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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Appliances <br />l/etal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranqe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Fire Damper <br />o penings <br />Installation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />4n/ottRough Mech.167/ <br />Final Test I <br />Meter Release A\ <br />FINAL I -z*1 v v-wn) <br />Notes, Remarks, Etc <br />()wNllR ltutl,l)ER IrEt,( aR/\ ltoN <br />J|)I,licrnr tur rl.nnils'htc.rlrlr rntli.rnrn) n(trilNrrlrr-ol ornim rlrr lnr hrfdrcd d.llrh (55(nr <br />_1. us owmr oarhc pmtEtly. or iy cq,lotca wirh w.gc. a, th.n sh comp.ns.'ion. vill lh rlE sGt d rrr sr.rElw h mr <br />inhrtr.rotrrcdfo.slc(S(.7lX4.Busine*udProtsiionsCorleThcConrscroasLic.scLitrdoes.6raprllyroanowMof <br />rhc ,Ioltny sb boildi or inpmts ft@.| ood who dE sh wll timcrf or her*lf or lhmust nk r hE o*n cmplor*s, <br />prcvidcd thol such imprcEmdsm mI i,l.ndcnorotrcEl ror sb,lf. towNi rlEhiikh!or inprclm ii eld wjlhin om )4d <br />ofconpldinn. E Owrcr Builhl qill hlw lhc bod6 oapmvi.g lh,l lE or shc did mt buik or itr{tmrc ttlc pmpoly ltr tlE pn{nr of <br />-1. <br />!s ow. of thc <br />',otcny. <br />!mcxclrsivcly conl@lin8 *ilh lhctrsd .onkmk,6lo onsldcl rlE Foj.cl (56 7O&- Bunrcss <br />lrd fiofssion Codc Thc Conrscrol! Liccn* L3w d6c! @r iptly ro uo*nf ofprop.n, who buil&or irprcvcs fircon.and *ho 6.tncrs ftr such rmj.lls wnh o ContBcro(s) liNrcd pursunr ro rhc Conlrsrols Ltcns LIw). <br />I r r.tnt ondcr S.rr <br />*,". ql'tOy'f <br />t!!I8tr!Erraul!)$it9r <br />I hrrch, arlirnuidcr pcnrlryofpcrjuryooc ollhe ftn <br />-l <br />huvc ud willnEnrrain a Ccniliclrc of Consnt ro srll.l.surc tur qorkcB compctr\&ti(nr. !s providcd for $y Sccrirn l7l)0olrlr <br />L{hor Conc. for rhc pcrlornNrcolrhc work f.r whi.hrhc pd rr i isu.d. <br />-l hivc an<l *ill minlain *ortcrs co'nrcnsl ion iNurorcc. !r rcquiEt bt S(l ion 3100 of lhc L{hor c(dc. tor thc p.rformrce of <br />$c erk fdr whi:n fiii lcmi is ho.n. My so.kBl mmpcnptk n insurnm cuicr and policy nuhhcr e: <br />P,,ln v Nunkr <br />-ErDiics. <br />-l <br />c.riiry lhrt in lh. F.formm of lhc work rdr whiclr tnis pcrdn h is.!.d. I \hsll .or cnrLy dny pcN'n in aiy @mt$ aslo tEcom sublccl lo llrc wo*nl compcnelion Lwsofcdliromi,. and,88 rhar ifI should tE o rubFr h rh. <br />worksl @mp.nsorion lmlisionsotScdion ll0l) oalhc Libor Cod..l nnll lonhvilh onplywilh lho$ pmvisions.. <br />WARNINC: Failurc lo s-uE sorkes omtcnsalion covcmBc is unlawtul. atrd sh.ll suhjBl an cmploycr to aimiml pcnohics.nd <br />cilil lnrc\ trr lo orc hudrcd lnou{unl dolh,s (Sr itr rddilbn lo lhc co{ ofcommnsotion- donupcs !s prolid.d fnr lhc <br />smrn'n 1076 urrF Lshr Crdc. in7/>o/t f <br />DI',CI ARATI(}N <br />Ihccbynlfirrutrdcr p-.rlrt.l lcturyrh l rh li€tr{d uidcr ptr,vnion of Chrpro 9 (co'n'ntuin! sirh SNri T(XX})ofDlririon:l <br />of rlrc Busi.c\\ d Ppfc\si,,n\ Codc, dxl nt licn\c i\ in aullli)rcc mdcl,acr <br />q ,' <br />CoNEIAICUO!.rENIuN(iSCENCI <br />I hcrcb, lrfirm udc! IEnolry of perjury lhrl th.rc is a coniruclion lcnding a8crcy for rhc ,l.nmmn.c of fic worl for qhich lnis pc.nril k <br />issucd (s( ltr97. civ. c.). <br />AITUIANLDEILAEAIIIIN <br />I h.Rt y aliinn uMc. p.nalty ol Frjury orc of lhc nnbpinB d(lrarionsl <br />D.lmlirion Pcrnirs Ash.srG Norili.arion FddcDl Rc8ulnlt,ns{lIlll &. Par16) <br />-Rcquncd <br />hller ol Norilictrlion <br />-l <br />c.nify th.t lhc a.dcml Egll ions ESording lrtr{ol rcmval aE nor npdioblc ro rh nrF.t. <br />l(cd'F'h lts\cnrJrh^Jfr,hLrrtr'ndrtln, rrhr rhcatxrvc inlnrndi0n i\.oiiccr laEcnrconlnltsirhrllciryrtulcounry <br />nl'nrrc\\r,l s,larr llq\ rulr'nE n, huiltlins L ndn$,,n.nrxllErcbyrurlmri/crcprcsnrarivcsol'rhhCnyandCountyt'enrslIonrh. <br />.'hrc 'tu 'nxlt pmnldy rdr'tr$?.rlFEtu\ <br />"n"-,,,11i,^'. u',, d'7- ?' /3 <br />/?en-J <br />I <br />Grease Duct <br />Co rs.lor: <br />I <br />F <br />= <br />=