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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS ollNERatrILDER l)l:1,( ARA rr)N
<br />Iho.hvrflt und( p.niltyol |trury rhd I nD cx.nrPr fton rhc CoMNtrf I'i:ctrlt I]s tur ilk i.llosina tc(qD (Stc 7).115
<br />Bu\nr{ rRt holc\\n Cqlc) AnyCiryor Counr! (hi.h rcqnncr d lEnnir ro coi{ru.r, (hcr. iNp.rnc. dcmolnl' Iftl\'rrtrv
<br />|rnlc{\n \C.dc)orrlrrhor\hchcrcnlnrlEclionntdrhchrri\itrhcrlltlcdcxcnuior An!dnlionolScdii,nT(J.rl5byrny
<br />nmlrnrr nn .rcnnirsrhrd\ rhc rn!lic.trl ro rcivilr.mhr"ol 'xn
<br />nnrrrhntr ll\c hundrd,lollrr\ l55(x)r.
<br />I $ owtrcr ol rlrc r()Ilcn y. olny .hpkJy.cs sirh $r8cs 0s rhcir qrlc conrNiqr ion. $ill d. rhc *.rk ald rhc sulur. i\ rxn
<br />irr.Blc,l or oltcrcd ntr sh(scc.7u,r. ausirc$ rnd ltoli\irnscM. Ihcc.nrB.ttr \ Lic.rsc t-trv docs nor xPplt h u oqm, ol
<br />rhcf,pcny s'lnr tuinn or i'nprnls rhrNr.0trd $ho (loc\ {rh *o* hnn(lfor hcts.ll( lhou8h his or hd ostr cnrlkrr_rt\.
<br />|) ovidcd rhrr such i'nJrcvcmnh 3m nor inrcndcl or o,lcnd tr $h ll, hl,*c\ c'. rhc hu iklil)s or ioPrnc.rnt is $kl wirhii ofc F!.
<br />nlc.mnhrion. rhc O*ncr Buildcr willhtrvc llf, hu'(lcn of,nori'rg rlrr tE or \hc did nor huik] or inDnnt rhc PmP.ir lir rtE tulrscol
<br />L r(.un.roirh. |nDI.ny. rncrchsncly.onti.lnrt \ h liccnscd cotrrrct)^ b sniru.r rh.l,n,jccr(Sa 7lll'r- Ru\iks
<br />itrd lh,ll1\hiCodc thcCo rnc!tr s l,i.cn\c t-as doc\ nnrilplyh rnorn{ otrn)rcnytrh. build!or irprurc\rhcr..i.
<br />rnd eho conrrucr\ l{'r \ich rrojc.h wilh 0 (in mchnn licrnscd trr\trrirk,rhcCo lrlclor'\ Li.c \ruw).
<br />I rnrcxcnrl undcr Sccr
<br />Df,Ie
<br />uarf,ESs:.cau[ENs )!
<br />DIEI,IIBAIII}!
<br />I h.rcby !finn otujo l.nrlryofFrjuryonc o,rhc finb*hC dc.l irnns:
<br />I huv. dqilltuinruii,C.nirt cofconscnrtnSel{lniuN tr workc( comp€nsuri(r n\ pmvidcd fo.bvSc.rioi.1700.flhc
<br />tntrr C,hl.. hn thc |clxrru'r'c nr rhc wnrk ior nhEh rhc Frmtr n N'dr'l
<br />Lr(l U. ,'a *,rr ',.nr,, * Acr'comn n.ari miudn.c.!s rcrrutcd t'y s.dnrn:l?(x) otIhe htlor Codc lor ttu FYr{mmeof
<br />f rhii?I-I6, trhKh rr,i. n(n Nh\uJM!wo,kcr'conFnlrtr'n'n.$Nrr.mH.xjF'lrytrumhIr
<br />' '/ty\/<11 1vw<-
<br />LA \Dao 2f7 l2-
<br />-l
<br />$niry $d in ltE Frto{Emc 6l rhc wo.k fot whtch rnis ,.rmil is is\ncd. I shall nol cmPloy lny Pc$otr in ,ny manmr
<br />mNlobccomslblNlrorhcso.ncomnnulionhesofcllarorni!,andngNlhaliI!stouldtEomsubj.{l16rla
<br />*orksl cofirnsario, otuvhioN of Sdhn J700 .f rhc Llt r Cod.. I shull- lonh*nh conll! whn fi.s !m!isio$..
<br />wAFNlNc: Fnilurc lo scurc workc.i .on!.nunnr orcmB. n unhwto
<br />civil fitrcs ut, Io o.! hutrdrcd lhou$.d doll6rs l$l0o.uD). ir addiriotr l{,
<br />l. dnd shsll subFt {n nPloyet ro niminal IEnClis lnd
<br />lhe cor of compcnsrbn. d.roec, .i pvScd ror rtc,"r orrhc I:'lu( {tr1.. inrcrc{ rtrd
<br />l-3 t'2o
<br />I hcEhy llltrm undcl pcnaky or pcrjlry ltar I ah
<br />oi thc Busincs a.d P&tcsiidn. Codc. Md my I
<br />,)n,ri\i( ol Chn|ncr I ($nnfun.i.8 $irh Scclion 7(xx))dfDivi\iotr 1
<br />108t69
<br />-,", l' 7!- 2a za 3 t-n 5l-
<br />(:(tNSTRUC'IION LFNI'IN(: A(;ENCY
<br />i\{nl rs.. l(D7 Civ C )
<br />btuleir Nrnr:
<br />-
<br />L.n.lci\ Ad.lrc*
<br />-
<br />AUIICANI"DECLA.EAITAN
<br />! hcNhy dtinr uidci !.nrlry or,'crjry otrc oilhr lnlk,$iri8 dcclarri rs
<br />D.mrliri Pcirnils Ashc\ros Norilicition Fcdcml Rc8uhtions(lirh.l0. Pdr6)
<br />-Rciltrtcd
<br />lirrs of Miilicrti[
<br />-l
<br />c..lify rhar th. fcdcEl icsllhtnrns rg.dinS .sh.sto. rcmval arc nor ut llh8bk b lhis pmj.lr
<br />rRl (ircrhrrrhcrhrlc n,hnnrri({ ir.orcd I r[rcc t,.onrdy sirh rllCirtn J coutrry
<br />ivN ul rhir Ciry lnn G,u , k, cnrd uton rhc
<br />/a,,-," /- t t' )z' 7"
<br />ordimnc.\ ud Shrc tjasrLrirr8 k)n,n, dd h.rcby.urhorirc rcprc\cnr{
<br />rtn\c nEtrri()ncd pmncny ntr iN /<--..
<br />,\pt li($l or ,18enl SiAnol
<br />ft- -t
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipinq
<br />Rool Drain
<br />Tubi Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Ivlain Drain/Pool Pipino
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq
<br />Final Gas Test
<br />Meter Release t.l A G,
<br />FINAL 7WlC00 WW ry
<br />Notes Remarks Etc.
<br />UNDER GROTJND
<br />Fill Line/Back Flow
<br />{<.0^,,-,u
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