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HomeMy WebLinkAboutLA175033 � e��, � � 7��3 ��� K���. � � ���. � � +'�.�, �, t � a � r�f�� � � � � �g Pd,KY� p � 'A` . �.,�f {�.""`g��!���.k�3!.f^nh i?F'.,���,ci^:t,.. :'� ,�.;�_. Manufactured Home �ystems Test Affedavit This form must be completed in its entirety and t�e subrnitted at the Building Final inspectic��for the instai{�tian af a manufactured home. Alk tests must be completed and signed off on this form. A cerEificate of occupancy will na��-=e issued until th;s completed farm is recefived. ����/ �__ _ _ /�� /��;,� 'n , , n l�� � __ f �'�������__.__ � ____ SY�T�M� TES�" 10�#�IFI�ATIQ�! � _,_� _._ __._.._ ----_________.___._._---___ _�__._. _.____ __ _.____-------_-; � Description Date Passed iigF�ature of Tester ! .___-- ��,,�-��xm.�.:�..�-____-_ __. _._ ___ -- ��w�.�..���. �,._ . _ ,� w�,.�.�����-�,�.���-� ���_-�_ _.._____ _ .. �:�; Drain Line: Pursuant to CFR 3280.6�2 (�) Date ; ___--- �..,�_._._ _ _. _ ---______ __ -------�_ ______ _---- _._.--_ . _.� + Print Name af T�ster ar�d Company: �� � -_,-�.�_ __. . _=� ..�.�._a= .___ �:�� _. _ __ =------ _. .--_._�. ,__���-._s_ ,...__._ -- ,_.__, _ ._. _ . ..._. _ _ _ _ �; --- --- --_ __ _ _ ---��-- -- Water Line: �ursuant to CFR 32$o.s�z (a> ' raace: ' � _.___�_____�___�_----._._ __.___ __. ._.___`.___. __ .......______ .__.___. ..._.. ---.. __ ______� i Print Name of Tester and Company: � :_� -� �.. --- .�._____._._� ____�.,��. ¢ _ _.=_ �,-_ �� _- .� _.._�x_�_:__ .,,�t�. F(XtUM'@ T�St Pursuant ta CFR 3280.612 (c} Date Print Name of Tester and Company: � , �,_ .�w_ _.�,��__._._ � .,�. - r. �-�, ;_�- -,t.� �m�. _ �,� _� _ �.a��_ �� _. n,:._ . _�_. "� G8S TeSt. PursGant tn CFR 3280 705 and IFGC 406.4 I Date. ��1� � ' -- —� _ _.. �___.___.._____.... __- ----._ __._.,:_ � , - �+ -- Print NamE af Tester and Cnmpany: � �l���.... ��� �'�a��t �,Q �„j��: ����(..;�_ � ..__--�-,� �= R�� z� �� __-,� __ _ � .��_� . �-- -� 1 -- - Electric�l Operational: Pursuant to CF 3285.702 � Date: ._.._ _____�__.._.__.._�._____�_ � _..��._ i -- __._..__ ._.__._1 Print Name of Tester and Gompany: I ; _ ,._.�_ _ ,�� __ �� .�.,�- x _�_..._ _. -�, -,��..R...,�--- ��.,�.� � __ ,� E1eCt1'lCc�l Pol�!"Itjl: Pursuant to CFR 3285 7fi2 �Date: r ; ---_-_-__- _ ----•-_ ; -- -_ _ ------- _-- --- -_. ._ _.� � Print Name of Tester and Company � � Eiectricai�Cnnt�nuity��Pursuant to��m ����. �_�_ .._ . -,.�,.�w��,�r_� ����,.���.��-� � CFR 3285.702 �Date: � ; - ---_.._--_��___ _ __________ _. .____. ._.__.__._---______.__---__.._�1 � Print Name of iester and Company: i f , .�.. .�-�z�-,- �._�,.�-� _ _:�. --_ _--�� ---�,�.�. --�-���.F _�: _�z.�_ _ ._.. �_.� -- __ _.:__ . _ __ � Srt'10kG AI81'1't't T�St: Pursuant to CFR 328Q208 i Date: i _________. ._._.__ �_ __ _______..__--- __ _____��___� _�....---._.__ _._..__._._.__... _ __�_a � Print Name of Tesier and Company: ' , _.=�=-�.r.,�=--��,�.�.,,�_ �..o�,P,�..�,..�..�.=.:.a:.�� v_��_ .F.,...,,:.r,�, _::s---__:,�.�,a�� __ .. :.LL.�. i czRify the above systems testing has been campl�ted and was f�unc�to be in compliance witi�the pravisionr,id�niifi�d for c:a�h ' systems test: + � � �—� 4. - (�? � Siqnature: __ � - - C��t,e=--------_____ _..__�_e_._._._.____. �'��..�.:� �r��' � C�Q3,3 � �� � : � � ���� 4�E a.��t��� .�� Manufactured Home Svstems Test Affidavit Ttiis form must be completed in its entirety and be submitted at the Building Final inspection for�he ins���l�ation c�F� manufactured home. All tests must be tompleted and signed aff on this form. A certificate of occupancy will rat b� issued unti{this campleted form is received. _ ._______� __....._ __.______-_------ -__.� __---____.___..__.__ _..__.---- ----- SYSTEMS TEST VERIFICATIOh] �- — ---- ----_ __._ ___ . �� Description � Date Pass�d �ignat�.�r� c�f Test�r � ; �t'�in L'tt18: Pursuant to CFR 3280.612(b) i Date: ��� ��� _._ � ' Print Name af Tester and Company: i f w=��� . . _ ...__ _..—__mW,,._. ,,� ' Wat@f Lltl@: Pursuant to CFR 3280.6'i2(a} i Date: � ; Print Name of Tester and Company: } � �.��.�._._-� FixtUt'e T�St: Pursuant to CFR 3280.612 (c) G Date: ; --------------- ' Print Name of Tester and Cornpany: I GaS TeSt: Pursuanf to CFR 3280.705 and IFGC 4d6.4 date: � � P�int Narne of Tesler and Cornpany: �� __ ___ _ Electrical Operational: Pursuanc to CFR 3285.702 oate: � ' � �— _.. __ �14� c�_:..___ �' `C�,�i�...--.„ Print Name of Tester and Company: � ! �,Q �1�� C� {,,��,���„{� � _ _ � �,.e..� I ;, Electrica) Polarity: Pursuant to CFR 3285.702 � Qate: (.�t ' ��G„��� N �-__ ---_ _- , d �`� �a --�' � j Pr�nt Name c�i Tester and Gornpany: �� �� ���1r� �° " � i �^�--- � �, �c ' � � �G�. s�� �� r� � _ �m.�- -- � Electrical Continuity: Pursuant to c�R 32e5.�o2 j oate � 1��� ` � --_.___ _._ { � ------._....__. ; Print Nams of 7ester and Company: �� �,,� ���� �� � ��,� � -[ � � - - - -.__.-: . _ � Smoke Alarm Test: Pursuanx to CFR 3280.208 ; Date: _,........_._._.--_.._._____-- ; I�rint Name of Tester and Company: k�=�,=,-_ _ -_- __ .. _ .�:-�=_ � I certify th above systems testing has been completed and was found to be in compfiance with the provisions identified(ar e��h j systems t t , � 1 5 nature: � ' �� Date: �� 17���� � �� kw �v ta� .a . , . , Manufactured Home S stems Test Rffidavit This form must be completed in its entirety and be submitted at the Building Final inspection for the installation of a manufactured home. All tests must be completed and signed off on this form. A certificate of occupancy will not be f issued until this completed form is received. -- ------ �: __._._._ _______ _ SYSTEMS TEST VERIFICATION -- __------------- - --- Description Date Passed � -- =-__---- Sign�t re of Tester -_=—=__