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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS ID/SIG.COMMENTS
<br />Appliances
<br />Metal Fire Place
<br />Eva porative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Rough Ductwork
<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 />Openinqs
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Meter Release
<br />FINAL Z 7b*hZ E /)i*il,r ll-w
<br />Notes, Remarks, Etc.
<br />OrtNER BUTLDTN DELCAAATTON
<br />I hcrcby umlm mdcr lE.lhy of pcriury lh,l I am cx.mpl fmm ln. ConlncloE Lirns. l,w for lhc following rca$n (Ss.?031.5
<br />Busincs and Pmfcssion Codc): Any City or Counly which rcquiEs a lcrmir lo constdcl. rlld. idlrok. &mlish nr q'at My
<br />st'ad!r. prior to ns issuskc. also rcquiEs rhc apl,liconl for sucn lcmir ro filc r si8ftd slarcftnt rh'l lr or shc ii lacctrcd pusuur
<br />ro llE lmvhidi! of n! Conrodols l-iei*d kw (Ch,fl6 q Coomci.! vi$ Sectio. ,000 of Divkion 3 of lhe Bosincss .nd
<br />Pofcsions Codc) or lh.l lE or slE is cxctr{,I llErclmm and llE ha\is lor lh. dkg.d cxcmplion. Any vioklion of Sdior 701L5 $y lny
<br />arplic. for a p€mn.ubjftk rhr rppli.ad lo.civilr.mltyolnor mdlhu fivc hlMrcd d6uss (1500),
<br />-1,
<br />as o*rcr of lhe l,otcrlr. or my e'i]tloy€cr *ilh *agcs !s lh.n et oq,cnsirhn. will d. llE *ori dd tlt stntlN i. nor
<br />id.!d.n or ofrcrcd fdr eh (S€.7Or4. Bnsifsi and Prfessionr Codc Th. ConrBroas Licctrcc Lis doca ml apply lo m o,mr of
<br />lh. proFny who huilds c nitmvs lhcon. irn who .roe sh wffk hiBcll o. lEr*laor thrcugh his or lEr own cmpk yccs.
<br />!6vidcd rhar such intpd,w@ds m 6r i.r.id.d GorErn for sL, lf. toftw. rh. hildbrg or i4rosmni L sld sirhir orc Fr
<br />ofo,q,brirn. rhc O*mr BuitLr *ill h!€ rlr hnhn of prcvin8 rhll lE or .JE dA ful hoiu m irtmr rh. ,,bpdr, ffr tlE N{e 6r
<br />-1,
<br />ns owtrcr of rhc lopcny. aockclusilclrconr,ocrins rirh liccnsd conrrrton ro conitu.r rhe FR,jccr (S*. 70,14. Bu.inc$
<br />a.d Prof$sbn Cod.r TIE Conh.roas Lic.ns. LnwdNs nor dpplyro rn o*ncr or proFrt, who huilds or nDprovcs rhcr.on.and *no conrtrls f{n ruch rmjccls with a ContEro(c) lians{ puEunr ro rhc Com@roar Licn* tjw).
<br />lLmrk.npr o dc' S..r 8 & l'( litrrhn r3lnr
<br />D e --- --,- oBner----
<br />wonxrns t rt.lrp-r,r-i,rriiw
<br />IECITIaAIIAB
<br />I hc6b, amrm und.r lenrhy ot r.rflry otu oa rh. touoeinB dcla,alions:
<br />trhtrC,\1.. lnrrhcNrlnnnrn.c olrhc strk liir wrrich rlt Nnnn i\ i\{rcJ
<br />I hrvc rtrd will tui zin wo crs co'nFn\,rion insuntue. r! 'c,lrtcd by S(tion:l7ID oflh. tahor Codc, Lr lhc F.rfornum.of
<br />rhc sork for whkh rhi( F.nrir k nqrn Mvs.rkdr 6nn nsriln 'n{u,m.mrin n l[li.ynunt{rec
<br />t< i,ndDia
<br />otB.oll 1t1 D ., -\lltolx
<br />-l
<br />ccnify thlr in rhc lErforBme ofrnc *ort for whkh rhis permir is hsEd, I inal nor.nfloyrny Fno. in &y ronncr
<br />$ as ro tEom suqier r. rhc vork6 smpcnerion laws oa Qlit mio. 3.d .gEc lh.l il I slsuld tr om sutj.lt to llE
<br />portcrs'cor{Ensri.npovisionsoaScdionlT00ol'h.llt r C.d.,l slEll. fonhwilh.omply rilhrhos fmykions
<br />WARNING: Faihrc lo surc rork€rs snrp.nsrion covcng. is lnlotrtul, hd shlll srb]ccr on corLrr to aininul ,xmlris and
<br />civil nncs !p to otrc hud.cd tholsnd dollaF (!,00.000). in uddirion ro rhc.on ofor{.nsalion, diruges as pr.vidcdrior th.
<br />Ssliotr 1076 of rhe ljbr Codc, inlercsr .nd anomy s fes.x
<br />OICLAAAIII}N
<br />I h.shy ulfirmundcr pcnllry ol pc,ju,y rhlr I !n liensd unlcr nrcvkion oIChq s 9(co.tftncinA wirh s..rk n 7fiD) ofDivision:l
<br />ol thc Bu\irEss .l(| Pmtcssiofl\ Codc. ud my liccnr h in full lnrcc and c,tccr
<br />.aq06Ll3
<br />"",.,-qltqlft'
<br />CONSIBIIS&NIINDIACTiDNS
<br />I heeby ufi nuodcrrcndllyolNrluryth.llhdcis0construcriotrbtrdir8o8cncyn)rlhctEfornrnnccoflhcworkn,whichrnislddin
<br />issucdiScc..1097.Civ. C ).
<br />AT]LICANLIIESAAAIION
<br />I lrn$y nlnnn u ndc. lcntrlt, ollcrruryotrc olrhc Iollowing dccluntriors:
<br />Dcmnirin Pcrmih AstEsk'r Norilicarion Fcdcrrl Rqularions (l'irlc,{). Pan6)
<br />Rcquied t-(er ol Norifi .dx,n
<br />l. "ril\ 'l-r rhr t ,l i '.culr'i.,n. nrr1l.1r r.h.i," j. tr!\Jlr. tr,1 rt1,ln"hr k, rhi t','r\ r
<br />nl
<br />abovc m iinrcd nmpcny for insrccr
<br />Apdicini or A8cnt Signalurc
<br />III
<br />I
<br />I
<br />DATE
<br />Smoke Detectors lnstalled
<br />Final Test
<br />"",",'4lt4l$
<br />kndo'r AdrlrEs'
<br />,"., -ql4ltt
<br />Ehevaw'tt
<br />=
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