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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDEII DEt,CAI'A'IION
<br />I h.r.hy il6rn undd lf,nalry {,r Frlury rhal I an crenu Imm thc Cont*xn! Liccns trw ror rh. rolbwinS rcrtn (Scc 7031 5
<br />BLsilcss Irl Piolc\ion C{xlc) Ant Ciry or Coudy shich rcquirc\ ! pc.mn h ..n{tucr. ,hLJ. nnpii)v.. dcn{ni\h r rc,'Jn Jny
<br />,ru.rurc, l,ior ro irs i$uam., oho rcr]uncs rhc upplicanr ntr such ltrfrir t, ,llc r siencd {nlc cnl Ihrl hcor xhc is licci{d p!r\o,ir
<br />k, rh. povi\hr( ol r}h conrd.tu\ Licctr$d tiw (Ch.prcr 9, Commcn.i.E Niih sc.ri.n TlxD ol Divtion I oflhc tilrinc$ !.d
<br />Pofc$ n'ns Gdc) oi thar hcor \hc i\cxcnrprrhcEfn,mand rh.ba\is ntr rhc tlkgcdcxcmn'ion A., viollliooofsNri,.70ll5 byiny
<br />rrplirnnr rd tr pcnnir suhj*r\rlr .l)t,li..nr r. ncivillctrlxrolnor nmrcrhan lile huidrcddoll-\ (S5(xD.
<br />-1.
<br />$ owmr ofrh. protEnr. d my cnploFcs eirt w.ecs ar rlEi sk omFB.lion, *iI &, d. qdt ad dE srocN ir Dr
<br />i .dcd or of.rcn fd sb (Se.7044. BEiEs, &d Pr.fdrions Cod.: Th. cofl@rol! Li.cn* l-,e ltar ml q,!ly to d owmr of
<br />rh. p,DFny *no huil.k or inpo6 rlEtuo &d who dG Mh tr* hirslr o. tuEclfor lhDust his or hr o{n enrlor€.s.
<br />providcd thn s.n inpowmds @ ml inldr.Ld orofierd for sl.lf.lbqt€. tEtr[rin8dinprDErnl t $ld *ithin oft J@
<br />ofolrTktiorl rlE o^*ftr Boildd Mtt hlr dE Ur,.n otFEvi.! oEr lE or tE did ml hrB d itprot llr ImFry tu tlE pltrlos of
<br />-1.
<br />s ow*r of rhe FnFrly. .m cxclusiEly conlmlinS wilh liccnsd onl,elo6 lo @nnru.r d! FtFl (Se. 7044. Blsfts
<br />lnd &.,fsbn Cod.: Thc ContEctoi s Liccn* Llw dc hr rml, ro on owncr of prcp.rly vlD huilds or innows rhctmtr
<br />dnd who @mftcr! for ruch pmjels witi s Cof,hcto(s) licns.n ,,!^unr ro rhc Conraroas lians llw).
<br />-l
<br />an crcmfl lndd 56r B. & P.C. lor thn Easoo.
<br />woRr(r'{s coilPliNsaT(rN
<br />DECLABAIIO]!
<br />I hcreby a,fi ro!rd$ pcnalrydf p.ruryon.of lhc lollowin8 dccludio s
<br />I hrlc nnd*ill nrn ninrCcni,ic(rcofCo.\cnrt'Sclfln\urclor*ork{r.onBn(dirtr,n\ Pmvnhd for6ySccrion-l7ll)otrhc
<br />tj&rC(d., frrlr p.rlumutucolrhc sork !'{,rwhi.hth. ncmil n h\!cd
<br />-l
<br />hav. !trd will minlain *ortcs conDc..arion inru,.Nc, {s rcquiEd by Sdion l?@ of thc Libor Codc. lot tnc p.rfmmc of
<br />rhc work lor whict rtis ,cdir is is$.n My *6rkcN @qxndion i.sur.re ceid ed p.lty .uoh.r ac:
<br />E-)..,r\ T.J) u.*.cc
<br />,L.l j o 7,t a a /, /,s
<br />-l.cdityrhar
<br />i6rhc p.rrornDftc of lhc work for*hictltis pdmi ar i*!.d.l.hall not cnplot any pcron in sn, Mtut
<br />$ as lo tErom subj.rr ro rhc *orlcd s'ollenerio. liws otcdliromia. and aBe lh ir I sk)lld hc.om subltr ro ltrcqort6 ompcnsrrion pmvnio.s oaSccrion:1700ofrhc Ldr* C6dc,I shall. fonhwith conDly *irhllx,$ pDricion...
<br />WARNTNG: Failurc ro surc wo*crs .lmpcns.rion corcn8c is unl4tul. ard shdl $bi$ nn cntlo)er lo niniml FNllis i"d
<br />civil finc* q! ro om huodrcd rhousond dollm (S|0O,0OO). in addition lo thc.o{ of.omFnsarion. d{m8cs !r p,ovidcd {or lhc
<br />//a
<br />(iilq in'crcd end allonEy\ fccs
<br />K",.,513r.
<br />DESAf,AIOX
<br />I hcrcby iflnm und.r pcnllryotpcrjlrylhal I rn li.!tr$r und* rornn,n ofCnrptcr 9 (omn.n.ins wirh sNrb.7000) ofDivnion 3
<br />oa rhc Rusincss Md Prorcssions Codc. rd my liccnE n in flll ll,ar rnl cfaftr
<br />,/o/(rOz/
<br />CaNEIIIICIIONIENDIN(jAGINCT
<br />I hcrchy llltm undq rtuliyoln rjury rhd rhnc k 0 onsrrucrion lcndi4 rBc.cy ir Uc pdronNftc olrhc Bork fu ththlhis Pcnnir i\
<br />isucd (ss l097.civ.c.).
<br />APPLICANl' DFCI J(RATI(TN
<br />I h6tay uriinn und.r ,E.al', ol !,.qury orc ol lhc f{rlo$i.E dBhorn,oi:
<br />D.n&lin,n P.mir\ Alhio\ Noriricalioo t{dcrll Rqulor tu.s fillc 40. Pun6)
<br />Rcqlircd trkr.f Noriicrlion
<br />-l
<br />cLnily rhd lhc f€dcrBl rcsullr i.n( ElddinB dsh.nd r Dvdl m nor 0ptlicablc to rhn pritr.
<br />-l
<br />cdrity rhn I n v. Md !hi. trpplt.ion a,n dstc ltar thc otorc inroinarion k .or.<r. I !8r lo oq y qnh !I Cny .nd Counry
<br />ordinrM$rd Sr.re Lls Elarin8 lo buildinS conntudior! sd lEEby dulhoriz. EPEsntlliwr of lhis Cily and Counry ro cnl.r uFn tlE
<br />r /, e!+\-\
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building 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 />Ptrap/Drain Line
<br />Main Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rouqh Plumbinq
<br />Final Gas Test
<br />Meter Release lt ll .,.:\
<br />FINAL Q/11 fi /18+t ,l)
<br />/-r "'Notes, Remarks, Etc.JI
<br />I
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<br />t(,
<br />t-t9 <""*^,41--__-
<br />trnd.iq Nrn.
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<br />Miscellaneous
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