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PLUMBING.INSPECTOR RECORD
<br />ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping PI\YtQS.I r-1-ttr yl,+10'
<br />Roof Drain -IEo t"('n''
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main 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 />Rough Plumbinq
<br />Final Gas Test
<br />Meter Release A
<br />FINAL "1-lt-lY )twq
<br />Notes, Remarks, Etc
<br />OTVNEII IIT]ILI)ER I'EI,CARATION
<br />I hcrchy rffinn lnddr Niahy .f fqury rlu , fl.xc ,pr lnnn rhc C. ktr.tu^' Li.Ttr* Lf,w tur ihc Llhsin8 rcnqn (Scc.7oll 5
<br />Dusincs rnrl Pnitssnr Codc) Any Ciry or Counry {hi.hicquir* r pc.mt r, connrucr- nlr.r- n.p.ovc. Jcd)li\h o. hn1n rn,
<br />srdcrurc. prior ro irs hruancc. also rcqunc\ rhc lprliconr ttrsuch p.rnir b lil. a \i8ncJ idcn*nr rhd h.o. shc n licctrscd !u^u r
<br />ro lhc B)rnfiN olrlI coDlra.tu s Li.cn*d L,R (ch.Icr 1), cunnncmin8 wirh Scctiotr 7(In oa Divisior :l ofrh. Businc\s lnd
<br />Prcrc{sion\ Codc)orrllrr lrcorshc iscicr.Dr rhcrclmnran! rhc h!sis li)rrhc allcscd c{cmrrt,n Any vn,hrk orS(hn70.ll 1by.try
<br />.ffli.r nrn p.nnir ruhjdcrs thc inflicrtrr kr rcivil!rislrrofnor nxrcrhsn fivc hundrcJdollrs (!5rD)
<br />-1.
<br />6 ow6 of rh. ,rDFny. d ny ciqrbyc.i wirh ,rgei di rn sk @q,.Ndio.. wil] do UF vo* qn tlE $rI1w Ls mI
<br />inrcn Ld or oficcn fo elc (Se.7044, Busimss ud PFfc$ioac Codcr Thc Cona.crol! Lt r$ Law dEs rct !!ply ro M oenf ot
<br />rhc pmFny ql[ hilds or irtma ll.E@! ard *ho dN sEh erk himrclf or h.r*lf or tuou$ his or lEr ovn.mplorBs,
<br />provitcd rhrr reh in{ftv@ s @ rci hrcndcd orofi.ed for slc. lf. howcq, iE tilildiog o i8porcmd ir Dh wilh om Fr
<br />ol@nplcrioG rlt O{tur Build.r eil hrw th. h!&n of proving tur lE or rhc dil mr tdld or in{,ft llE pBtEiy for |hc p6!6s ot
<br />-1.
<br />as owftr olrlE tlbl,cny. @ .rclusiEly conh.ti!8 wirh liencd co Rlos ro .onsrru.t rlE l,rcirr {S(. ?O14. Blsitus
<br />ad At'fcsion Codc: Thc Co Etols Lkc.sR La* does not .pply ro !n osrcr ol pr6ldt, who build. o, impr.v.r rh.rcon.
<br />.nd who.onrmlslorsrttmtttswirhaCon'mto(s)liccns.dpuBusnrrorh.ConrractolsLic.n*liw)
<br />-l
<br />m excmpl un.lcr Selbn- B & P.C for lhis E&en.
<br />Drl. Om.r
<br />w()RI( FRS', C()[rPEt{S TION
<br />DECIiIBAIION
<br />I hcrcby al6l undcr Fnrlryofr.rjury.trc ofrhc h,Uowi.A d(l 0rions:
<br />-lhavcu
<br />will frrn nin a Gn i6!{rc or Con\cnr ro S.lf-lnstrc for wortcli comFn$rn,n, a\ roridcd li)r t y sdri.n :1700 of rh.
<br />L*'or Codc,lor rlr p.ntimn c ofrhc wort for which thc prirnir is hsu.d.
<br />-l
<br />hlvc rtrd $illnRinr n sorkcF codpcnslln'n insurancr. $ rcquircd b,Scclb.:l7mofrh. tf,hor Codc. ror
<br />'h.
<br />p.nbrBrEc of
<br />rhc work ror which thh pcrnir is k$cd. My *o.kcs compcnsatiotr inslrare cnid ml polky numb.r dc:
<br />-l
<br />€cnify thor in rhc pcrformncc of rlE wort for whici rhis permir h hsucd, t slallnoi cnlPloy dy F*on i( any nmnd
<br />b N to b.ftm subix! Io lhc wmkeu omp.ns0tion lars ol Calironrh. nnd tr8N thol if I should beom subi{l lo tlE
<br />roicN'conp.nelionpovnionsofScclion37{DoflnchhorCodc.lshall.bnhwithconPlywilhlh,sp,orirhn..
<br />WARNINC: Failurc to suE &rleF .-np.ns{ion corEsc i\ !nl0{lul, drd shau subjc.r ,n.nplo)$ ro ain nrl Fn0lti6 and
<br />olco.rrcn\dnrn. dimecs .s prolidcd for lhc
<br />1
<br />9 (cunnEncins wirh SrclionT(xn).rDivnion l
<br />of rhc OusiN$ ad Pofcssiois Codc, ail ory li..sc h i. tull f e {!l cflacr
<br />199 (s7
<br />(
<br />I hcrchy itltnrundcr pcnrlryollcrjtrry I
<br />r!\u.d rsLr 1097. ( iv c.r.
<br />tocri,n lcndiig qcn., tor lhc FrfolmRc of lhc wrt l'or *hth rhis Fflnir ir
<br />-l
<br />arrily rhir rhc tueBl rcgul.rions Ee..ding artErros Gmvd e mr rfl'licrbk b lni. prcix1
<br />ead rhis amlicarion Md star. rhd rhc.borc informrion h cotrccr. t aExe ro ohpl, wirh nllCi', and Cou.ly
<br />fl':i,ii::,w*%-"'tr atul h.r.by lurh.riz rcprcscnrorivcs of rhis Cn, ! d Couoryro c
<br />Pemxeq(*rl .?,^:
<br />t"r.f,t0 7;;-
<br />APPROVALS DATE
<br />a\
<br />I hsby dlirn und.r ,cmht of Friury
<br />I fldcr's Andr.r{
<br />-
<br />ATTI.IqANTDECI,Af,AIION
<br />I no!6y dlnn nndcr p.n.lly oa pcriury om of lh. lollowirg &{l[orions:
<br />lxmlhaon Pomir!-Ast os Norificarion Fcdchl R.Suhlk ns Gnh 40, Pan6)
<br />R..luir.d t rl.r ol NolifEolim
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