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HomeMy WebLinkAboutLA175435 r ' � � ��., '�� qY i . � r i Ma�n�ufactured Nome Svstems Test Affidavit This torm must be completed in its entirety and be submitted at tne Building Final mspectian fa�the�nstafiatinn af a manufactLred home. Ali tests m4st be completea and signed off an this iorm. A certificate of octupancy will not be issued untii this complet�d form is�e,.�ive:d. ��� „/R����j �F��ft ,_. _.._.._..._.... .._..._.__.,.... /�l �"1 .,_.,.....�.. ._ .. . . . ___ ._. ._.... ._ _.�...._. _ __.._.__._.._..__..�....�_.,.........__.._..._._._..._._____._.� � SYSTEMS TEST VERIFICATIC�N ; ._._ _..._ . . ._..___.._______._._.�.__...� _ .�.. _ ._�___..._.._._____....___.._...; : Descriptian ; Date Passed 5ignature�f TestPr ; ;..., ., ....�.�,..,^.... _ _____.,,_._.�.�.,._........Y...........�._._. j Drsin �ine: �um��nc u,cFR a7��.��a�h j : �ac�� : � i �_.,______._.._... . .. .. ..... ._..�_�.... . .. ._.. .. __._. ._ .__. . __ ..�. -_ ._. . _ l �3 Z6 Z D � Prini Name of Tester and Carnpany. /�k r,i� / /]/3u.r�►���r /�(�2 L L-� : GS' �- ,_..._....��----._. ---:...�.W. ___. .�.e,.. , . , ._—_ __., ..__....,�.....:......:,�:- ( W8t�1'�.Fn�: Pursuarrt to CFR 328t1.612�gi} ; Date. ��.��{_ �j Z� .� �� V•.• � � _...�__._.___.____..._�.._. ...._.._....____._.__... ._._._._.__._..�.._...._... �" . _____� � p �- i�T�../�"�/`C� 1 Pnnt Neme of Teste�and Cocnp�ny.��,��� v• ��Jl�l,�e�^ /�/�/�/�. LL� � � ' ..J ._.. �-•�--�--�R - -- _,, .. , , ; Fixture Test: �e,��a�t ta cFr� a2aa.s��tc� ' aate: /I-�3 _ 20 2 D i �._______..__�.... __. _�..____._.._ _.__�.,__._ ..__...._. .._. .s._ , �......_._._ _... ... .._ . .__..w.� G%� s�1�� � Pnnt Nama�f Teate�and Ccrtipany ���L/ � /�,� � M f fj'L L L � _ -- -`�;�._...�..,..,__ --- ----- - .�..; � GSL'T��t: Pursuar.t i�CFR 3'�8U 7�5 anc: lFU� QJh.� Datb: � J. �_ - j D ��. J�_ _,- — ` � _._._..__ _ . ._.___ ......__... . __ ,.__. .. . .. .. .. . � I ; P�nnt Name ot Tester�nd Cam �n � � � y� ,dGlYr� �SSk_� � �QS-�Q1'I��U�r � ���;�Q lC� � -- ,..,_...�.._... '"' .r""'.,�.�".� EI8CtP1Cal Q�6f8t�0/181: Puisuant to CFR 2�a.�u2 u�ce• , , � i � � � ; , f--- ---.._...._.___._.._...._.. _.._..__--- - - _.� ..,._. _ �__. ._ ___ . ....__.. _. t � ;�,�. t i.� , �/ .-, � � Print lV�me of Tester a�t!Coin an C.. �� '`�' s� . �` ' ;'�'. ..� � �i�'� i p• y� � ; ,, �--r-�--+�. '"�.'"....".� � � ; Eierctrica! Polariry: Pursuant to CFk 3285,702 . ; aara . � , ; F ____....___ . ..__._.__._.._ .__._ ._ .._._ . .... � ._.� . .____.w___. ' � : �'_ - - � , �'u'. ; i ��.. i ; Print Name ot Teslar and Gompany: � ', �� � , t�� i , ' >• . I i _ i i..� •;�:`t d. �L�� � �.i:_ . ,(.c.a�....M.�...� ¢. a..�,,........,..V:...� ^ .,....a...�. � Eiecttical Continuity: Putsuant to CFi2 3285.7t]2 , a�t8 ;! 'f -r��,�' � �-.-, {.. I . i ____.--- ..__. _�._._�.....__ . . _...__.._W .__ .__��. _ ....__.______._ - y ,� }� � . i J � ��r ,,� �t ' ' . � Print Name af Teste��nd Company. � � ,,' . j, ;��, r..t �t j.�( �,�.:t,; / ��'�; . �' _ {. � ...,.�,, . _. .. s..,..,..� .........,......._,r.....w..�....,..,., � 5rttioke/4larm Test: Purs�,ant to c���x�c.2t�� : p�'r":// -0�3 - ZD7.�15 ; ` _..,....----_._.._ ___.__..........._... ..__�._.. _.. ,.�_.___. ... ... _._ . _..._.._.. � ' Print Name oi Tester and Company �/f,�2 L� t ` �—� � D a r��� / /�� .L�u.S G��wt e1' L : ..,.. ., ��._.�.._._. . --'i i I cer�ty iha abave systems tesbng nas been campletad and was faund to be in compliance wfth the prov►sions id�ntifiad for aach � ; systemsatesr. ; ' r��'`-- " -� � r- •, , ; ��� . . , , � � . , :.,.. . � - � - , �. . , .�� ' 1 • � , , f L'� ; �jl�neture � 1 � �� ���. ��1 ..�. � ,;�1 t�"�1,• , _ _ ..�._ _._...._ �au w....___._..__. `_��_ �...�..j,:,... --��__. __a _.___._.__ ._...._.. _._..__ . ---. _ --J � . �-._---- .��.�_` I [� -?,G -��I,` ��y-��'G�s�'�`— / r -U�- �z.o