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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER I}UII,DtrR DFJI,CARATION
<br />Ihcr.htarfirnuid.rn.ialr!.rNrjuryrh,!Inr.rcnuri.nlhcGnnrclorsl,iccnsclirvf{nlhcfollo$intr.r$n(sc.70.rl5r
<br />Ir$irc$ an,l Pdtsid' C.de) ,lny Ciry .r Cou.ry q'hi.h rcqute\ ! Ix.nir t, condtu.r. ilrci nnlb\t. dcntnnh or rcI'oir Jtry
<br />ddcrLrc. priorh irs i\\!ricc. rl\. rcqrifts rhc rpflicrnr ttr such p.rm tu 6lc r signcd rurcrk-nt rhar hcor shc k licrntd pu^hnr
<br />lo lnc pro\nnnrs or lhc (nnlft.rors Licctrscd lnw (( hrnl.r 9. C.trnncncirs sirh sc.ridr 7(x)0 of Divkmn I of lhc Businc$ and .
<br />Itolcrsnnr\cl .lorllNr l"or\hc l .icn,tr rhcrclior 3trd rhc hasi\ ntr rh.rllcBcdcx.trrfril Anyviohli.noisc.'rirn70.ll5byln!
<br />r 1li. d ttr rrrrfrir suhjc.isrhc ipttli.am ro d.ivilt.n.[y.rnot nkncihitr fivc hundrcddoll$ (S5u))
<br />ZGr. ^ ,**, r ,* n-rny. or n,y c'nplq8 sirh qalcs n\ rtun $L .onll]rtrsortrfl. *,ll(ro rhc wmk n rhcdtu1u,.istu
<br />inrcNlcd.rolt.rcdlorelc(SN?o,t,l.DusirrsaMhnlt(ior(i c'l'fuO,ntrcrtr\Li..trtltrsd,)csnor0mlyroatro\Nrol
<br />rh. ptr,pcny sk, $oild\ or inllr*$ rhcR\ . rtol*ho dd\ such *nk hnnrclfor hcrslrorltmu8i l,t o, ncr ow..mpk,r".t'.
<br />nr'vxlcd rhtrr such nn|[r!.m slrcforinrcndcdor.fcrcdhr\ulc.lllm$clcirhchrildi'rforirfbvcnsris{ildwir[irorcrrr
<br />ofconpl.Ibn, rh. Owno Build.r' w,ll hrvc tu hord$ ofpi.unB lhrt hcorshcdi,l 'x l iBornnnmvc dt pmltny fd thc PurF)sof
<br />-1.
<br />.s owncr of rhc protrcny, am cxclusivcly con|md ins with li.cnscd conrr!.r66 r. sncloc' lh. rojd (Scc 7014, Buiircs
<br />,rd llDfissirn Cod.: Thc Conlra.lor's Liccns t wdo.s ml rtplrlo on owncr of pmtcn, oho build. or inp.orcs rh.tcon.
<br />lnd *ho onImcls for such pmirh *irh a Co dctodr) ltcned tluisunr io rh. Co.rrcloas Liccns lj*).
<br />-l
<br />h0velrlNill nmn 0i'r.Ccnri.lrcolConscnrk,Sclfln\lrcitrtrr crr.on,Nnsarnni. !s pro\idcdlorhrSccri,'n:r7(xlorrh.
<br />Lrtu codc,lorrhc pcdonntrNc ollhc *ork hr snich lhc ocrnrir is h$cJ
<br />-l
<br />hnv. ,nd will minrain *or*.B comn nsalio. i ur.rc. N rcArircd by Sction l70O ot rtE L*o. Codc. for lh. p.notmrc of
<br />fic work for which lhis r.mil is isud My worlcs mmrrcnsation inirrane dnr drd Flicy numb.r N
<br />9Gl.cdiri rhd if rh. nsltrmrc. olrhc \ork nn Nhich rl,is pcnnn n i\$cd.I \htrilnor c tnot rtry lthotr rtrymrtrn.r
<br />{, r\hh.ronf,\uhJC.(n)rlic$o o\ cofipctr\rrii lrnrofcrlinr ir. tr(lrtr.crh ill \hn,ld 6..o'rt n$j.d hrlt
<br />sork.^ mn,Fn\"rn j,n)vnn 1ofScdi( l70OolrhrI- htrC({lc I \hnll. hd l,sirh .ondy { ir[ rhi,k t)n)rr{ion\
<br />WARNING: FailuE lo surc sorkcr conlErsrtion corcmsc is lnhBtul. aod sh,ll subi{r ,n .nplortr lo dhinal pcdlri.s aid
<br />civil fin.s np l. on. hundred ltousmd dollo^ l$l00.OOO), in lddilt,n h rh. co, .l conFns ion, da'Egcs as flovided for rh.
<br />::-:i lr':q:-i{""* " l--::i* qr&- t3-{U.-!-
<br />ucliN iDtotrI&ll]aa
<br />Dt CL:IMIaX
<br />ol rhr Br\i',.\\srd l,rofr\rnnr\ (inl.. nry lrcNc i\ i hr llnr.c u .ilccr
<br />Lieolc Nur r
<br />caNlalqpNrElutN!-a{iEM:r
<br />i\suc'l (Sc..:1(Y)7. Civ. C )
<br />dtfucAtfDEclaaallltN
<br />ItrruSyxlimunds pculry ol Fljuly oic of rh. r,rk'wing d.clahrio's:
<br />Dcm)lili.n Pcnnir$Ash.sros Norificrlion tudcrrl Rqul0lions rTnb 10- lan6)
<br />-Rcqune
<br />lxlrerolMrificarirn
<br />_l ccnifyrh rhctd.n,lrcgullinntr h8ddin! islrno\r.nhvrldc tror{l'!lrrhlc k'lhisf0F.r
<br />f44 ccnilyrhir I hJrc rcd rhi\ rpplicJri{rn3r srdcrhrrrhrtrhnrnrrornrrt is.on$r.IaErcct'c.nurly\irhrllCiryr dcoutrl
<br />drvc ftnrnnEd p,opcn,
<br />ApFlictr or A8ctrl SiBnrl i:'f'{ffi; x*N
<br />* EJJic Qra\\qrdo
<br />l>-a1-(T
<br />Appliances
<br />lvletal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />tvlisc. Equipment
<br />Duct Work
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rough Ductwork
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<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.7-/ I z/rc 5:lE *tgvl c
<br />Final Test
<br />Meter Release
<br />FINAL ,x4 ,U1,K1r7tu4\ tq>ttt 'L2 t ltg 8y 5D 99
<br />Notes, Remarks, Etc
<br />t
<br />-)
<br />Pre-lnsulation
<br />Vents
<br />Other
<br />t; c^-.Q.
<br />; Tilr'',i-"i1 .*.,. dl.s,>'H",u--g
<br />u0a&l&1-1:a!leEA$a.roN
<br />D&CIIIIAIION
<br />I hcrch! allnN u.dc, ncMll, oip.rjurroN ofrhc n'lhsior dcchraliois
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