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DATE COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Gas-Underfloor
<br />Building Sewer ilnln gl w/*^ fr 2--
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Rool Drain
<br />Tub/Shower Test
<br />Rou gh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Ivlain Drain/Pool Pipino
<br />Fill Line/Back Flow
<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 />Hough Plumbinq
<br />Final Gas Test
<br />Meter Release Ir
<br />radlt-lsFINALzIiltfi fn )-.
<br />Notes Remarks Etc.v I-\l f
<br />PLUMBING-INSPECTOR RECORD
<br />O14 NEII BUILDER DEI,CARATIoN
<br />I turchy lififln undcr pcndty of pcrjur] lnd I 0n cxcmfl nonr rhc C.nklnl Liccn\c Law lir rh. fdlowing rcasn (Scc 70:ll 5
<br />ausiic$ ulj Plnision Cdcr: Ai, Cir, or Counry n hich rcquncs tr I'eir.ii ro co.\1ru.1. rlrLr. nvrovc. d.rmli\h ", rcrrJn . 'y{ru.lurc. prirtr r, irs is\u3n.c. al\. fuqui(\ rhc.pplicrnr n, \!chlcnnitro lilc r \i-s.cd \rarcmnl tl hcorshe i\ liccn\cd p!^otrnl
<br />tu n'(.,)t,!hi,,ni or itu ContD.trr l.iccn\L.d l-aw (ChnDr.r 9. CoDnrErcir.( wirh Sccrn r 7lx[ of Division ] oi rhc B!rin.\s n.d
<br />Itoicsiotrs(ndc)orrl hc.rrhetcxcmflrhcrcrionandrhchr\i\forrhLallcA.d.rcnlnrion Anyvi(,lrri()norSc.rhn70ll.5hy,iy
<br />,pplicrnrlur rErmir suhrccl\ rhc lpnlicurro rcivilpcnalryol mr nnr.rhinn\c hundrcd dollirr ($5ur).
<br />-1,
<br />at owno of 0E prcNny, o. my cmplolBN sirh qagcs as rhcn sb .onlEBtlhn. eill & tlE wdk dt $e sm$e h mt
<br />lnl.nd.t or ofEd aor eh (S*.r044. Busift$ Dd PrDtEssioB Co<!q Thc Conr@toC! llrrc ttw d.cs mr Aply b e owmr of
<br />lhclmFdy Blx) buildr o. idproBs rtEMn. nd who &B Mn w* him.ror hcffilf or lhmld his or hsoM. ployccs.
<br />,,rovitLd rh6l skn iqrctlm s e ml inl.nd.d ff of.rcd ftr sb.li h.mw. ttE bdiiting 6r irpbwEd h sU aithin om )&
<br />of@nplcriol rlr O*M Blud.r *i[ har rtu hod.n ofFoving t]er lE q slE dad mr hild or hproE l,E pmFry for rlE po4D$ of
<br />l. a ownc, or lhc poFny, ,m g.lorirly NnrEritrg rirh liccnsd mnlmdoF ro onsrruct rlE projcr (Sec. 7044, Burircss
<br />ad P,DLs\iu Codc: 'l hc Conlrrclols Liccns ljw dGs rcr.Iply lo anowmr orflop.ny qh6 buildr or imtov.s lhcrco..
<br />and who .onrhch tor swh l,.j.Ets wnh r C.m@b(o licenkd ,uBudr ro lhc Conradols Ltcorc Liv),
<br />I m*cmd uDdd S(Don . E. & P.C. fo, rh6 Econ
<br />O*mi_ _-
<br />El}atrE8S:C!.t[IfrNSAlt!]N
<br />PECLAMIION
<br />I hcrchyrlni, udcrpcnnlryoln rlrryoicofrhctnlL'*in8(lcch.di,ins
<br />II'r!cr *illmrirrui'r!Ccninclrcolcon\cntloScllln{,cturworkcrrconllrcr\alion.ss prov cdlorhySccli '1700orllrl-rhtrCo(lc.l ihc p.rlornBnccolrhc work rbrwhich rhc Nnnir r tsucd
<br />I hivc n.d will nrinrain wo'k.ri.onpcnsnrion inslruce. as rcqutcd hySccrin.lT(nolrhc l-lnn Codc. tor rhc r.if.fl1r.r of
<br />lhc wort fttr which rhi\ F.rmn is i\\ucd. My worl.rs .onr--n\ali(,n in\unrc cutricr ud Flic, nlmbcr m:
<br />Poli.ylutr$.r: Erpirc!
<br />WARNING l'dlu'. tu sxrc ad*.rs .6nDcns'in,n corcr0sc i\ unlu$rirl. ond shlll \uhjccr an cryhrrr to dininll IEtulrEc and
<br />ciril finc\ un lo om hundrcd lhouxund dollan (SlLx).(xJo), nr rddnion to lnc cosl ofcomDcnsarion. d0nB8cs as proeidcd for lhc
<br />,'T.trasPxiz
<br />ugiNtu.[aN1&lql)n
<br />DXTLLBTIIION
<br />I tcEhyrtlilmundn F.nallyoftErjury rhar I on utrdc. povirim ofChi|nd q (onxrrncnr! snh tucrion 7m0).iDivismn 3
<br />or rhc Businc\\ Md Prcfc*tr.s ftdc, ,nd ny lt.nsc is in aull forc l8r cflsr
<br />-cz?
<br />N it
<br />I h.rc$y afllrD lndcr pcn.lry of llcrjlry rtlr t
<br />issucd (S.T. 109?, Civ. C.)
<br />hndinB lgcncy for rhc pcrfonmne of rhc work for shtn rhis Fflil h
<br />AIPI.ICANI.DECIIAAIII}N
<br />l,tttby imlndcr pcnohy ofpcrju,y om ofthc folloeing dc.lu{n,ns:
<br />Dcmoiion Pcrmns-Ash.sos Nori,l..rion Fcdcra! Rcguldtk,ns (Titlc 40, Pun6)
<br />-Rcqutcd
<br />trllcrof NodlE rion
<br />os r.mval trrc ml ,p,,lical,lc lo lhh pmjRl
<br />hclh)vc ir,nnD io i\comci I .Ee to otll,lyaith aD Cnyand Counry
<br />snlariws ofrhis Cny.nd Cohry ro .n
<br />,re
<br />r
<br />APPROVALS ID/SIG.
<br />Water-Under floor
<br />-l.criiry
<br />rhd in rhe l.rformtr@ dtrhc wdrk for sfiich this Firtril is issucd.l sh.ll nor cmploylny pNn i, any danncr
<br />m aslotrsm bhd lo tic mlkcs €nncnsario.laws ofcllafomh..nd rg'!. ihar irl siould b..om hirr rorhc
<br />*orksf oqrnsolion pmvisions of Sali,tr 3700 of ih. tjbor Cod.. I shdl. fodhwnh mnply wirh ltb$ pmvirions.
<br />I rr rhi\ rffln"rnrind {rrcrhlr
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