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HomeMy WebLinkAboutLA172357 ,- k . ' ``� �� �1 ��. 3�7 ��� ������� ����.�� � ��������������������������������������� t��tr����d t��< ����tt�a�.c�t���r�t�.��d aff'�n�h�.�rr�. A�e t��c�ut�i�y����� �������cam :, �����r+��: , ' : ���"����;R��?���t"1i'3�i ����€ _ ���t� ; $�t�rt��f,T� ���� �u�r���.s�o�4�.�} t�a�: `5-!9. . Z p � , �����a�i���, Nf�fi�F ��� �����-.,-.�F , � . , � ._ _ � � ��'�`��;�*��,t����-' ���.�t� �� �� � ����� � x ' �-1� - 2.0 � ,� � `P��t��'�r�d'��►�r J�'lrt�2 L l:G : ., < , _ .. . . , . ���"��;�,+�i�'���0:�����} �e: ,5'_j`� - �.(� �',; �T�r���t,t�, �l�t c� L L,C , . , � ; +��'�'`e�,.,Pt�u�r�it�.���:�'f���t���a� �: Pri�N��T ` �'�tr►�r ���"r ��+�96t���`�urs�►�����t�:7� fl�: !��i c�C,� j{ {f�/+}� . ,R ��e(4�t\��rl/Y ��., .��,.���C���������� �, ��� ,� . . � �»� f'������ �3��°�� ��=� 1� ��•c.� �'��� ��. �:_ �,. , � ; � _.. ����._� � � � � �� ����I'��!"���+�' ����a C��7Q2 �y,j�i� ���` ,,, , � "i`�;,.e �!r�' ,- ��` �ru! > �v�-�--- ��..�,, ' a� ` ���r;���il'���r��,�����.�+� t�; �_/�-Zp . ��a►c��'����an,�: �1 H Y� �.. +� c ' I a��et��iar�����;b�a��I+�d���'►ct�tr��i�'�`v��t►e,����r��,'�� ��r�i?€�: - . ��i�.�/�� �� � � , ��..�i°c�,•-�- ,� ��-�..�.�,-- 5- r� - Z v �anufactured Hvme S,�st�ms Te�t Aff'idavi# This forrn must be completed in its entirety and be submiited at the Building Final ins�ction for the insta!lation of a manufactured home. ,4f1 tests must I�compfeted and sigr�ed off a�this#arm. A cer�ificat�af occup�ncy wrill n€�t be issued untii this campieted farm is reteived. U �� �-�,„� ,r ,�,, t�� �� �YSTEMS TEST YEE�IFICA'C�ON Desc�ptian Date Passed Si�nature of Tester Dra�� Line: Pursuant to e��t sas�.s�2{�r) aate: P�irrt Name cf T�and Cornpany: W�1"@t'�It't4: PurSuar�i#�3 GFR 3280.612(a) C�ate: Prir�t Narr�of Tester and Cam�sany: F!X#Ui�@ TP.S�. Puesuac�t to GFR 3280.612(c} L}ate: Prirrt Narr�e o#T�ter arui Company: G8S T8S#: Pursttant ta GFR 328t}.705 arrd IFGC 4t�.4 Ra#e: �.-�,. . '�� Pr�t t��ne o#Tester anc!Ccunpany: ��'� ��.���-�' ��C..�.�' ���1 �.�1,,.� �"�. El�ctri+eal t)peratinraal: �urs�a�nt to G�r�szs�.�oz e�ate: Prir�t N�nte of T�and Cc�par�y: Et+�ctr�cal Pol�rif,y: �ursuant�o c�R s2s�.�o2 Qat�: Prir�t Nartte af T�er ar�d Camp�any. EI�tGt�'i��Cdt1"dflUity: Pursuant to GF'R 3285_7� D�t�: Print N�e o�T�ter a�td C+�mpatty: Smoke Al�r'n Tes�: pursua�t tc,CF�3280_248 trate: Pririt N�rxe of T�r and ccunpar�y: !certify f�►e abc�+r�e systems has�com�bet�!ar�f was fc��r�d to be in c�n ` w#���t ' ic��d for e� sy�t�err�s te�t: i [}a#e: ���