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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BTI!I-DER DN!.CARATIoN
<br />I lErcby nliirr trndo Nnilry oi pcrjur! rhlI I cxcnU ior rhc Coitrktrr l-i..tr\c La* rar lhc iollo"ins rcas'n lsc.70.ll 5
<br />Bu\lnc\\ on hotsson Codc) AiyCiryor (,)triry shich r.qurc\, Frnrii ro con{rucr. rlrcr. i.n[oE- ictrx,lnh,tr RfJn Jny
<br />ro rhc prcvi\nnr! ollhc Conirr.rn.\ l-iccn\cd llw lChrflcr 9. Co,rmn(rne wrh Sc.ri$ 7lx)0 ol l)ivi\ion:l or rtu llu\inc\\ d
<br />Px,tc\\n,A Codcrorrhrrh.oishc i\ *c.r|, thcr.lio rtdrh.hr\isli'rth.rllc8cil.\c'nnlion Any!i(n]ri(n.fSc.ri{'n703l.5byrry
<br />Erplienr lornNnnir $btrci\ rhc rpplicld ron.ivil,,ctrrlrr-ol rDr nnrcrhxr riv. hukt dd.llxi\(s500).
<br />-1.
<br />is osmr of fic phFny. o ny.mplorB! wnn v,gcs ar lh.ir sk o,{Enslrion. Mll.lo tlE "qI ald rlr rMm is @t
<br />inr.nd or oficrcd for sde (Se-?044, Busincs and Pmfcssions Codcr Thc Co rodor's Li..nic Ljw do.s ,ol {,ply lo .n owftr of
<br />rh. pmFrry eln t{ilds or in+b$ Odo,! ad who dc sh s* hi@lf or h6*lf or dmuSh his or tEr oh chplo}lci.
<br />provid.d rh( su.h impowmnls e mi int ftLn orofimd for sL. l[ tDM. tlE tdildins d imrrcEmor n $B Pi{in om Jer
<br />ororpbiion. d! Owrcr Build.r sil niw dE t{nLn ofpmd.g lhor lE tr dE dil ml huild or i,qmrc dE Fepory ror ilE purF$ ol
<br />-1.
<br />.s ovftr of rh. ,DI,.ny. ah ciclusivcly co ructifls with li.cnsd coflreloa ro.6nstrtr
<br />'
<br />the ImiEt (Ss. ?044. Buims
<br />ud hDlssin Code: The ConrEcr.r's Licensc Law dms.or anply lo Mowncr ofprcr.nywho hlilds o. inpov.s rhcrcon,
<br />{nd sho onhds fm slch pmFls wnt a Co r!clo(s) liccnsd pu^@r rorh.C.rra.rq i Lic.sc l,w).
<br />I amcx.nrrr undcr Sccr
<br />IJxrr ()lrntr
<br />uaSsESl:l:qMfEN$aIlo!
<br />DEII,AIAIIO!
<br />I tE cby lmm undcr F..Iy of pcrjury orc of the rolbeinS dsl,r.lions:
<br />-l
<br />hlvc .!td will minltin , Cenific0t of Co.mr b S.lf.l.s@ fd wdk6s' on'Ffl$lbn. a ptuvid.d for by SRlhn 37m of llE
<br />Linor Codc. for Ihc Ddformcc of rhc m* fo. whictt lhe pcml ii h.!cd.
<br />x har. and will Fainrain wort.a compcnsatn,n insullncc. ns rcquicd by Sedion 17fi) ofihc tlbor Codc. for Ih. lcrformrcc of
<br />work rdr *hich rhis p.mit is issuct. Myworkcs ompcn ion insurancc onicr !.d Frlty numra. dc:
<br />CU-9
<br />l.cniryrn in rhc FrhrnEnc€ ol lhc wo tuwhi.hlhist'€rmil is isucrl, t shall n.r cnDloy !n, Pcs.n in on, mnncr
<br />s sro tEom subicr ro th. lorlch conpcneri.i lau\ orcrlif.mid. and a8mc thot ifl should tl.ronE slhir! ro Itr
<br />{orkcls comFnsariotr Imvhions ofScction lT0O oflhe ljhr Codc,l rhall. ronhwnh.onDly wilh lhos tmthions.
<br />WARNING: Fnilurc ro $curc workctr coinpcnstrlnrn covcnSc is utrlaeful. and sholl $bjc.r dn cnrrl.Fr ro ainlin0l ,En0ftis and
<br />cilil finca !r! l(, oN hundGi rhouend dolldrs (Slu).ooo). i. lddilion lo the co( ofcomr,.serion, drmecs m PmYid.n tor lhc
<br />il:ii]Efltr-:Y-
<br />LtclrNsELcoNraaclaa
<br />DES.IIN{II9N
<br />I hcEhy lltmu cr Ntrrllr of pcrllr, rhrr l $i licctr{l undrr tft* ^n ol chrprs 9(cotrrNn.ing *irh so.ti{,n 7(xx)r ol Diri\n)n 3
<br />ol rhc Brsirc\crfir l,mlc\si.n\ Corlc. nl nrr l]..n\c i\ h lnllli'rc. aidrlfu.r
<br />C3 00s
<br />.n**"..iA
<br />cl)Nrraucrl()[LrilDllli-dtiuicl
<br />I hcrbyafin u cr |tmhy ol rurjur r rhrr rhcrc i\ ! conn rd i(r lc tli'r! +rn.y nr lhc Frr'onnrnc. of rh. ruk for whic[ rhi\ Fmir ii
<br />ns!.dls&:lul7,cr c.)
<br />I ccdifyrhd I hnvc rcd rhiupplic ion ud srolcthot thc atx,vc infonnarn,n hc.ncd.I rgm ro mmply wil h all Cil! and Counly
<br />oktirumrs rnd Srrrd lrw\ r.brit b huildinS.on rn h.rcby sulhornr rcFcenrarilcs oarhis Ciry dd Counrylo.nle upon llE
<br />rh)r nf,nri{nrd tn'p.ny fu i'r\
<br />Apdicn orA8cnrsboaroE
<br />P*ir* ** tp.i"rl, * -V\-
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rough Ductwork
<br />Venls
<br />Toilet Room / Clothes Dryer
<br />Residential Range
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinos
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />Meter Release
<br />FINAL B-t,-/g J/J,h &9
<br />Notes, Remarks, Etc
<br />-)
<br />li<Lar Nm:
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<br />Lcnddt Addrcsr
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<br />AIzuCANfDEIJ/AAIIO!
<br />I lErhy lninn undcr FnrhyolFrjury onc.rrh, rolhrinE d..ld,rn)ns
<br />Dcnnninn Pcrnrils.Ash.sIos Noriri.ariotr l'cdcrul Rqulations (Tnb 40, PnnO
<br />-Rcqutcd
<br />L!lrcr of Noritunrnr
<br />-l
<br />ccn if, lhd thc lc{cml rcgllarions rcgadin! !4bcsros rcm)val 8rc nor ,mlic$lc Io lhis prclccl.
<br />slel"L
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