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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS {)wNFR BUr.Dr]R nfl ,C tr,\TI()N
<br />I lrrchy rfi und.r p.ialry or pcrjury lh,l I m cx.npr fmnr Ih- C.trir .ron l-i.cn\c li$ i rhc rdbwinS rcNr (Ss 70.rl 5
<br />Ilusir.{\ a*l P()fcrsi C,ic) Any Cily or Counly shich rcquircs r If,rnir b.onnfl.r, rk$, inuorc. dcnrni\h,tr fttt8iFJn}
<br />slnExrc. pri.rlo irs t\uooce- lko rcqtrirc\ rhc JPpli.rm f.r llchFnnir t,lllc, si8.cd srltcntnr lhrt hcor nt i! li.ctrql nu'\uJ -
<br />h rhc lr)vnnnN ol rhc Cotrrh.ktr s Liccnscd liw (Ch!plc! 9. Comtrrcncing qiih Sc.rion 7(XD oi Division:r of rht Rusk$ Jnd r
<br />l'mics\i(nr\ (id.) or lhlr hcor\hc is*.n9r rhrrdko and rhc hr\is lar rh. Ilcgcdcrcmnii.n AnyviohrionofSc.ri.nT0ll.5hyrny
<br />applicanrftrrpclmir\uhJ..rs(hc rmlicinr ro icivilllcnalryofmr nnrc rh a\. huid..d dollrs (3500)
<br />-1.
<br />r\ owr ollh. pr)p(nt. {n m, cnlpl,,tc.\ sirh sr!$ r\ rltn \'[.on]Nnqrinr. qillao lhL Bork rd rlt {flchto i\ trti
<br />rhcpn't(rry *hrhtril s .r inprn c\ Ilr(,n r *nod,{r{f,h*orkhi'n\.ltorhcr{|r..rhr{r8lrhis.rllcrowncnYn,yccs.
<br />ol.onrrldir ri.O!nrr Uuildcr Rillhrlrrtu burd. olpn,vi',! rhrrhdor \hc dd norhuild.rnl]'{ivu ric l[)p.ny li,. rh. ru.tM ot
<br />-1.
<br />$ o*n( of rk t'up.ny. am cxclusivcly conlrrcl i,B wilh liNnsd .ttrltrto6 ro onsmcl lh. E icl (Se ?O14. Busims
<br />lnd Eoi6sbn Codcr Tnc Conlrrctols Liccnse Lrw docs ml.prlylo {n owner ofpoFrly who builds o. imp,olcs $crcon,
<br />8nd wno Nnlnclr for such trcrc.lr enh . Co.hct (s) licN.d puN$l lo th. Conra.ror's Lk.ne l!w),
<br />-l
<br />d dcnfl uMc, Secri.l
<br />WORI(ERI' CONIPENSAT!ON
<br />DECI,AAAI]!]N
<br />I hcEby alfim !nd.r pcnllry or pcrjury onc ofth. following delaratiotrs
<br />I lulc i'{lsill nri,nrin rCcnna[c.l(-.ns.nr ro Sclfltr\ur.litr sork.rs co'nr.nsrion. r\ pnrv cd tur bySc.rt$]7(x).1rhc
<br />tih(r CoJc. tff rhc N'f.i,nri.c of rhc wolk ,ir whrh rhc Ennir is isud
<br />-l lErc lnd will minlaii wortc^ corD.nsaribn ins@m., s rcquiEd by SElion 3?00 of llt L{bor Codc, for rn Frformn( of
<br />7[i;,fr]']"
<br />hsd Myqorkc ..mt nun,. nsurancc caricr md Flicy numbcr N:
<br />{{.l^'laA
<br />\4,I l.\.?.
<br />-l
<br />ccnifylhor in rhc lcrforromc olrhc worl for whrhrhis Isrdir is irsucd. I stull not.nploy lny tEMi in any nun*t
<br />s N to ltom subirl ro thc solkfl .rmp.n$lion l0ws orcllifomi!. {nd lsrcc rh{r il I should bcconE subjd io rtE
<br />wo cii' d,npcnsar ioo povnions ol Scclion l7(x) of lh€ ljtor Cod!, I shlll. fonhwnh.omply wirh rhoe pmvtiotrs..
<br />WARNING: Failuc r. suc workcR smpcns.lion .ov.ro8c is unlovtul. Bnd shaU snbi{ ,n .nplo}s ro qimjnol Fn0lties and
<br />.ivil fincs !p ro.rc h!fttEd rhousrnd dolls ($100.{)()0). in addnion lo lhe @sr of@nt .sriotr damgcs as Pr"vidcd ta lhc
<br />sr-^rion 1076 0l ihc lJhtr ctulc. inr.rc( and1.t-t
<br />ol rhc llr\irc\\ atrd I'r lisso,r aodr. rnd nrt lic.n{' ^ id rull n)r.c a d.l1..rI ooqq)4I ic.nBe L
<br />l.r.t"
<br />-
<br />conl.r.lo.:
<br />CIINSIRIJCTION I FNDING AGENC-Y
<br />I hcrcby atnrm ondc! p.nolty of lcrjury rhrl tac i$ mmrruciion lcnding agcmy for fic p€ orm*c olth. wotk for vhhn $is Fmn is
<br />issu.d(se 3097. civ. c )
<br />AITIICANLDE.CI.IIa^-TIAN
<br />Ihl'rtyillir rndcr |tnrlry orpcijurr.m oirh. rolhBnre dc.lardio.r
<br />l)cnmlirion ltrn,iN shdos Noriti.,rion f'Lalcnl RcEUhbns r'I'nlc40. P!nO)
<br />-R.quncd
<br />la(q ol Noni,crii,nr
<br />-l
<br />ccni, thst rhc fcdsal E8lhraoni Eg&diog &ilr os rcmv.l !r. @l {'0ltablc to l}ln pDiir
<br />fAcdir, !hir I htrk rcrJ rh^Jr,nlic
<br />+'iinrncc\ lnd SralcLrws Ehrinsro hxi
<br />I trC@ k, $r ywirh!ICnya.dColnry
<br />or(his ciry and Counryto cntcr u8rn thc
<br />ahow mmion d pop.ny lor
<br />lppli..nt o. ,\!€nl Signni
<br />UNDER GROUND
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Ir/ain Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool HeateriGas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq ?/F?-/c SN*fr
<br />Final Gas Test
<br />Meter Release
<br />FINAL l/b/lv Aqx
<br />Notes, Remarks, Etc.
<br />Waste & Vent
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