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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OTVNDlI BUILDIiR DIiLCAIl]\TION
<br />I horchy dl1l.n r.ds pctrrlrv(n p.ljury rhlr I n cicmpr nonr rhc ConhcxF Liccnse l,w for rhc tuln'sins rownr (Sc7).115
<br />ausirc\s (r1 Ptulcsiin Cod.): Any Ciry or Coumy whict rcqlirc\ r pcmir ro condtu.r- ulrcr. imlro\r, dcdoli\h or rprk dny
<br />slrudurc. lrfi ro irs issunn.c. rko rcqutcs rhc {rlicnnr fu \kh Fnlir t, filc r signc{ {drcnrnr rhar h.or\h. $ licctricd pu^xr.r
<br />ro rhc pnrvhi{n$ .r r)f, cotrtrrfk, r l-i.cn\cd ljs (ChaJrrq 9. Commcncins wirh Sccrnnr 7(ur ol'Divisi(in 11 or rh. Bu\nr\\ lnd
<br />Prolissiors Codc) o! rhllhc.r\l[ iscxcD rhcr.fronind rh. hNis for rhd rllcg.dcxcnun,n Anyriol,ion.fsc.rirt?0:llthyrny
<br />:l'pli.',mt li J l.'nr shJc.l. rhc rnfli.rtrrL LcrilNtrJk).fmrni.r.rhr.'nchundr.dd.llr'(\r(]l
<br />.t l/
<br />\lw(d* ,**" r,r" p,, 1'..1..{ r,v c,nnr,4!u. tri,h trn.(\ u. rh.tr v,r. !u .r\4eror tr,rrdn,hc q,rr.drr,hc.rar^ F 'xinrcnnrl oroficrcdforelc(Srt7(!.{,Bu\irrcssrdPnrlts\i{,nsCod. l hc A,nrrackr'\ t-iccn{ ljs dos nor lPply r. r .$trcr or
<br />rhc rflilf,ny *ho huild! or inl,mr$ r,rFn.3nd sho de\ uh w)* hnnrlfor hcncll or rhmugh his or hcr own crllloyccs.
<br />p.ovidcd rhd su.h nnlk)wEnN rE k ir ddr\l or ollitod fn qlc ll l.i)(rvrr, rhc hikli4 or i.,pbvcn.nr a v,ki sirhfl oN )rd
<br />ot.onUkri4 rlt Ow cr Buitlcr *ill hf,rt rhc hofllq of rlorin! rhnr hc .r shc dn nor buili or imprnrc lhc pmFaly nr rtr puqiN of
<br />-1.
<br />!s owncr of dE tspcny, an .xclusiwly conrhding wirh liccned conrrdm ro onstrud th. proicr (Scc, 7044, Bulirs
<br />a.d Ptu4ision Gdc: Thc Cotrl@lor\ Ltens Liv dms nor dplly to m own r of lroFny *ho builds or impmvcs lh€r6n,
<br />and who onimk ror such prcj.{k wilh a Conmcio(s) lienrn psu ro t,E Co.t,lctols Lken* L!*).
<br />wtinxpniiciirrpe .i,rrroK
<br />t)[ltL8lllllJN
<br />lhilo 'rlwilln inrxinaCcnii.xtol(i,n\e n'Scll:lr\urclorworkc6 c.nrpcn\irior, trs pn,vnbd &r hySccri{nr.r?(x)olrhc
<br />LxtxtrCo c-itrrlEncrlonnnm.ollhcwork lnrwhichlhcNnrir is i\nd
<br />_t h{vc and will mainlrin sorkcrs .onFnrolion insunnc.. trs rcquied byS.crion1700 ofrhc tlbor cod., ror rh. ldformnc.of
<br />Oe worl ,o, snich lhis rrmil is is$cd. My *ortss comFnelion nsu.@c cafti.r lrn FIcy numbcr m:
<br />/,1a.
<br />unrhr: Erpncs
<br />afy lnar in lhc pc brmkc ot rhc *ort fin *hich lnh l,$mil is issucd. I sfilll trot ctrllrloy any ,cnon in an, &nner
<br />s ss lo tEcom subjel lo th. vortcs omFns.lion hvs 6r C,lil6mi{ rnd ogc rhd ia l sh.uld lE{om ru6}xt b llF
<br />M 6l oq,.nssrion provisio.s ofselior 17(10of6c brbr Codc I sh.U. fonhwnhconlply witi rhoe pmvi1ioni
<br />*ARNIN(; Frilurc ro *curc *ortc^ .onrlrn{rnD sv.risc is lnl3wiul. lnd \hall sn6j$r r chplortr lo ai.rinal Jtnrlri.s and
<br />.ivil li.cs up ro otu hundri rhon\and doltm (!lO0.O(x)). in addition lo rhc cod of co
<br />inrcrc{ dd arormy s nc\
<br />U(Ifl-Ul-gll-IB:llllJB
<br />DECIdBAII(rN
<br />I hctbyrflto,undc, pctrullyoIp.!j!rylnri I n liEtrsl undc. pmvision olChaDrcr9(connmncinB rirh S$rion 7O(x)) otDivnion:l
<br />or rhc Br\imss and Pnntsions (ndc. d myliccnshintullLreu clricl.
<br />Liense chsi-lic.N. Nunt r:
<br />D.rc:_ Co.tncloi
<br />COXSIBI,CIIONIENDINC-AGENSI
<br />Ihcmhy lllriuid.'Fdnlryolpcrturyrhrrrhcrci!rconsrf'.rionkndilr3u8cNyntr[.pcnonnrn!coirh.to lnr whi.h rhn J).nnir i\
<br />irsurd (Scc 3l)97, ( iv ( l
<br />APILICAIIDECLAMIION
<br />I hmt'y dlm und.r p.nulryofp.rrnry oe.arhc fouowins dslararions:
<br />D.nrlnion PcrDns Ashnos Norific io. Fcdcnl Rqul0tiotrs (Tillc 40. Pan6)
<br />Rmximri l. d.rNdtrr -n.,-7,
<br />I4rycd,[ thd rhc rc.]o !l rcFulo,hh Eslrdins $tc{o' Enrvrl uc .or rnplkol'lc ro rhis pmrct.
<br />-l
<br />ccnilyrhar I h,v. rcM rhis +t!li.a( ion alt vdc rhdrrhc atn!. infomrion ir corM. I aEre ro snll)ly wirh dllChylnd Coun'y
<br />odi.lRrs dd srar. kws Ellllin! ro htrilding .onntu.riotr lnd hceb, alt r.pr.{nraiilc\ ofrhn Ciryand Counirh cntr uFinrtr
<br />.bov. mnrioncd pmrcny t,
<br />Applio orA8enl Si8nllo Z
<br />UNDER GROUND
<br />Water-Under f loor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptori Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />lvlain Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Lawn S prinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />FINAL t tKltq 1 Vlx,i^i?)4 '2e)
<br />Notes ul, Remarks, Etc.tr
<br />I hcrchy imrftu dcr Ftnrliyorlcrjtrryotu ofihc lb)bwins dcclutiotrs
<br />t. n,t." . \,t (\.
<br />Waste & Vent
<br />Tub/Shower Test
<br />Water Service
<br />Meter Release
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