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MECHANICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<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 / Clothes D ryer v xJL[14
<br />Residential Range u
<br />Other
<br />Hood
<br />fype 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 />-/i;A-..-//*
<br />?Rough Mech.z ryw
<br />Final Test
<br />Meler Release
<br />FINAL 62)-1 V k-$-I0
<br />Notes, Remarks, Etc
<br />owNtiR tru ,rlr:R t)Er,caR.\1 t()N
<br />Iluitr.r\ r Pn,l.si{h Codc): t Ciry or GDtrry *hi.h rc{utc\ r p.mil r,,.ot(rcr. rlrcr. imprx!. .lcnnnirh or rcn3ir rny'
<br />t) rhc fhrsnn,\ ot rhc Conrra.ttr's l-icrn*d l- * (Chunr.r 9. Con ncncin8 wirh S.crn,n 7(xx) ol l)ivirion ] ol rhr llusinc$ nd
<br />llolc\si(it(Codc)or rlurhc.rshc acxc rtr rhcrcli. irttrthsirtrrhc lrgcd lorrri(,n Anyvi,,lrrn,nolS(ri,,70:rl5htrnr-
<br />rfIhcrnr hr n p!nnil suhjc.rs rh. intlicanrrr) 0ci!iln.nrlryofk n!rc(hntr,lvc htrtrrlrLridollrr\ (!5{X))
<br />-1..s
<br />Nmrof ln troFrly. or my.q,loFs eirh wag$ as ficir $k @npcnstio.. eill.lo dcsftk.!rd tlE $BrE ir rcl
<br />i e,tkd oroffcEd for sL (Se.7044. Busiftss.nd Prcf.sionr Code: TheC.dEcrols Lien* t w dms rct .pply ro !n o*mr of
<br />lhc pDFny who hild. or inpmw.lh.mn. a.d who d6 Mh turl hinsclf or her*lf or lhmuSl his or hf oen cnDlorr6.
<br />provhcn fiar slcb inFDwrnts @ el hlcrxH o ofi.Bl fd slc. ll howE dE b'rildinE q intftErrt is sld yhhin om )ts
<br />ofonpLdon. fi. Owrr BuitL. wi[ lBrc 0E htrd.n ofprovi.s dur h. or shc dii fl buiu or inpor dr poDcry f{r dr prllr€ot
<br />-1.
<br />as owncr of lhc prcl.ny, an cx.lusivcly contddin8 *nh licencd conrruclos ro ..nrhcr rtr rmJd (Scc 74n4. Buvrua3
<br />nd l1bfcl\ion Codc:'lhc Conrrlclols Liccn$ L!, docs nor lpply t, unosncr ofrmlcrry *ho builds or improvcs lhcrmtr.
<br />snd sho mnlBds ld such pmj.rls wnh 0 conhcror{s) liIcn*d praudr ro rhc Co.b&rofs Lt..s riw).
<br />lrmcrcmn! unJcr Sc.r
<br />WOIII(ERS' COMPF\ISATIoN
<br />DICIJAAIIIJN
<br />I hceby a,film !trdr pcNlty of rojury otu of lhc followine d.chBrions:
<br />-lhlvc!,nwiumi
<br />ain ! CrniaEal. olcotr*Dl ro Sllt-ll,e for rcrt6 @r{Enstion, a prcvidcd fo. by S<lio. 1700 ot tlt.
<br />kbor C!d.. fo, rlE pcrlffi. 6f rlE wo.k for which rhc D.mn ir irsuc!.
<br />_l h,wand{ill nuintlin*orkca .on{Eisalion insuroftc. a nqut dbySNrion37moflhc tibor Codc. for rh. FrfdltEr. ol
<br />ir is isa.n. My workcr'coDp.nsdion n$u.rcc.orin 0,n poli.y numb.r trc:
<br />+
<br />W^lltlN(;r l,ilui. ro {.urc sork !( .o,npM\rnr .ov.tusc ll \ubjl{r rn .nrdo}rr h dininrl lrrulti\ riil
<br />ol c.mpc {ri.n. datugc\ r\ pn,vidcd tur lhccilil fincs u0 ro oft hundrcd rhourdM dollds (Slo0,om)
<br />se.ri, 1016 orrh.l rhtr (ii{lr ir.trarrxl,
<br />,.*-4/ze/JL
<br />urENsliDrollraqrraa
<br />IIECI.ABAIION
<br />I hcrutylfinmuftlcr pcnultyolpcrjuly that I om li.ctrE\l urdcr pmvhio, olcluplcr 9(c.nDEncin8 wilh Scclhn 7O(t)) ofDivision I
<br />of lhc Businc$ nnd Prcltsions (t)d.. and my ltcn* is in full r.r.. rnl cflitr
<br />B '-7o tq t?
<br />ZD/tf
<br />ION,TIBUCIONIEIDING.IqEN(.I
<br />I h€rcby !,firnundcr lEnlll,olFrjurylhal thcrc is a conirru.ti,n LndinB,B.Rt ror Ih. p.rformm. orlhr work n, *hin lhn Fmil is
<br />hsu.n(sa 3097,ci!. c )
<br />a.rrL.ltANLu&l;I4I3.{I[lN
<br />I hftt y anim undcr ,,.n!ll, ol peru,y onc olthc folloq,ir8 dccturrion\
<br />Dcn ni(r P.nhih Asb.{u{ Norificrn,n Fcdcrrl Rcguhtnnr{ (litlcll). Pan6)
<br />-Rcquircn
<br />b crof Ndificrrion
<br />-l
<br />ccrrily thar rhc acdcml Egu&rions rc8lrdin8 asb.sros Emvd m ml apDli.abh lo rhis pmjet
<br />_l ccni! lnll I hnvc rcad lhk apllid io. srd slal. thd Ih. drnve into@rion ir .oml I oprd ro .oq)ly sirh ,ll City lnd Counly
<br />odinsncc\ ffilSrorc tiNs ing connruclion. Md lrrcby r.tntivcsolthn Ciryrnd Colnryto cntcr upon the
<br />aborc mnlioncd pmtEny
<br />ApDliconl or A8cnl SignatuE:H,e-Y (e
<br />at
<br />Furnace
<br />Dale osn..
<br />|oli.yNtrtr ri ErIi'.\:
<br />I c.dilyrl ir rhc pslnnnrmc.llhc $1trk lar \rhich rhr\ l]tnnir r! i\\ucd.l Orlltr.t cmtl(itrtry Nson iortr, mrDncr
<br />$ r!ro lt.onr \uhr.r r) rlrc *.rlch .onfc \ nni htrsor (xlitunrir. and rgrucrhrr ilI\h.ukl hcc.nr {rhJ.crri rlr
<br />sukc.l .om$r\dnnrt,n)vi\i(,n(,'fS.cri( :17(X,otrhol]htr(-l),ll.]\h]ll,lnnh{irhcon,!l!\! hrho{prri\trtrx
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