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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNf, R BUILI'EI DEI,CAR 'I'ION
<br />Ih.rehyrmnnunddp.Mlryofr.rturyrhdI..x.hflfen,rhtConlrMlosl-icenseLnwi.rrlE,iJlbwiryEisn'(s.c?0ll5
<br />Businc$ and P(rlession Cod.) Any Cny or Counry qhich ..quiEs n r.m tu connruct, ilin, inDr.\r, dcnnnhh { rcnin iny
<br />srrucru.. p.ttrlo ns issafte, il$ requtrs rhc .pplicinr nr such p€mn lo lilc r srBmd srar.mcnr rh.r tEor shc n liEtr*d nuNad
<br />h rhc rmvi,ions olth. Contactois l-iccn*d l-.s (chiprer q, Coonncncrns vnh Scciion 7000 of Uvhion:l ofthc ltusin*s 0nd
<br />Pmf.arionrCod.)orlhll h€orsh. hci€mpl lh€relrom.nd rh.tlsis fo, lhe ollqcd cisfl ion AnyviololionofserionToll5ty0nt
<br />np,!lica tu a p.mir iubjcls rh. lrtliclnr lo acirilp.nolryofnor mrurhan firc hundr.d dolltrE(5500).
<br />_1, I owBr of thc trDFny, 6r my .ntploys wnn w.ed 6r rhcn $b omDaelioa will do tn work dn lhc fitd@ b e,
<br />intsid.d orotrcEd for slc(S@.704rt, BuriIB a.d Pbl*ions Cod.:'l'h. co.lr!.lol3 Lidn* ttw&16 mr afl,lylo owroa
<br />rh.rorEny who toil& or iqm6 th.@,r .td eho do6 tun hd. hi@lf oi hlelf o, lhrcu3h hir or hd own.mplorEn
<br />pmvid.d th.l sch iq,owm.l! N ml id.i&d orolGEd lor $h. l[ hoM,lh. tuildirE or iq'dtrElr b mE enhin orc rar
<br />of@mpl.laol}lh. Oaftr Blildd willh.E thc btfdd olomviie u hc or dr did ml hlld or irprlw $. plopdy for $c Flrhs of
<br />l. osownd.fth.I,mFny, am cxclusivcly conlmcrin8 wnh lic..kd conrmctoN to consldct rh. pmj..l (Sa. 7044. BuriE$
<br />lia Prolieioo Codc: 'l h. conra.rors Li*ni. lj{ doca mr ap,'ly lo snown.rofpol.nywt6 builds or impmve,lhcr.on,
<br />rnd who s a.lr f.. och pmldts {irh r conrmdo(s) lift.ed pu6u0d lo rh. ConlE.lor's Licdr ta*)
<br />_l .m .xemrl undr Sdio B & P c. ior this .a$n.
<br />.uaaf,raftottlEltA]Ia!
<br />DECI4XA]XA
<br />I h.Eby .mm mdd p.n lly .f pijury oE ofrh. followinr d*lanrioB:
<br />I h.vctudwrll min rin. Cenificar.ofconrnr ro self-lnsur. aor \wrksi..nrp.isornrn, ff nmvid.d fitrbyS6rtun 1700ofrh.
<br />Lah.. Co{.. lirr rh. pdormm. oirh. tro& nr *hrh rlr tn. ir N.u.d.
<br />_l hw. .nd will @inain mrk.B comp.n$tion ircmrcc, ar r.quircd by Ser ion 1700 of lh. L.hor Codc, for lh. l.rfomtuc of
<br />'\c\,rkr w[rhlllBrcr'nr,s $rn vvLvolos nlF,lc]n''nrn"a.
<br />,..., -SJ.^\a tr ., nI:z;dq 1 -\-
<br />_l ..dily fid in rn l.rfof m. 6ilh. worl aor which rhis pmir $ issx.d. I .ha!l mt .mploy a.y rc6on in ony mmner
<br />$ lo bdom sbjc.r to lh. wortd'onptr ion ln* of Crlitomio. and a8r thnt ifl slnuld h.com. $bi*r rorhc
<br />10r*6r'mmp.NlioflnmvLionsofS.dion3T00oath.L.hrCodelshall,tonhwithcomplywilhtho*pol,fthni
<br />!o *crr workn' mnPt.$rbn cokds. ir unhwtul. r.d .hall sublcr m .mtloy.r lo siminol !.mlti6.nd
<br />in add rnr h rhc co{ .fcomp.nsN'ion, d.mgcs ar pmvided fo. rhe
<br />Lc.,c\
<br />lll!1,:!.!l:lll0:l
<br />I h.Eby dmrmundfi p.ulry o t r.rjurr rhd I tui licchcd udd pmv6i6nof ch,,'rd9(co@in8 wiln Sdion 7000) otDivision l
<br />ol rtl BNi*se nd PDfc$ions Codc. arxl ny liccns is in tull firc dd.fftr
<br />5*l lBEl
<br />o". 1
<br />I cdiry rhd lh. i:d.6l E8ularionr r.8ard,nB a.bdt8 r.mml aE mr rpfli.abL h thh pmjd.
<br />-l
<br />ccrlity tld I tsv. rc.d this applicalion md rhar th.ohoE infomarion i. corer I .sa ro c.mply wirh lll
<br />ndimnccs an<l Stilc bws El.tin8 lo ioq ind hcrcby aurh..izc .e,'i.$nhrns ofrh,r ciryand
<br />ahove h.n'ioncd rmpcny fo!
<br /> ppli.{nl or Ag.f,l Signnlur.
<br />a 0
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn S prinkler ,"sr
<br />Sanitary SeweriCap\1.1-lq x,\1.i1t)
<br />Back Flow DeviP U
<br />Rough Plumbing
<br />Meter Release A
<br />FINAL r-31"1'l ).vf-10
<br />Notes , Remarks, Etc.
<br />taNualJcIIoN-LElDllCICllCr
<br />I h.Eby omm undcr p.Blty ofr.qlry th llrE iB ! connruclion LndinS ag.ncy lor rh! pofom.cc ofth. vorl fo. which lnis tEmit is
<br />ksld (Sft. 109?, Civ. C.).
<br />L.ndE's Nim. _
<br />a.rrlr.c NLDtclaSAro!
<br />I h.riy.limu derp.nrh,ofpcrjuryokofnpaollowin8ddlararmns:
<br />DdD,l n,n Pqntrrs A(hdor Nd'fi tr,n t'hl.'tr| n.lull Fns(I a. 40. Pod^,
<br />-Requircd
<br />Letter ol Nolifi carhn
<br />Final Gas Test
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