HomeMy WebLinkAboutLA185804 test affidavitt
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Manufactured Home Svstems Tesfi Affidavit
This form must be compfeted in its entirety and be submitted at the Building Finai inspection for the installation of a
manufactured home. All tests must be completed and signed off on this form. A certificate of oaupancy wiU not be
issued until this compfeted form is received.
SYSTEMS TEST VERIFiCATION
Descriptian Date Passed Signature of Tester
Drain Line: Pursuant to cF s2ao.6 2(b)Date:
Print Name of Testsr and Company: r
Watet'L111e: Pursuant to GFR 3280.612(a) Date:
Print Name of Tester and Company:
FIXtUI"e TGSt: Pursuant to CFR 3280,612(c} Date:
Print Name of Tester and Company:
G8S Te3t: Pursuant to CFR 3280J05 and FGC 4Q6.4 Date:
Print Name of Tester and Company:
Electrical Opera#ional; Pursuant to CFR 3285.702 Date:
Print Name of Tester and Company:
EleCtt'lC1l P011Cltj/: Pursuant to CFR 3285.702 Date:
Print Name of Tester and Company:
Electrical Cantinuity: Pursuant to cF s28s.7o2 Date:
Print Name of Tester and Company:
Smoke Alarm Test: Pursuant to CFR 3280.208 Date:
Print Name of Tester and Company:
1 certify the above systems testing has been comple#ed and was found to be in compliance with the provisions identified for each
systems test:
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