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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OIVNI'R BTIILDER DTJLCAR{I'IoN
<br />I h(ehl_ rl,irn trnd.r l.mh, oI l1erjrry rhar I m .iedlr lmm rh. (i,nirado6' Licens I {{ f(tr rhc lbllosiir rca$n (Scc 70ll 5
<br />Dusnr$ aftl Pmfcssion code): Any Cny or Counry *hch rcquircs r F-nnr ro co.srrucr, .ks, inrrrole, dcnrlish or r9rtr my
<br />srucru.., pno. ro irs is(rarce. aln, Bp'Es r lr ipnlrcanr lirr nrchpemnr lo fi|.a ng en {arcN rhd lF.rdr
<br />'s
<br />lrccnscd noq0nr
<br />ro rh. pnvision, oirhc Conkrclori l-ic€nsed L.w lchirr.r e. ConD.rcin3 uith S.clnn 70(10 ofDivNion I .rrh. Brsn$s and
<br />,'nt csi.ns Codc) o! rhal tE..she iser.mrr rh.,ear.mnnd rhe h.it forrhe lesdriemtrion Anyliolationols.crionT0ll5l'yiny
<br />dnrl'c. nrrpcrn sul,J4h rh. drplmnr b , cr,l nerhy o f nor morc rhan ,iv. hundftd doll.rs (5500).
<br />fut-.rh.k ,,r,r, .Iihc nn,nenr. n ,ny c,nf rn).6 q1, h qiges c rtur src conpcrsr i,,n. srrr & rl. y.or( aur rne ntucrm N nn
<br />'nrq d orofliEd fin elc(s€ 704.{. Btrsne\\.nd PoGssn)ne(-dc Ihecorti.xtr l ! rccn{ I-a*docs nor l'ntly ro .n otrftr ol
<br />rhcnmFny wl[ hu'ldso mp6\rs rhaNn,.nd wrs di\iu.h w .hnns.lforh.RlforrhmtrEhhB.rheros'ncnrLy..s,
<br />nruvrdcd rhrr such nnrev.DEnrs ue mr i fllcd o. ofiial lor sk l[ h'qc\ ci rlr huildin-e .r nnpro\lmnr h $kl urhin orc xar
<br />oicoorlcrio( IIE()$ne lruilll$ wrllltrlc rhe hordcn olnnr$n-* itqi n. or she dd o huld or imnhvc rlr pmneny h. rhc nuqnc.l
<br />_1. 8 owr otrh. lDtdiy, M.xclurivelycodr.cling with [ccnred co.lEclonro mnnrucl ltE pmid (S(. ?M4. BBiffi
<br />a l PmEsion Cod. Tfi. ConlEcroas l-iccnrc Lov do.s mi .nDly ro an own.r ohmncrly *ho blilds or idl,bv.s rh.r6i.
<br />.nd $h.6.'r6drtnrflchp,Dlf.wnhaco,udo(.)lk.Bcdpnr@mbih.Co,'lr.durLic.Mhw).
<br />und.r Sdrion_. B &P lax,*kirl
<br />!9Bhl:tr!:g!!l!!:Nsl!a!
<br />DfCLARAIIoN
<br />I h.rcby rmrm undr p.MIIy oft dlury oR onh. following .h.l,mhrN
<br />I h,v. dn will mintain ! C.nitcsr. of CoMt ro S.lf-Im,. for work6 @mp.noion, I Fovid.d for by Sdn n 37fi) of rh.
<br />t bor Codq lbr rh. I'nfomm. of rh. s* lor wtth rh. Fnnn b i$u.n
<br />_l ha!. rnd eill daintrin qorkc con{Etrrariotr iNBtuq .s Equt.d by Scrion l?00 ol$. Labo. Codc, fo. rhc 0rfo,tlr,8 ol
<br />rl& w* f6r ehich thie ,,.dn i! btu.d. My wo,l6 comD..stion iNuaM 6ir. di polky nunbo &.:
<br />'.fu^nr,n -rn" r*^rrorcc nr,h. wor( to, qh'chrhhF.mn k i*!<t.I sh.llmr cfrploy any p.Mn in .ny m'nmr
<br />s Nr.he,m. ruhld t,rh. qork.F .,mr.nirrtrn Lws.lc,hrornB. and 0rrtu rhd ral rlsuld b(om suhjNl lollE
<br />{o.I.m' s6r,.ner $n povriof oi s{ri.n J700 olrtu L,tbr cod., I s1Ell. fodnwirh cotrDly wirh rlBs ,nrvhions.
<br />WARN,NC: farlurc to surc ertcc' coop.netion svcms. is unlov tul. and shlll obj.rr M dtlorq t. 6niml Fulti{ .td
<br />civil llncs !t ro.rc hundEd rholsand doll.G ($100,000), in 0ddirion t. rh. @ .f coot4dqlio.. dnfrB.r a. lrovd.d for lh.
<br />t tnr (-od., inl.r.si and afion*y s aes.
<br />(I %,_26-
<br />uslllr:lroNlxacll)x![crdr.arrc]
<br />I trcbyrfn'n un{lcr !.nDlrJolpcturt rllr I n li.c.ai unJer pro\ie.n oi( hJnl$ q (co nm cLd! \ (h SL{ri(m 7(rl)l)l.lDi!6i(rr:1
<br />ol lh.llLrsnesnrl lt,iltsnonr(inl.. xn(lnryli.cns. rs n tull l cc x'rleil.cr
<br />calsrBucllaNrllulc_acr:Ncl
<br />I hrr.hy amrnr !nde. n hrlrtolnnjrryrh ihde isr.1'nnrudon lead'ns i8.Ny l'or nr Nrfomlrr. . f rhe work lor{hichrhs p.mr h
<br />Frucdlscc :1097, Crv C )
<br />AIILTCANfDIICI,ABAI&!
<br />I tf,ftt'y.llmundd Denalry oltdiuryon. of rhc lhlkNins decliralrn.
<br />l).n[LlFn l'crn]ils Ash.(or Nolificarion lcdcmlRcrulali,,ns ('lnk 40. Pan6)
<br />_Reqtrncd I ctrerolNotlidru.
<br />I..d'ft'har rh. adl$d r.guhr'onc mFrn'n8 dih.r.rrcnn,lrl rc tur arnli.ahl. r. rlnr ftulrrr/rx-
<br />,/=li.niryrhrIhnlcrcrdrhrudicrrn,nrnl{ircrhrtulhrein,nmmiotrhcod(lI08retocomplytrilhrllC,3nd(ttrnry
<br />onlinrnc6.nd St.te l-a$ rcLnll3 ro hurldin8 co,rsrrulrnl\ dxl h.rhy iur hoirrc repEs.darives ofrhF CiryMd.ounryio enrq ulxlnth.
<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 Pi ping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P{raplDrain 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 Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbinq
<br />Final Gas Test
<br />Meter Release
<br />FINAL t2 {tB .{/ttfrtt
<br />Notqs, Remarks, Etc.
<br />I
<br />!hor. tffiriomd pmp.dy for inip..tion purFr!
<br />i*,-." - ^"."*,*".'- % b -,r,^r,* * ,"n*r, rFlrnr)4 O otsLa 4*,u lslta
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