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MECHANICAL.INSPECTOH RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNEf, BUILDER DELCARATION
<br />I hcr.by sftum und., Fmlry of F.iury ihai I m c&mfl fiom rhe Co.leroR La.cM h* fo, 6e followi.8 rc.sn (Sc.?03 1.5,
<br />Businc$ !d Pmfcssioo Codc): tuy Cily or Counly wnich rcquiEs a Frmn lo onsltud. allci imprct d.mlish nr qun d!
<br />stocrur. I,ior ro irs i$!are. rlso r.quies rhc $plhanr for xlch Fnnit ro fiL a siSn d slal.m rMr lE o.3lr ir ljccnqd puNusr.
<br />lo ltu pmvhnrns of lhc Conlrlclols Liccn*d l,w (Chetlcr 9. CommcEing wnh Scction ?000 of Divisiotr I oflhc Busincss lnd
<br />Prcfcrsn,ns Codc) or lhal lE or slE h.rcmpt lhcEiiom lnd $. h,.h for th. dlcScd crcmplion. Any vk lalion ofs6lion 7011.5 b, an,
<br />{l,nlkanr for a !.mn bj*rs rlr .!pli.. ro . civil fcnalry of mr mE tha, fivc hlndrd dolldr ($500).
<br />-1.
<br />ss oprcr ol lhc potErly, or my cmploFes qilh wlgcs &s lhct $lc onpcnsal ion. will do llt qnk dl tlE $ntr@ i. nn
<br />inicided d oncrcd for sL (Se.1X4. Busirc.s od Prolcssions CdIc, Th. co.hdols LitrF riw d@s ml lpPly lo on .Md ol
<br />rhe tftrEny wlF hlilds or iIltftri rh(otr a.d who dei sh @rti nie.llo. h.Blr or rkou8! hk or lEr ovn crylorca,
<br />pmvidcd rhll sh inpmwmnrs m nor i,lcndcd or otu for $k. l( howcE. dE buildinB tr inprorctunl h $ld lilllin om yw
<br />oforpkion. tL olrncr Blibs wiu haw rhc htd.i oal,oling rhar lE tr shc did tror tdld or itrpbw th. t'bpciy for lhc p!4ixc of
<br />_l- s\ o*rcrofihr Inop.ny, dn.klxsiv.lycinraciihg $nh liccnscd c. tacb6 ro..trsrucl lhc Imj.ct lscc. ?014. Bunncss
<br />$d Eof$sioo Codc l hc C.nrraciols Liccnsc Lrw das not aFply b M o*mr of prol'cn, *ho blilds or imrrovc\ fi*con,
<br />ud uho contrucrs for soch poj€c( vir[a Co ntractod sJ I iccnsd Dusuonr ro rh.Co"rBcrols Ltcne t!s).
<br />-l
<br />rmercqr udo S6tion- B, & P.C. for rhb .c&r
<br />WOR(r,RS' CoIIIPFNSATKTN
<br />DICI./IIAIION
<br />t hcrcby rflnn undc. r..0lr, ol'l)crjury onc ollhc followirS d.cl,.irions:
<br />-l
<br />haE rrd will einl.in a C.nifrd. of CoM m S.lttn$E fo. srkd @np.ndio!, ar prcvid.d fo. by sRlior 1700 oa llE
<br />Libor Code for lhc p.rfomtuc of lhc *ori for which llE Frmil h irslcd.
<br />-l
<br />hrvc ,nd *ill nriordi. eor*cB co,np.nsarion i.snhocc, trs rquirdd by Sd ion 3'l0o of ihc bhor Codc. for thc ,rslbrtunc. of
<br />lhc wrk lor whkh this lcrmil is ksr.d. My Nortcn ompcnsario. insururc caFicr an Flicy Nnbcr @:
<br />S'la4e Fuud.
<br />t,q 4o'ao I Uo
<br />-l
<br />ccnify rhlr in rh. psaoirmfla of rhc wo aor pti.h rhis l'c.mir h iss!.n,I shllln cmtloy.ny pc66n in rny memr
<br />s s ro h..$,rc subiir io rlE eort6 .orIp.flsorion hes otcalifomir. and a81E rhli ilI stnuld t$om subjel lo lh.
<br />mrtcm .onFnr ion povisiorls oiscction lT00oflhc Lllhr Cndc.l slull.lonhsiln omplywilhrhos pmvhions..
<br />WARNING: Faihe lo sac w.,k n .otlcnsarjon covcdgc is u.hwtul. nd sh0ll subjet .n.nplorr lo aiminrl p€dlhs und
<br />civil firer np ro.rc hrndrcd rhousnd doll06 (llm.ooo). in rddirion b rhc o$ of compcnsalion, damBcs as porid.d for rhc
<br />Scclion 30?6 or rh. tjbor Codc, inlcEs a.d brrcy\
<br />ucllllllcaNuacllr3
<br />DECIIIIAIIIJN
<br />I turch, afilr undcr!(.,lryolp.rjurythat I anr licnayl u.dc. Eovnion of Ctuflq 9 (.ommmins *irhSdb!?fi,)of Divhionl
<br />oi rhc Busincsl aod Ptrrirsions Codc. r ny liccn* h in full l(re od .lfNr
<br />€foao f
<br />tL DT6 i3*,'Ic!e tr Tpc,
<br />C!}!I.1I&J(:U9II.IIiNDINC.AGIIICI
<br />I hcrchy dlftm u.d.i F.,lryoltrrjmy thlt lh.!. is d $n{fl.rn)n hndinC,Bcncy for
<br />'hc lr_dnrmne or lh. work aor shi.hrhis t*rn'n i\
<br />iss& (SN.:ll)97.Civ C.)
<br />-l
<br />6lify rhar I h!v. rcad rhi$ppli.rdon ad l|tle rh.l dE sbovc infomrion t c6rE l. I .8c to o,ply ailfi all Cily !d Couty
<br />ord'mM ud Surc trm Ellrin! ro b ildios oNrrudbn. od heElyourl'od4 Gp.c* ,livB of rh! Cny od Coun'y lo mld uron dt.-6;;---" ^ U
<br />^,",*,",.,^*",,*,*,,..(l-227-*X &h,"..z/r6/(t
<br />"^,,***r*,,,. Dntt"L T' G,lsv'a ' '
<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 />Vents
<br />Toilet Room i 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 tol/11/,AWfl-/b-
<br />Notes, Remarks, Etc
<br />D{re. o}n.r:
<br />o*., '7 /
<br />trnd.li N.m:-
<br />lxndci\ ddr.\\:
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<br />ATTLICANI.III;IIAAAIION
<br />llmh! {frnmunlcr Ntrrlry oifcrltrry otrc n! itu Lln,wrS dcc[r nnr:
<br />D.'nolin,n Pcrnir Ashcsros Nori6cr'i(r FcdcrrlRcg!hli,nrs (lnlc 10. Pr(,
<br />Rrquifu d lxncr ol Norili.di,rr
<br />-l
<br />cdify rhdt $c fcd.rdl E8ulalkrs RA&ding rsh.sros EnDval d. .or apllic.blc ro lhis ,mirt.
<br />II
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