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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWIIER EUILDER DELCTTRATION
<br />I hcrcby arrn undcr n n!ll, r'f pcrjury llEl I m cxcmlt fmh lh. ConlrrloF Lt.ns Lq for Ih. follosins tqon (Sd.7011.5
<br />Blsitu$ ad Aoacssion Codc): A.y C y or Counry whi.h (tlids a Frnir ro .onsrrud. alrd. in'pmrc. dcmBh or rc!.ir dy
<br />smdurc. rrir ro its issuaN. d$ rloncs rhc dpplicdt for skh pcmir to fik 3 sisftd alemnr rhrl h. .r lhe i! liftn{d pursA
<br />ro rhe ptuvhhn. oltrE Coor&bls Lic.nsd kw (Cluph 9, Com@Ei.B wirh Sdion ?000 of Divhion 3 of lhc B.sincss od
<br />Pmfcssions Cod.) or rhll lE or sh. n cxcmpl ltcEfioh md llE l[sis aor rn dkgcd cxcr{,lhn. Any viohaon of Selhn '7031 ,5 by lny
<br />dprlica lor opcrmit sul,jNtr rtc snplica b a civil pcnalty of nor mr rhln fivc hudrcd dourn (1500)
<br />-1.
<br />as oMcr of ttu p,!FRy. or my cnployEs *ith eag€s $ rlrcn slc oqxnsrion. wiu do rhc w* and 0r mrxiw ic rcl
<br />inrcnLil or oFcr.d for $L (Se.7044. BBimis Md Prcf.siioni Cods Ihe Coir&lofs Lhcns llw de! ml .p!ly to d o*mr of
<br />llE poFny wtn hild! or inplrc lh.mr .rn vno &B uh *Drt himrcr or ncBr or $Fosh I'L\ or hd own eoplorNr.
<br />prcvid.d rhar sch ioFowEnk G ml i onilcd dH lor $lc. lt howE, llE t ildhS n itrprwmnl Ls sld *ithh otu rw
<br />ol6'q,hrbn. 0E OeM Buildq *i,l lar tL hhtcn of FovinS thd lE or slr dil dt h,ltd d inpl4 UE pDFily ld tlE p4Ds ol
<br />_1, osowM otrhc pbpcnr, !o qclusiv.ly co.nlcr ing *irh tiftn*d.ont&ro6 ro co.{rud llE l,ntd (Ss 7044, Busms
<br />a'd Profssion Cod.: Tn Conlracloas Liccns. Ljw dos noi aptly lo oencr oflri,peny*ho builds or ihprclcs rhscon.
<br />aid *ho conrEcIs f(tr such Fojcds wirh r Conh.b(i) liccn*d l,ualanr h thc Conrodor's Lkcn* Llw),
<br />-l
<br />rmcxcflrpl und.rSslion-. B &PC forlhisrcason
<br />Dlle Osner:
<br />]IOBTESS:g)IIPI!6AIION
<br />DEgdAAIIq!
<br />I ll.rcby artrn undcr p.Mlly of rsjury om of lh. following dNlaBliom:
<br />-l
<br />h.vc .rn pil @inrsh s CcrrifE.lc of Con*nt ro S.ll-lnsE for mrle6 .omF saion. !s Foeii.d aor by Seion 1700 ol $.
<br />txhor C.dc. for rhc pcloruFc of fic wort for *hich ilE Feit ii islucd.
<br />-l hrt rndsillnrtri uin*orkcr'com!.nralioninslranc-asrcquncdbySe.lt,n:lT0oolrhctjtxtrCodc,rorlh.llcrlonun.col
<br />rh. sork turahich rht p!nnii is n insufuncc carifi ,nd ,oli.y numhcr trc:
<br />fuND
<br />o
<br />_l ..n ity rhar in $e pqlortuncc 6r rhc *ork for whth rhis pcrmir ir hskd. I sh.ll not cmploy ony pcr$n in anI mnmr
<br />s !s lo beom subj.ll to lh. work B'conpcnsrtion hws ofcalironrh. Md l8c lhd itl should t .om slbitr lo rlE
<br />vortc^' comFns io. povisions ol Sc.lion 3T0oollh.lihor C.d..l shall fodhwilh conDly wilhlto* pmlisions
<br />WARNINC: l:lilurc to sccurc rortcrs conrpcns ion covcrrsc is urla$ful. and shrll rul,icr an cnrpk,r.r k, d,ninal JEtr,lris Md
<br />ctil fincs up lo orc nundrcd tholsdnd dolla^in oddition kr thc co( ofcorfanrrion. datuler 3r provid.d ior rhc
<br />Sccriotr 1016 of th. L.tDr Codc- inlcrcsr and
<br />UI]I,NSf,ILCONT&I.CIAB
<br />DE(IAB/II&!
<br />I h.Eby affrm undc, ,.6,x, of !.rhry rhar I m liftn*n und$ t&virion or Ch,/.r 9 (q,nmRin8 wilh SNlion 70dll ol Divisin 3
<br />nl rhc Busincs ud t']dr*i{nisCoJc, a l n,t liccr\r i\ i1r tullli)rcc riJ.lT(r.'
<br />A
<br />llttT--T-
<br />I hcr&y rfii.n rndcr pcnalry ortcrjory rhar rktu k aco.{tucri,n khdin! rs.n.y tur rh. p.rrortun.c.rrhc work nr qhi(h lhis |E,nir i!
<br />i\{dnlss.- 3lxr7 ( ir a r
<br />AITI.rcANLD&CI,dBAIIO
<br />Ilrnt, limundcrpcnnhyolp-,juyoncof lhcrblbunr8d..l aliors
<br />aJ.niniid Prrnrik Asb.(o\ Norifi.dion F_cdcral Rcgrhrion\ (Tirlc.rl,, Par6)
<br />-Roqutcd
<br />krrd ol Nolirrc io.
<br />I mnify rh.r lh. fcdcral rcEuhrio.s EB ding astrsos Ermvrl r. nor gl,licahlc lo rnis rmFl.
<br />-l
<br />Nnifrrhar lhdcrcld rhkuppli.arion.rd {arc rhtrr rhc rtr'le iilonturnnr n.oft.r I sgimtuonp}ywnhrllCiryrnd County
<br />ordinanccs ond Stalc l,rws
<br />lhotc nEorioncd rroDcny
<br />ro 5lildinB .onntucrioi. utrd hcrcby lurhori2e rcprc\cnrdilcs olrhi\ Ciry,nd cou(yro cmcr DNr'hc
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />lvlisc. Equrpment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rough Ductwork
<br />Toilet Room / Clothes Dryer
<br />Residential Ranqe
<br />Other
<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
<br />FINAL a/tz/rp Etunrt
<br />Notes, Remarks, Etc.
<br />Vents
<br />Hood
<br />6olot lta.
<br />*,-61!1
<br />""i&lElh
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