HomeMy WebLinkAboutLA178543 � c,c..l, �'�' �� . �°�
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Nlanufactured Home �vstems Test p�davit
This form must be compiefed in its entirety and be submitted at the'Building Finai inspection for the installation of a
t�anufactured home< At#tests must be corr►pleted and signed off on th'ss farm. A ce�tificate of occupancy will not be '
issued until this completet!farm is reeeived.
SYSTEMS TEST VERIF#CAT1t�N
Description �ate Passed Signature af Tester
Dra�n l.ine: pursuar,r to c�€t s�so:s��c�� Qate: �;,2�`�2.� � �
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Print Nams af Tester and Company: * � � Ct��` e.t'e� �o�o�.S'
Vll�t�T L.i11e; Pursuant#o CFR 32�t1.612(aj Date: '�'02 9"� �t�
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Pr�nt Nasne of Tester and Gornpany: •
Fia[tut'e TeSt: Pursuant ta CFR 3280,612(c} Date: ,2.�� � �
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Pnnt N$me of Tester and Gompany: ,
G1�Te�t; Pursuani to CFR 32$0.705 and fiFGC�Q6.4 Date: `l a 3�P 2 ' '� � �
Rsirst Name of Tes#er asd Campa�y: V�^�S�e,,,- ��,..�,,o ��� ".S.Q�J i� �- �L,� ��
Elec#r�ca1+Dperatit�nai;�ursuant to C��s2s5.�a2 t�a�:.��-���z/ G'�2���r,�--
Prin#Name of Testsr and Campany:C'',12C� �U'/�r f.� �!i/Gt�G�/� ��G'l/'1 G
Electrical P'ctlarity: �ursuant to c���2s�.�o2 Q�te:�-�-2C���
Print Name�#1'ester and Company: ��t'�a✓".� ���'S �/l' ��G'�i'r G
EI#'Ctt7G3l Ctlfltltluity; Pursuant to CFR 3285.T42 Date: ��c�.�C7�/' ¢�'�
Print Narrte af Tes#er and Corr►pany: ��;�c�✓� ��.��'/�� ii��/��+ .:-,��fY��
�moke Atarm Tesf: Pursuant to CFR 3284.2Q8 t�afe: ����.. � 1 n�
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#'rir�t Name of Tesier and Company:
1 certify ihe above systems tes#ing has besn cctm�letsd and was faund to t3e in comptiance with the provisions identif�ed fos each
� sys#ems tes#:
Si n�tuce: � Date: ..• ..�-