HomeMy WebLinkAboutLA193294 - 331 Brutus Dr - Test Affidavit ��
� ��<''�,�'$�� ��` i �
��3?� �
Manufactured Home Svs#ems Test Affidavit
This farm 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 compteted form is received.
SYSTEMS TEST VER[FICATION
Description Date Passed Signature of Tester
DCBift Lifl�: Pursuant to CFR 3280.612(b) Date:�,., �(�y�� n�
Print Name of Tester and Company: � c �� A
-P � ��- � � a
Wate1'Litle: Pursuant to GFR 3280.612(a) Date:
Print Name of Tester and Company: � ��
FiXtUCe TeSt: Pursuant#a CFR 3280.612(c) Date: ..._ �� �
Print Name o#Tester and Gompany: �� ��:�J`�
�
G8s TeSt: Pursuant to CFR 3280.705 and IFGG 406.4 Date: %-3 p � a � � ,,.��Z...-------.
Print IVame of Tester and Gompany: ��v�v e y►�a��`�r y+2,��;(,Q y(.�,� �(v[t,�o
Elec#ricat Operatio�al: Pursuant to CFR 3285.702 Date: �_ ,�� f
Print Name of Tester and Company: �-t�i,,,�K�"� �jt�r �C
Electrical Polarity: Pursuant to CFR 3285.702 Date: � _ C�.��
Print Name of Tester and Company: t f i(
Etectrical Continuity:Pursuant to cFR 32s�.�o2 �ate: �_ y' -� !
Print Name of Tes#er and Gompany: j � t (
Smoke Alarm Test: Pursuant to CFR 3280.208 Da#e: — �9,..., �
Print Name of Tester and Company: � C�
1 certify the above systems festing has been completed and was found to be in compliance with the ptovisions identified for each
systems test:
Si nature: �—z,- �
Date: