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MECHANICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS ()wNnR BUI-D!tn Dr.!-C/1R]\Tl()N I hcrchy nriirtrr und.r |Enrlry oi tcrjury rhd I u crc U lioo ihc Co tarhr Li.cnsc tls lhr rhc idlowin8 r.av'n (Scc 70.11 5 Iiurincss ! ttor.\si,)n Codc) Aiy Ciry or (i)uiry *hi.h rcqurc\ r Ptrnil lo con(nr.r. 0lrcr, inrn,rc. dcfrri\h ,tr run Jnv ntu.hrc, t' ff h ir\ ($in c. il$ rcqrncs rhc rmli.rtrr ri, {u.h pcnnir h illc u \i8'rcd (3rc,rcnr rhJr h. or \hc n lNn\cd puhunnr ro rhc nrcli\n,n\ of rhc Coirflcnx \ l-i.rn\cJ ltrN (Chaflcr q. Coh'tufuirs \irh sc.rion 7l{I} of Divi\ion ll oi ll[ Bu\i"rs\ rnd Itnns\ i,in\ Odc r or rhrr h! or\tu i\.rc'npr rhLrdiomrnd rhc hr\i\ lar rh. ilLecd cnnlt'rnn ADyri()lari{DoiSd.ri 70.ll5hy0ny rpplicanirairIannnsubjc.hrhc.ppli.rtrrk'rcnil,)ctrilrlulturnucrhulivchundrc{ld.lhr\($5(x)) -1. ss owmr of rhe poFny. or ny cnplolEs wirh wrscs &r rncL $lc coop.nr ion. wil do llE wdt lnd llt nrleir hr hro{tcd or oifcr.d for eb (56 70,14. Bu.im* &d Profdrionr C.d.: TIE C.nrEcroas Lien* ljD &$ mr oroly ro an owm, of th. rDp.ny *ls hoilds d irlrlts dleen, uid *ho dG tuh @* hinklf ot hcMll or ihmugh nis o h.r oq cnq,lorr.s. providcd rhdr su.h inrrekmnl3 e mr intMd':d oroflcEd ror et. Ii howc!6. rhc tiiuing.r itrlrohrc.l h $B wnhin oR ra of cotrrphrioc 0r Ouncr Aliba Bill haw lhc bodd ofProling rhll hâ‚¬ or sh. did not huild or iq,mw thc poFny for dE pqns of -1. &! owmt of rhâ‚¬ F,Dcny. am .x.llriwly conE&ri.g wirh liccnsd .onr.ch^ ro orslru.i llE pmjel (Se. ?044. BniN< lnd ftoLssion Codc: Thc Clnrracrol s Liccnse Llw docs nol lmly ro !n owncr of porcny whd huilds or improvcs theron. lnd who cr mds for slch ntujds *nh a Conr@ro(o ltcisd p!s@r ro rhc Cortmcxn s Lia.sc L!*). -l dcrcdfl !'dtr S*rion- B, & P.C.lo.thir Bon D"lc:- Orn.r:- IOAf,EBI:CI}!4PINSA.IION DICITABAII(A I h.rcby .lfirm undcr p.n.lly or Frjury orc of lhc followin8 d.cbBtions: _l nrw un will @intah ! Cfiificsrc of Con*nr ro S.lf.lnsor for *ortcB @dFnlaliotr a Fovd.n for by S.clion l70O oa llE Lrbor Cod.. fo.rhele.lomDB. ofth. vorl for which th! pnn n iss.{. y'l havc and *ill tui ah *od(6 onpensdr'on insurBncc. s r.quhd by sccrion rhc $trl ltr * hkh lht permil is stucd My *orkc' r (otr4â‚¬nqrion in\udN .0mr cqicr' <'rfrl?- filb Jroo .f lnc Labor Cdc. fu rhc n rfommc of * q64 ?>r-20/Ra I ccnify lhar inrh. Frformrcc of thc wort ibr whi.hihh pcir"ir h icsucd.l \hall nor cnploy a.y p+.sn inlnynumr $ as lo tEom $b.iEt ro thc worts' @rpcneti.n hsr of Cllitdmia. md agE rh3l if t should kronE s!$jer lo rlt $orkqs .on{,cns ion pmvisio.solScclio.lT00ofrhc litnr Codc.l shall.lonhwilh.omlly *ilfi lhos pDlhn,nr. WARNINC: r{ibE lo suE workcs $mpcneliotr covca8 is y.r ro siniml Fulris ard thou$nd dollar (Slm.U-n). in daau8cs !s pDridcd tor the t.lclj]SriLg)lu&!lll)aDrcr &!!!a! ol rhc lnAir.s ral Pnil.si(trI Cod., r 'vlirr \crsdlllllnRrtrlcllc.r t0!$f,ucuol{tElDlNclcrNcr I hftby dfirn ldâ‚¬r pcnaly of Frjury rlur llErc is a .onsrMrbn lcndirg ,8cmy lor th. !.rfomre ot llE e* for ehi.h lhh pdnt b issucd (sc. 31)97, Civ. C.), rU&llANfDlig.rBi IIIA! I irrchy dtirN Undcr pcfulrt ol t)crj$! o r.l thc lollosi'rgJcchrirn s: Dc xnirnfl I'crnrir\ \hL{or Noiiil.rlion I;crlcrrl Rcguhriurs (tirl..l0. Prdar R.qutcn ljrtc,.l Norirl.rrion -t ccrriiy rh0r rhe fcdcEl rcBubrions osdding ostEsros rcm)lal d nor nmlic$lc ro fih tmr.d l ccniry rhlr I hr\r red rhis .p!li. ion nd *0rc rlu tu r,rc informil .onccr l lsrcr k, co'nnly *irh nllCiryrtrd Counry odimmcs lnd Srrrc Llws dbrins k, blildins ltmvc mnlion d pmpcny fm Afpli. nro' Ag.hr Si8trxtrrc: Appliances Metal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation lnsulation Smoke Detectors lnstalled Rouqh Ductwork Vents Toilet Room / Clothes Dryer Residential Ranqe Other Hood Type I Hood Type ll Hood Grease Duct Fire Damper Openinos lnstallation F.D. Drop Test Above Hard Lid I Above T-Bar x/%lt*r*lt ) I Rough Mech. Meter Release FINAL lo/z'tl rl Notes, Remarks, Etc. I Final Test I ----+--- I