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MECHANICAL.INSPECTOR RECORD
<br />APPHOVALS DATE ID/SIG.COMMENTS
<br />Appliances
<br />Metal Fire Place
<br />Ev aporative Cooler
<br />Furnace
<br />Compressor
<br />It/isc. Equipment
<br />Duct Work
<br />-A
<br />Smoke Detectors lnstalled K-"ny Y.V$t)
<br />Rough Ductwork
<br />Venls
<br />Toilet Room / Clothes Dryer
<br />Residential Ranoe
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openings
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />Meter Release .A
<br />FINAL ?41r v.w5CI
<br />Notes, Remarks, Etc.
<br />OWNER AUILDER DELCARATION
<br />I heEby ofirm utds pcnalry of lcrjury lhal I m .icdpr fiom thc Codra.roR' Lhetr* Liw lo, thc lollowing msn (S*.m31.5
<br />Aurjnets lnd Pn,fe$ion Code)r Aoy Cny or Coury uhi.h Equircr a IEmh r. onsrucl. lllcr. improlc, d.tulhh or E .n my
<br />sldcrm. prbr ro irs issusc. sl$ EAtiEs rh..pplta.r ftr skh Fmir ro fiL a sisEd sl.rem rhsr lE or rlE ir li.cnri lumMr
<br />16 rhc polisions oi rhc Conlreror'. Lkcnsn Llw (Chaprcr 9. Comm.rcing whh S.clion 1000 or Divisior 3 oalhc Busincss lnd
<br />Phf*sions C.dc) or thll h q shc i! .x.n'rrl rh@frcm and rh. lBh io, rtF dlcg.d crcn{'lion. Any lhblion of Sc{ri,n 703 L5 by 8ny
<br />rrplicol for rlcmn subjc6 rhc trpplicenl lo a civilpc.allyofnor mrc lnnn fivr hhdrsd dollars ($500).
<br />-1.
<br />as owner ot ftc popcny. o my cmplor.cs with w!gc! us rhcir slc conF.sdion. wil do th. w* ad llE stn&l@ h ml
<br />inrcid or of.Ed tor elc (Sa 70.i4. BusiFss onrl Prefcssios Code: TIE Corr,s.id\ Lk rc bs dei mt .pply lo rn o*ftr of
<br />rhc pbpcny who ttr ds or imrmws lhcmn. od wto dGs un Rort hihscr or hc^rlr or rhrcugh hh o. h.. own.mplorrcs,
<br />pnvi,e{, rhlr such iitDrftnB e Dr inrc,ld.rl oo,Idrd lor elc.l[ tFew.l& hildinS or imFowmnl h $ld *idin otu )@
<br />of.on{,lclbtr rhc ovncr BuiB$ will hsw tlE hrdcn of poviie thrl lE or sh€ did bl build or irymw lh. I,oltay fot thc puqD* of
<br />-1.
<br />s owmr oflh. I,lo!.ny. anqclusiv€lyconlrrclins wilh liccnscd conrEroF roconsmd lh. rn,Ft (s(.7044. ausmss
<br />,nd hnfir$ion c(dcr Th. Conlmcror's Liccnsc I-.w des nor aptly lo tr.owncr olF.olcny who builds or inpnEr ihcreon,
<br />lnd qho otrrEch tor slch phrccrs sirh u Co .Ero(9 ltcnscd ruB{Mr ro rh. Conrd.roas Lkcn{ tzs).
<br />-l
<br />mcremrr ldv Serion- B. & P.C. forrhis e!s6n
<br />uaf,f,ExtroutlNsaL!
<br />I h.rcby llltm utrd.r ncnalryof *,j,run",,t't" i,tt.*i',*ffi*fflB
<br />X-Linvc Jnd will ndmrotr' r Ccn,fi.drc ICi,n"cnr x' Sclr:l.surc l (ortc .u!Ntr$ri,n. $ pn,vnhd b. by Sslintr l?00 ol thcrtlh{ ('n,l.. r,r rh. pd,rmncc ollnc *rl lm qhrh rhr n.rm sr\ucJ
<br />_l navc aM will nunrkin wor(crs' co'np.nsarion insuranc.. trs r.qdi'.d bySerion lTlX)ofrhcljho.Codc.lorlhc pcrl'on"mce of
<br />rhc solt nn $hich rnis pcmir i\ i\\r.d. Mys.rkc^ obpcn$rn,n in\ u r.n.. .rtricr .nd Frlicy numhcr rc
<br />PolkrNunbe ErpiBr
<br />WARNINC: Failurc ro sm *o*eF
<br />ciil 6ncs up lo onc hundrcd dous.nd
<br />S.crion 10?6 ofrh. tntm Codc. intcrcn
<br />is lnla*tuI. ud shall rubj&l d crlploylr lo giminll Fndlis and
<br />I comFn\arnnr. dx rgc\ d\ F)vidcd nlr l)r
<br />g-q -(t
<br />DD(LA!Ir\'IIQN
<br />I hcEby olfirm undcr p.rully of pc,jlrt lhar I an lianed udcr l,ovhion of Chatrn I (@MncinS *ilh Ssiion 7000) of Diviiiotr l
<br />of th. Busim$ 6Jx1 Polcssions Codc. arn my liccn* n in 6ill forc ud cil*r.
<br />-(
<br />, hcrby nfinn undcr Fnoxy or pcrjury
<br />k$cd (se lm7. civ c,)
<br />,cnriinB rycn.y lo, thc Frforturcc of rh. *or* for vhi.h lhis Fnlil is
<br />AIILICA.NLD&CIdSAIION
<br />I hd$, alinn undcr p.uhy or pujury onc olrh. iollowinS dc.lM,riotrs:
<br />Dcmlin'n Pcrnf+Ast*vos Nori,icarn'n Fcdcml Rc8ulari.ns (Tirlc 40. Prn6)
<br />-Requtcd
<br />Lcltcrot Notiriqri'n
<br />I .cnify rh.r lhc fcftml rc8ullrions E8ordinS 0shsros rcrmv0l lrc nor amliclblc ro rhir lln,ii
<br />lh. abotc inforrdiotr n comd I oBre ro ohply *irh lll Ciry 8nd Coxnly
<br />hcrcby"urhori,. rcpr.\ctrhrivcs r)rrth ( ny lnd Cornryh cmer !s,nih.
<br />2_ft
<br />,*, < 4 -13
<br />Pre-lnsulation
<br />lnsulation
<br />I ccnify tur in rhj pcrfor.Encc ofrh. wort for whth dk p.rmn ir issucn. I \h!llnol cn{iloy!.y tdron i6 any nmmr
<br />so oxro hcsm subicr ro rhE sorlqs'$dpcnrarion lawr oaCrliromi!, a.d ngrcc rhd ill sh.uld iErom subj.{l ro lhc
<br />wo si conF.sarion pDvirionr .r sccrion 17fi) or rh. ljbr Cod., I shalt. fdnhwith.omoly wnh lhos povisionr
<br />I
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