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PLUMBING-INSPECTOR RECORD <br />ID/SIG.COMMENTSAPPROVALSDATE <br />Waste & Vent <br />Water-Under floor <br />Gas-Underfloor <br />Buildin Sewer <br />Area/Storm Drain <br />r/ Clarifierlnterc <br />TOP OUT <br />Waste & Vent <br />Gas Pi in <br />Roof Drain <br />Tub/Shower Test <br />h Water HeaterRo <br />POOL/SPA <br />P{ra rain Line <br />lrilain Drain/Pool Pi in <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn S rinkler <br />Sanita Sewer/Ca <br />Back Flow Device <br />Rou h Plumbin <br />Final Gas Test <br />Meter Release <br />FINAL <br />()\tNr:R BUlt Dl:R l)t:L( ,\R,\ l loN <br />I lr.,cl,y amnn undet pcnihr otpdiurynrar l dn c\cn,nl lI( n rlt (-onlraclos' l-iccnsc l-in'for rlE folknin! reBotr (sc'70115 <br />Busnrs and Prersion Codc) Anv ailv or Counrv $hi.h !.qtrir6 . Itrnit lo co.sltu'l 'hs. iDprorc &molsh or rpin Mv <br />shdu( rirk irs irn'a .., also cqxnsrhcappli.n f.t $rch Fnnir lo filca sirned sl.tan d lld h'orshc bliccns'n PGlanl <br />nirlrpro\isiolsofih.Coraclor'sLi.en*dli\(lFpr6g.CoDnr.dcing$ilhSdi'7t\10olDivisi'nlofrh'Btrsin6satd <br />flollssionsc.dc)ortnh.orsh.is.xemplllF..@nmdlhctxsN.otlh.allclcdcrmFion^nyliolalionotsdionr0ll'b}a.t <br />nmlic0 for a pnir suhjds lhc q,pli.anrtotrcnilPcnalr'olnornu.rharfi\cnundrcddollds($500) <br />t. ar .Nlr.. oilhe pmtcdJ. o ny cdrnrr s $ith \ 3s6 as lh.n mt lunlosdion \ill & lhe $olt od lhc nMu€ is n' <br />mndcd oro,Ir.{ lm;b(ia 7oi,1. Bsnr6s and l\oassi.m (-odc IltconlracknsLi.oral,ssdodnor'pplvloan'trn'ror <br />rlE nNo€ny sho l,,ildc or iqmvBlhqqrn..n! $ho dossuch $od( lri selforhcMlforltrorshhisorheo\ncnrfloy€6' <br />p'niia.a ria """t' inpo\o,oGtucnol iDrqrdql u oll6cd roiek.lr' h,\ 6 6, lhc hrildin! or nnrno\ odr isend shhinon' !d <br />.fenDld{l rlt ()$6 tnius $ill h.!t Il!. hrdo or pr(\ ing rhd hc or sh. did d bqitd or in{rora lt€ propdv fu fte p!rlx'* 'f <br />Laso*ncroa(h.Iropclv.an€r.losnelyconradins\rilhlicdsdBr ndoElo $ns'nl.l th. PNjc.l (so 7044. Bu{h'( <br />a*r n 't*inn Cna",l r'" cunt.clori l-ic.nsc La\! d.6 oor all,]:'ro an o\od oi l,r o!.nv \ ho btrilds or imrrn\6 rhssn- <br />..d \rho ..dradstnrsucr,r rNls$nn a Conta(kn(sl licss.d pu6u.nr torlE Contad.is t.icmr' La\,' <br />I dqdpr unddsdio,.8 & l'( fd rhisE6on. <br />DecldSaflotr <br />I h.r.b, amirn mdd pa.tryofPdjuryonc ollhc f.llowins ddlaatio.s: <br />I haa. sd Rill mainbin a c.nificdtc otcoMl lo s.lf_lNur. lor \ ork6 .onpss.tion s pbva'd lot bv Sdion 1700 of rh' <br />\VARNIN(;: I;oihtr. lo s0r. trortsl <br />-t <br />I hfthy amrm undq pd.lty of pdj <br />of lh€ Busins.nd Prel6lit'N c <br />l)t,( 1,,\R,\Itor <br />r .! rrnls.tr il ( hxt)ro L) l.nDno.n'! rllh Scdiun rlri)tll.1 Irn s f : <br />0d m) licokis in tullfo,c.mdcrdl <br />,,","J/ <br />c 1(L <br />"r%tul{ta leL <br />I hcrehy,lliro (ndcr Fnilry.ipdjr^ rhal rndc is..ornni.li,)i ldrdifs alencv nr nr psnrnnxn" ollhc \o,k liir \hichrhi\ IrrDI h <br />isu.d (56. 1097. Civ. C.) <br />a.e&l( rlDgcrrrB r!o! <br />I lu&y aft'm und6 pc..lly ol torky otu oflh€ aollo$in8 dclararions: <br />DctrFlnio. I'mns-Ashslos Norific.l ion Fcddal R.* l.lions (1nl.40. Pan6) <br />Rqtuircd t.lts of Norilr.tion <br />)+t+l'"'h'Wair. rha t Im'e <br />f€ddal ,.gul.lions Essding db6ros 6oul e hol .polictbl. lo lnis pojd <br />sr.t.rhar rh€ atok infoanalion ts I 3S.c ro conply \rirh .ll cny .nd couniy <br />ordi.aM6.nd slil. lavt El. nslohr <br />.borc nanior.d prcp€ny fot <br />rcnnil@ ninr (prinl,,A 1o!/!rl- <br />':ffil;- <br />Notes, Remarks, Etc. <br />UNDER GROUND <br />Water Pipinq <br />ltlzhn/'JW /47 <br />I/