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Home My WebLink AboutLA178541 , `� �� . �� - � � ��" �Yw.�� 1 ' . . Manufactured Home Svstems Test Affidavit 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 issued until this completed form is received. SYSTEMS TEST VERIFICATION Description Date Passed Signature of Tester Drain Line: Pursuant to cFR 32so.s�2�b) �ate:, 7.,�� - Print Name of Tester and Company: �• C_�� r r � � � ��?�� WSte� Llfle: Pursuant to CFR 3280.612(a} Date: ,..��-� Print Name of Tester and Company: '� /�� Fixtu�e TeSt: Pursuant to CFR 3280.612(c) Date: ��-��-� � Print Name of Tester and Company: ' � G8S TeSt: Pursuant to CFR 3280.705 and IFGC 406.4 Dat � � � Print Name of Tester and Company: �/ � � � �J .�"� /��rv r,� w�as�'�rW��L� � .�r� —, Electrical Operational: Pursuant to cFR s2ss.�o2 Date: �- �-�� f��l P � Print Name of Tester and Company: :�'�, � ,i ��'�� ,�.��y �,� r, EI@Ct�iC81 POIaPIty: Pursuant to CFR 3285.702 Date: �- ��BZj� �� . Print Name of Tester and Company: ��,,,��,��,��.../ �,/'-�� r , � 1 �� / J' /'i��'t/�� G/r�!'! EI@CtY1C8) C011t111u1�y: Pursuant to CFR 3285.702 Date: �-�j�"'�� ' Print Name of Tester and Company:��U�,.?�� i� i��r��r �K � �.-��, Smoke Alarm Test: Pursuant to CFR 3280.208 Date: .._-��..r�� Pnnt Name of Tester and Company: � �� I certify the above systems testing has been completed and was found to be in compliance with the provisions identified for each systems test: Si nature: �~� � � Date: � �