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APPROVALS ID/SIG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Underfloor <br />Gas-Underfloor <br />Area/Storm Drain <br />lnterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Pipin <br />Gas Pi erng <br />Roof Drain <br />Tub/Shower Test <br />POOUSPA <br />P{raplDrain Line <br />Main Drain/Pool Pipin <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Misc <br />Water Service <br />Sanita Sewer/Cap <br />Back Flow Device <br />Rough Plumbing EXP RE <br />Final Gas Test <br />Meter Release <br />FINAL <br />Notes, Remarks, Etc. <br />OMa.Buil.ld DclBdid <br />I h4by aflim uDd6 p6dty ofpdjury 6 I d.r@Pl fm th. C6rialm'Lim.c Lrw fd lhc fotlo*in8 rcson (rc.ro3t.5 Burire <br />Md Prcferrcn Cod.) Any Crry d coury which B{ui6. Fmil ro co@Eucr.lrr. improvc, dsnolilh d rcr.i. ay .r.wr!!, pri* lo iE <br />i.suDa, llto Gqric rh. lpplitur rd ruch pcm ro ril. . ,istr.rl irat@r rhar hc or shc is ricarcd puuusl to rhc pr.vid@; of d!. <br />Corr.ctoas Li6s.d t w (Chapra 9, C@@cing *ith S.dion Tooo orDivili@ I of lnc Bsitre ed prof6!i@ Cod.) or tlt* h.o <br />shc ii q6pr th46m ed $c b$U fc lhc dl.t d .rdpron .Atry viol.don ot Scdid ?o3 t.J by uy .ppli@r ftr . p6;n rlbjlcE rlE <br />olpli@r ro i civil p.Dalry of.or m@ rh{ ,lec hu&d dollu (l5oo) <br />_I. a oma oafi. FotEO,, d 'ry dployG wirh w!96 s 6.ir rct. c@pdsrion. *iI do th. wo* ed !h.3Eu.tuE is not inl.ndcrt <br />or ofdcd fc i5l. ( Sa.70d. BuiD6 sd Pofsod Cod.: ft. C@nrcot U6r. L.w dc nor sppl, ro e oMa of $. prcpcny <br />who buil& or iEFw6 th.En, &d vho d.6 ech eori iiE.lf 6 hadf c d!@8h hii or ho M chplorq, Flvi&d lt.r sch <br />imprcvmenE @ nor i.!md.d d ofield ro s.lc. n ho*d6, rhc buitdins q improim i! Eold wi$i.-@;yq;of.ompl.li@, rh. <br />Owrd-Blild.r wiu h.v. thc hrdli of prleing dr.l h. or ih. nor build or ioFov! for lhc plrpdc ofsar.). <br />_1, 4 oM6 of d. FoFry. u .rcluivdy @Dens with liffi.! 6t *ror, ro orEucr $. pDj.ct { S.c ?oaa, B6ir6. edProraio Cod! Ttc CduEdt Ucfu. t * dG rd +DIy to a omd of pror.rry wno b!il& d inprov.s th.!@ . ud *ho <br />cnneu ror $ch projcd! ei$ t cdlb..id(t) licd.d D!n6r !o $. Con&ior! Lic@ Lp.) <br />_l n cxmF udascdi@ <br />PORI(ERS COMPENSATION DECT,ARATION <br />I hdcby aflim ud6 paalty of Fjrry oc of !h. followins &dar!li@: <br />_lhav.&d*illnai lin.C.njficd. ofcoNat loS.lf,Lsuc fd wtrkcR, comp@radon, s Fmvid.d ftr by S.dion l?Oo ofd. <br />Lald Co&, fq t. FrforMcc of rl. wdt fd whth thc panr i! i$Ed <br />_l harc ed *ill minl'in *o*cE' c@p.catio insumc., s rcquir.d by S.clion lToo of dE Labd Cod!, ior 6. pdfolfu@ of $cwoll for which rhir pdhn L isld My wdt6' cmp<.!.rio. irulm@ @ia ud policy nunbcr &r <br />Cmn <br />2Ar, ^,^^,*r^ @ orrh.wdt fs <br />beh. lubjd b dc wo*d ' ..hpa,!.ri@ lM <br />which lnis Fmir ir i$u.41shall <br />of cdifmi., &d aere tur if I <br />rh. L.bq cod., I 3hall, i(thwil.h <br />WARNING: F.ilurc to r.cur. wortc' @mp.nsri6 ovqagc is <br />fi nq up b . hud.d rhtued &lls (t|OO,OOo),in.ddid@ lo <br />dlc Lrbd Cod., intaBr dd lrioncy', 16 <br />a provid.d f6 drc S..lio 1076 of <br />LICf NSED CONTRACTORS Dt]CI <br />^RATIONI hcr.by afiD uidd paalry of Fdu,r d6l I M li6cd uidd prcvhioi ot ch.prs 9 ( <br />th. BNi.* dd Prcf6si6! Co&, ad my lico!. is in irll tm. &d.ficci <br />I talhy .6m ud.r panlry ofpcjury ta rtro ir r orEDaiod <br />isr.d (S*. 30r?, Cie. C) <br />of rI. work ad which rht pmn t <br />ATPLIC{YT'S DBCI"AXATION <br />Dcmlitim PmiE-A5bBt6 Nodficdion !d!r!t R!8drid, (Tidc 40, p..t 6) <br />_ Rcquircd Lct6 ofNdifcdid <br />.!ovc m6tion.d prcpaty lf ii.Idrio Fsp66 <br />ed Coury !o mla upon rt. <br />-o <br />-o <br />PLUMBING-INSPECTOR RECORD <br />DATE <br />Building Sewer <br />Rough Water Heater <br />Gas Service <br />Lawn Sprinkler <br />FEB O I 701Il <br />Poli.y Nhbcr <br />- <br />EiD'G ' <br />(Ixis sccrio. na! nor b. cdpldcd ilUc pdnh is fd on. tu&.d dolle llloo) or IB5) <br />I