HomeMy WebLinkAboutLA193293 - 817 Macbeth Cir - Test Affidavit �'C� /����-�„` �i��-- �.
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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 3280.612(b) Date:���'.�� � �
Print Name of Tester and Company: S � � � �,�
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Water Llne: Pursuant to CFR 3280.612(a) Date; 7,.,���� /
Print Name of Tester and Company: � C,��,�
Fixture Test: Pursuant to CFR 3280.612(c) Date: 7.--��
Print Name of Tester and Company: � /�
GaS TeSt: Pursuant to CFR 3280.705 and IFGC 406.4 Date: ?,��v� � ) �
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Print Name of Tester and Company: �p�,,c� ,y��s�',�r �p�„� �,,,.� ��-���
EIeCt�iCel Op@�at101181: Pursuant to CFR 3285.702 Date: �Z�S Z�
Print Name of Tester and Gompany:�Glj S`o '��s �f,Cj^�"jU„�� ,�/L�.'�i'iG
EleCtr'IC81 POla1'ity: Pursuant to CFR 3285.702 Date: ���6�Z�
Print Name of Tester and Company: �Lia►� ��.��� j'��GL�.✓� ,C'�LG'��"rG
EIeCt�iCal C011tlt1ulty: Pursuant to CFR 3285.702 Date: � Z6- z/ �
Print Name of Tester and Company: ��� �j,(�f/'S ���/z f�►i�y ,(GG�i',G
SlllOk@ AI81'Itl T@St: Pursuant to CFR 3280.208 Date: ?Z .Z6�Z f
Print 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: � ``