN <br />I hs$, 5fm undo tc..lry olpdjury onc ol thc followi,s d..ldariom: <br />Dsno[ion PffiireAsbdld Nori,]carion F.d@l R.gllaliotu (Tirl.40, Prn6) <br />Rqo&d Leilaof r,Jotin€ion <br />I <br />I <br />f--