HomeMy WebLinkAboutLA193992 - 523 Juliet Dr - Affidavit � �� ��3
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Manufactured Home Svstems Test Affidavit
This form must be completed in its entirety and be subrnitted 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 VERlFICATION
Description Date Passed Signature of Tester
Drain Line: Pursuant to cFR 32so.s�2��1 Date: ��� �
Print Name of Tester and Company: ./' ^ � I��
�- 'e f i' r� � �1'C ��. �
W8te1'Lltte: Pursuant to CFR 3280.612(a) Date: ��-���-,,�/ � �
Print Name of Tester and Company: !
Fixture Test: Pursuant to CFR 3280.612(c) Date: �_��"�
Print Name of Tester and Company: ��
GaS Test: Pursuant to CFR 3280.705 and IFGC 406.4 Date: 7 3� a `
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Print Name of Tester and Compa�y: -�" �e �` c�S�?,� /�q 5��/ /"�v 6Y I e
Electrical Operational: Pursuant to CFR 3285.702 Date: ��.,��. i^����
Print Name of Tester and Company: ZO�j �t�,�„f �����p ���,�,/�
EIeCtPiC8) P018►'Ity: Pursuant to CFR 3285J02 Date:��Z�z�
Print Name of Tester and Company: ��� ��,,.5 ���G��. ��,�CG�r-i L
Electrical Continuity: Pursuant to CFR 3285.702 Date: �2�'•.�
Print Name of Tester and Company: ��`�'i �tt'd ,�/CI�� l��r/'c�i
Smoke Alarm Test: Pursuant to cFR 3280.2os �ate: _2• -�� Z . —�/ �
Print Name of Tester and Com p a n y:
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: �V �