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PLUMBING.INSPECTOR RECORD
<br />(,IIN1]T IIT]II,DER DEI,CAR,\'IION
<br />I h.rchy aiinn und$ !cmh, or p.rjury rhd I nm crcmpr lionr rhc (t.tdoG Lhdn* t w for rhc fdlosi.s rcNrn (sec 70 r l '5
<br />Busincss lnd Pmicssn,n Codc): Any Ciry or Q,unry whrh rcqutc\ r Iinnir x' (hlrucr' dl.r' rnwovc, dcmoli\h 'r rcpat lny
<br />srocrlrc. prior k, irl kutrmc. lnorcqrn.srhc rlplicrnl f{tr su.h p.flnirb nk a siln d urcnr rhal hcor sho k liccn$d pur\urtrr
<br />b Ih. povistuns ol lhc Cotrtr.cro* l,iccnscd Lrw (chnlrcr 9. Comm.n.irA with Scclion 70q) of Divhnnr I or rh' Burinc$ rnd
<br />Prcl'cssiir\ Codc ) or rhar hcor rhc ncxc,nnr thcrcf,ommd lhc ha\t lnrrlf trllcBcdclcdfln,n An, vid0rionolscclionTl).115 hvtiv
<br />lpplicuir tur r lcrnrir sul,jccr\ rht a0tlic,trl to r(ivil!.ntrlryorn.r 'm.dho firc hundi.d Jollm (S5( )
<br />l. 0s .wncr of rhc rmlfny. or my c rloyc.s wirh wtr8cs trs rhcir sok .omn nsd tu.. $ill do rtt wolk anl ll'a (tu18 is nor
<br />inrcndcd or on*.d k; Jt (4..7044, susims md Pnncs\ion\ codc Thc contr.ror's Li.cnsc Lrw docs.ol0mlv ro un ownn ol
<br />rhc lr,Djrry wlo t{,ild\ or ilrr)vcs lh.pn. l] sh, dds ruch w()rl hinNclf or hcreli or rhntEh hh or hcr own cnrpbyccs.
<br />pmvidcd rld sxch irprornrnk fr mr i, cnddl or.lLrd lnr vlc ll h,wcvcr' rlE b{ildirB or imPmlch-nr is $ld wirhin ru r'r
<br />;f corylcrion- rhc owrcr Buildcr sill tuw rlr t{dctr of [oving rhd lt or shc ln ftn blild or inqro!. thc pmldv ror rtE puqx's or
<br />-1.
<br />rs osftr orrhc lopcnr. rtrn.r.lusivclyconradin! wirh li..n\cd conlruLn,\ ro connrucl lhc pn,jccr ls(. ?tlr'l- B^inN\
<br />Md Aollasinr Codc: rh.Conlracrois t-i..n\c Lnwd cs noi aprlyk, anow cr ol proP.nyrlD buildsor nnP('vcs rhctcon'
<br />!trd who.otrtr.dsl'or\uchpn!.rrssithaConlract(rliccnsdNruldrorhjConlrMrr'sl-i.xi{tjtr)
<br />Dt ct-l!tdl!!2N
<br />I hcicby !fl t'n utrd.r rcn,llyol|rrjLty o't
<br />I hr\.dil aillruirr!in, ( cnillcdc of ftr *orlcn ompcnssdon. &i provided ror by Serion l7m of $c
<br />ljhor Cql.,,.rrhc pcrformNc orrhc so forwhi.hIhen mir ir issucd
<br />-l
<br />hawa d will mnnrl.in sork.is'conT.nsart,n in\rrnn.., as rcquncd h,Sc.rion3?fiioflhrLjborcodc. rb. rh' JErf flmnccor
<br />rhc work rorphkh thhpc(ni is issucd Myworkc* .on'Fn{rion insurnr.d.nrtr indF,licv i!ob& e.
<br />Poli.yNumb.r: Ertircs:
<br />l.cniliihnri'rrhcFnnnnanccolrhcworkturwhthlhislErnlri\r\\ucd.Ishrllnor.Pk)yrrrvpcrso ritrvDinn'r
<br />$ 0\ ro hcorr {$jcd rorhc*orkd\ comPcns(nr hws of Crliraarit. rnd rlrcc rhxr ill ihorld h..o'ft suhjccr ro rlf,
<br />sorkcr\ conDrnsihotr pmvi\ion\.rsc.lion ll00or rhc l- hrr cdc,I shrll- lhnhwirhonll]lv wirh rrn$ Pnr*n N
<br />WARNINC: Elil!rc i. sur. wott F @npcft.rlln .owt!-!e ils lnlastul. ud shall rubj.ci M cmPloFr ro 6inin'l F{ulrier lrd
<br />.ivil nrcs up ro orc nu.drcd lhou$nd doUd {rhc cosr of c.mFMtion. dads.s ar pn,rided aor rhc
<br />E
<br />I heEby artrm undct Fnah, ol p.rjury lhal I an liclnsd u olOEprc 9lcoormicing wirn Scdion 7I)00) ofDivisiofl:l
<br />ol rhc llr\inc\s d.d Prolcshn\ Codc,,nd nry liccnsc is in tlll
<br />CONiIBUCII(II{IINIINGA{iENII
<br />I hcruby !fth ufrl.r pcnalryolFtj!ry rhnr rhcE t ! consldcrirn LndirB r8enc, fd rhc Frrbrmrtut.frh. "ork lhr *hich rhis Fnnit ir
<br />issx.d (Scc.3dr'7. Civ C ),t ndd s N.rc
<br />txnds'\ Addrcss:
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<br />ATTUIANI,.DIgIAEAITON
<br />I hlrby smd hd( p€nalry ol p6rury o.c ol rhc lollowing debrll ioB:
<br />Dcmlition Pcrnik-Asbcslos Noti6calion Fcd84l Rcgllarions (Tillc 'lO, Pdl6)
<br />Rcquir.d l.ncrofnk inc i'tr
<br />I ccnify lh.l rhc lcn nl E8ul,rions rcsedins dsh.qbr rcmlal lrc nor rl/kablc ro lht pojcd
<br />I ccrrity rhur I M!. rc.d rhh opt'licdion dd {orc lhd lhe abovc inronurion G corcci. I r8re ro.onrrl y wirh aU Cny trnd ColnrY
<br />ordnrm.s lnd Srarc Lrws nLlin8 o building .onshclion. d hcrcbyauhoriz. Eprcscn!.rivcs orlhn Cily dCoumvrocnlcruPoi
<br />dx,vc nrtrri(Nd pmpcny 1,tr
<br />Appli.rnl or Agol Si*mlu
<br />DATE ID/SIG.COMMENTSAPPROVALS
<br />UNDER GROUND
<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 Pipinq
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main 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 />Rough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />./Zcz-7FINALfit6'/ g
<br />Notes, Remarks EtC
<br />Fill Line/Back Flow
<br />^,,, 6/ ?/ /E
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