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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS
<br />UNDER GROUND ,<\
<br />Waste & Vent 5-31"]s k.
<br />Water-Under floor \7
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />I nterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent )a r -la
<br />Water Piping l1/
<br />Gas Pipinq t1-vz
<br />Rool Drain
<br />Tub/Shower Test
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary SeweriCap
<br />Back FIow Device
<br />Rough Plumbinq
<br />Final Gas Test
<br />Meter Helease
<br />FINAL ['-9 . /tr I I
<br />Notes, Remarks, Etc
<br />OWNER BT]tLDEX DELCARATloN
<br />I hcrehy 0tfirn lnncr ncnllrt of pciur! rhll I a'n.xrmrr no rht c(, rurM! Li(cnsc L:* anlhc lblbwtrStn$nlscc70315
<br />Bx\inc\s ilnd PoL\qn,n Cdlc) An, Cily.r Counry which r.quncs n tsnri ni con{dd, dr6. infrovc. dcmlilh nr rcnon iny
<br />nrudurc. pritr ro ns isu.tra,.l\o rcqutcs lhc rrplicanr n)r wh pcnnir t,6lc r siBNd (nrcnf,nr lhat hcor shc is liccnrd Puruair
<br />h rh. tnvni('ns .r thc C.nta.rofs l-iccn$d L'w (Chiprcr 9. (om.rcnciDs sirh s.crion 7o{n or oivisrr I of lhc Eusincs rnd
<br />Pmrcs\bn\ C.dc)orrhri hcor shc tcxcmplrhc,ctomlnd rhc tusis Lr lhclllcscdcrcnprn,n ,^ryvn riionofSccrionTi)ll5 hyrny
<br />ap,llicrtrltdapcnnns,lcckrncrrplicanrro!civilpenlliyotnormrcrhanfirchutrdr.ddollus(5500)
<br />-1,
<br />r\ osnoolrhc lh,J.dy. (r
<br />'ny
<br />rnlPlo)r$ wirh e.ecs !\ rl{n s[.on[.ns ior. *ill d. rh. so'k d rh. sMuru is mn
<br />inichdcd ur ofl'crcd lor slc l S(.?01,l. Ausincs nnd Pmfc$n r Codc: 'l hc Cofta.d s l-i.cnsc Lrr docs nor nptl] lo ni osnc, or
<br />rhc pn,pcny who huil& or inDn*ts rhljd , aftl N h, drN such $r)& hnnsc lf ot hcrcll or ltougi his or tcr o$n cnfl.yc.s.
<br />Drovnhd rh xuch inl0n\rmnh rE mr i.rcndM or olIcrci] tir, eh lf- ho{ ckr. rhc hikiin8 or nnFnr cnnr is <,ld wi,hi otrc ,ur
<br />or.oopktii,n. rh. o*tur auikln qlll h,vc tE brdcfl of!(,vinB rlu nc o, thc did ftn hikl or itrPr.vc rhc pmrd,lorrtr pu{Ds or
<br />-1,
<br />ss .wmr of rlE FUp(ny, am cxclusirly conterine wirh li.en*d .onn*'o6 ro oneo.l rh. tmjd (Scc. ?O14. B6itu$
<br />{nd ADL*I, C.d.r Thc ConrBlol s Lic.nsc trv dss ml .mly ro u owncr of Fopcny sh6 build. tr i,rpows lh€Er,
<br />and *no conrrck for Mhtmjets wnh aContr&bns) lkmsd puF@l lolhcConhclo* Liccnsc bw).
<br />I mcKmol undcr Scdion ,B.&P.C LrlhaE&sn
<br />I2T!LA.B[I]ON
<br />I h.rcby affirn utrdcr !.oally of,trury onc of rhc folbea.g deborions
<br />Ihr\catrd{r!lnx,ir rmnCcni,j. coiCotr$ roscllln\urclir*o rs' c.n|Jrn\rrnnr, $ I'ktnkJI'orhySccinrn.lT(x).lrh.
<br />l-!tnn C,xl.. nn rhr Fnnnru.c ol rhc sork lor whrh rhc Jtflnir h i\{rca
<br />I hovc .nd will mrinhin worl.ts codpcnsation inss!rcc. &i r.qlird b, Sdion 3?00 of lhc Lahor Cod.. lor thc ,ofre of
<br />lh. wrk for whth rhis Fmit ir b$d My sortcB onF.srion insurm fficr en lDlicy Nnlf,r e:
<br />PolicyNunbd: Erpncs
<br />WARNINC: Foiturc ro slr turkcs or{xn9li6n .owngc i. lntawtuL uid shall subFcl rt cqrloyo ro onind lcmllts and
<br />civil fin.s u! ro om lDndftn rnoosnd dolls (3100.000). in lddirion ro the cosl of mmp.nslion. dregcs $ prcvidcd lor lhc
<br />S(lio. 1076ofrhc L.tior Cod€. intcEsl andolromr.s tccs
<br />o"'., C)l { -lD --)o
<br />(t n,",-*k
<br />ttDct ArL{TroN
<br />I h.Ehy atrn !nd.r pcnalry of Frjury ft{ I am ,ieosd undr n6vni6f, of Chlpts 9 (
<br />of thc BBires .d Pmfessions Cod., !d my lkcnE n in tuU forc an l cfld.
<br />CAIEITU(:II!}NIEIIING.EGENII
<br />I hcEhy llfirn ondc. Ilcnllty or p.ijury rh.r thcrc is a cons!ructi,n h.difls ugcncy t6r
<br />'h.
<br />p.rlblmm. oi rhc wrk for $nich rhh IEmn i!
<br />nsucd (s(. 3097. civ. c ).
<br />NETCAN:LDECIdBAII9!
<br />I bdrl,y afiim uaLr pcnrll y of pc.j(try onc ol rhc n,l!,wing dcclEar ionri
<br />Dcmlnion P.rFn$Asb.ros Norificlrion F.ncnl Rc$lations (Tirlc 40, Pd(,
<br />Rcqui.cd ktrcr of Ndiamtion
<br />-l
<br />.cnify rhlr th. fcd.ral Gsularion\ rcg,rdinE sh.eos omvdl rc nol !,'l,liclblc lo rhn torctr
<br />-l
<br />enifylhd I hrlc rcad rhis ,ntlicdiotr and starc lhal rhc atFvc inlom ion iscoftcr,I aE@ ro.omply wilh lll Ciry and Counr,
<br />ordi.aNs dd Srltc L,ws Ehlng ro buildine consrdction. a hcrcby oultorirc ep.cenrar ifts or rhh Cny and Counly lo cnle llnn lh.
<br />obovc aEnrion€n IroDcny ro.
<br />Applicon( or Agenl Sian.lle
<br />r/8L
<br />rJfnA)
<br />Pool Heater/Gas Line
<br />-,.01{ Io l( .*"
<br />l.cdifyrhal in rh. ,).rformorc ol lhc wort for whichlhk peirnn n iss!.d,I shau nor.ntloy an, l'cson in uny mader
<br />so $ r" l$o'E slbjcd ro rhc w.drds oq).n{rion Lvs or c0lilomio, and agB thal il I \nonld b..om subjd io llE
<br />work.6 drn\rnsarion nDvicionsofsdion l,moIlhe tiff Cod..I null fonhsnhcodtly *nhrh*lmvisions..
<br />Lie.sc Closs: Lkc.s. Numbc
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<br />t ndm (Natr:
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<br />-r1+1 14
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