|
PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS
<br />UNDEB GROUND
<br />Waste & Vent 7 -Z?4Q.L{e 2a
<br />Water-under floor 9-z;z'ft-,R-a2
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnlerceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pi prng
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />Pirap/Drain Line
<br />Main Drain/Pool Pipino
<br />Fill Linei Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous ---.,1,ffi2Gas Service 9-28-tb ?/
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbinq
<br />Final Gas Test I Pl>l a-l 'rtfurrfr.t)vu
<br />^a,,,-*1FINAL,ol>l t8 T 'vu)
<br />Notes, Remarks, Etc U1-a
<br />oWNER NUII-DI]R DF]LCARATION
<br />I hcr(hy rrnirn unncr numny ()l |trjury rh l unc$nDr rn rhc Codh.ntra l-icctr{ Lrs fitr
<br />'hr
<br />loll,,$irs rcN rsccrlr.ll5
<br />Bn\nrc$ rtrd lt fc\ri(r Cdcl Aoy Ciry or (i,unry shi(h rcqutc! a ,rnnll lo con\ltucr, nlrcr. i'npn'!d. Jcntr,li\h or rLNn rtry
<br />t' rhc !ro!isi,,n\ at lhc Cotrlricntr s I i.cnrd l.!s (Chl'nrcr 9. C.nnnen.irs +irh Sc.rion ?ur) ol [)ivi\ion .1 or rh. Rusinc$ rnd
<br />Pn,lc\sn,nsCodc).rrhrr hror \hc iscrc'npt rhcrcfrofrri{l rhc br\i\ ir rhc rllcgcd crc lIrnnr. ir vn,hri,,n ol Sc.ridr T0:l l 5 hyxtry
<br />aptli(ntrrlnrrlonrir\ulic.Nth..ptli.urror.ivilpc.rXyotnorinftrhMllvchufldrcddollrs($500)
<br />L rs o*nrr ol rhr F,prny. omyc , ot(\ airh*r8o\r\ lhcir {i c(nn|Fn\rri(n,. willdr rh. *ork rnd rhc (ru.ruic n Nr
<br />rhc p'.pcdy shobuildror irrlrrofl rhcnanr !' u,lm dms {r.h $ork hN\cll.r hcr{llorrhriu8h hF or hcr ostr cnrpiDt.\.
<br />tro!trl.d rhrr{rh i'np'ok rirsttc iorinrcnJ(lororcrcrl,nr q[ ],]howd.r,rhchuitling.ri pr,lc r i\ y)kl tirhh on!: ycr
<br />l. tr\ owtui oflnc pmFny. Lncrclu\ivclycont|dnrg*irh licenscd c.nrtu(,on ro .onstur ilr fmiccr {s(. ?044. ausrmrs
<br />afli tr,Df.\si.n Codc: Thc ConlErols Liccnsc ljw dms nol arply to !n ovns or proFny vho builds or imp,.vcs rhcd,n,
<br />and who co r.cls ror such llruicrs wirh r Conra.tois) lic..scd pusuflr to lhc Conlmctols Liccns L3w).
<br />I ue r.nd und* Sction . B. & P.c. for this EMn
<br />.AI)8trEIS:.EQMIBIAIION
<br />DECI,AIAIION
<br />I h.rcty lmrmund.r pcnally oi lEriury orc of$c iollowin8dcc!tr.iio.s:
<br />Ihr\tuxt$illminltrinrCcnifi.rrcofCon\.nrhS.lalnsurcinsork^.omp.nunnr.r\troviddturbySc.riotrlT(xlofrhc
<br />l.!Ixn Codc.litr ihcI,(rrinnanc..lrhc *nri ntr trhichlhc pcnnil i\ i\{d
<br />_l h,r..d *il! 6ainr0in worl.6 .ooltnrnrion inslr!rcc, $ eqlied by Sdioo l7O0 of rhc tjb.. Codc, ror
<br />'hc Frforffic ol
<br />rhc wor* for*hichrhLp.mn ir hrucd. Myworkc^ mnlensrion i.rumrc.onid md polky numb.r a.:
<br />PolicyNuEt( E!!IB
<br />-l
<br />erlify lnal in lnc lcrform.na of lhc wori for qhi.h lhh pcflnit G iNlcd. I sholl not employany lcmn in lny MB
<br />s .! ro b..om slbjcct ro rlr wo&6 onp.n*ri6n h*r 6a Caliaoni( ard lecc rhal ir I sholld b.src rubjd
<br />'o
<br />th.
<br />mrtss om0.nsrion rnvisions ol sdion 3Tm ol rh. Lrhoi CqL. l rh!U. fonnwnh onlly vnh rhos povtiofls..
<br />WARNINGT rnibrc ro suc vork ^ cotrqEnsdt,n c.rmse is unln*tuI. and rhall srhjer {n .mtlortr ro aimind ,LmIi6 snd
<br />.ivil fincs up lo on. hundcil lhousrnd nolh^l0O.00O). in diion !o lhc cosr n,.ompcniirion, dlmgei N I'rovil.d ror Uc
<br />rhc I x{xtrCo(|. i'ncr.{ rn(l l,L----t
<br />Ll!tru,D_!!r.tilx (rgts
<br />tr,tct,,\Rrt'to\
<br />I hrrrhyrltunru'alcrn! rlryol prrjurt I am li.cnci dcr pmvi\io! of Chtrprd 9l c.nrf,.cing with S*rbn TUD) ol Divisior l
<br />ot rnc Busircs md Prolisions Codc. ind myliccnE is in lull forcc ond crhcr
<br />().su
<br />,"," 66tLq \LU
<br />I hcN$y rrfir xnd$ Fnalryor,.rjurylh,r
<br />h\ucd (Scc 109?. Civ C.).
<br />is0mmrtudion lcnding r!. y ror rh. pc.fornBmc oflhc work tur phich lhis pcrmir t
<br />AIILICAI{LDECIABA.IION
<br />I hotbyailmlodrFnohy ol pc,jlry onc orrhc f.Uowing dNldalions:
<br />Dcmlilion Pcrnils-Ast sos Notification Fcdcral Rc8uhtions (Tirlc 40. Psn6)
<br />-Rcquncd
<br />L.llcr olNonfr.tiofl
<br />rcslrdin! asl,csros gnovol urc nor appliclhlc r{, rhh rmFcr.
<br />n dd st,rc rhd fic .tnr info.@rion h .odet. I lem to sq,!y wnh ltl Cily and County
<br />in8 .onslMliotr ond h.nby arhoriz Efesc olivrs of fik City ond Colnty lo cnlcr o!'.n lhe
<br />]\pplirMl orA[mtSiIntrl coMito
<br />Meter Release
<br />knd.lr Addre$ L
|