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Home My WebLink AboutLA190280 Affidavit �� ' � � o�� . . 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 s280.s�2(b) �ate: � � �� Print Name of Tester and Company: e j-��, ��, � � _ �� WBteP LI11@: Pursuant to CFR 3280.612(a) Date: `� ,�� _„� Print Name of Tester and Company: �� `%r� FiXtu�e TeSt: Pursuant to CFR 3280.612(c) Date: �� v�� Print Name of Tester and Company: � /�� G8S TeSt: Pursuant to CFR 3280.705 and IFGC 406.4 Date: �_ r�Jj � P�int Name of Tester and Company: � � , � i' �.= �e J v� �yvt uS�H✓ yM.� �� S�r�t`tP EleCtriCal Operational: Pursuant to CFR 3285.702 Date: rG l �� Print Name of Tester and Company: ��-.e� ��,� �,,�u�.L �� EleCtrIC81 P018rlty: Pursuant to CFR 3285J02 Date: l��Gl �p�+ Print Name of Tester and Company: � f �C Electrical Continuity: Pursuant to CFR 3285.702 Date: ja—��-� � Print Name of Tester and Company: t� �� SI'Y10k@ AI8�t11 T@St: Pursuant to CFR 3280.208 Date:`� ../3_ / 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: � �7�`--.� � D� � �'` Si nature: Date: / �