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PLUMBING.INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS 0!INIR llUll-DllR DEL( ARA f ION
<br />A!\i',c* rtl ltolcssim Co c) tt Ci(t or Counrt $hi.h roquncs qti,nil k, c. {fcr rlrrr. nnti.r.. d.nxni\h '{ n']ltr .trv
<br />rpnlicrfr lnr r n.nnirsuhtrc( rhc rpplicrnrt) tr cn ilDctrrlryol'xn nnncrhrn lNr huiJr.rldollrr\ (55rX)r.
<br />-1,
<br />as owmr of ric prci,cny, or Dy cmplorrcs sith M8.s $ rhcn 5! onp.nsrrion. *iI do rh. *ot &t rh slnnm is mr
<br />inrcRlcd or oficrcd ror slc {Se.7Bl4. Businc$ Md Ptuac$iors Codcr Th. Cont d.ls Lie.$ tjw docs nol llpl, lo sn orrcr of
<br />lhc rm!.ny who hikls or nr{'rc6llEDn, od who dNF sh w* iirue lf or heNlror rituush hk or hcr ow. employ..3.
<br />t tuvidcd lh{ skh inprosBnB s mr inl.nd.d or oft Rd ror s!. lt n pcwi rhc ttiuing tr itriiotrir h sld wirhin m Far
<br />ofcorphlbn, rlE Owmr BuiLlo will hlr llE hod.n orrmvi.g
<br />'rE
<br />lE or sh. dil ml toild or t {,mt th. !mFr, tor lh. Plrpor of
<br />l,.sowmr orrhc ptuFny, amcxclusiwlycotrkrcrLrS *nh li.cnsd.onr,cros'o oNtud rnc rmrtr (Ss.7(114. Btrsid$
<br />and Pnf6si,n Codc: Thc Conhcrols Liccnsc Lnw docs nor omlr ro an o*ncr of,rolcny eho b!il& or ifthvcs lheron.
<br />lod sno .onrtuk aor sxch poFrs shh u Conkd.xi(9 li.cnad luHunr ro rhc Co.r0ciols Liccns. tiw).
<br />I trnrcrdmtr uodcr S&rio
<br />UOStrEIIU.I]ANITNIAI]ON
<br />DEI;LAIAIION
<br />I lrmb.'lrtr r d d nri irynl tf,rlx'y.nc,{'h. lnlhi$ ! d('*rrtr,rs
<br />Jllhr\c a, *' ll 'tu'nriin a cen,fiurc rc n\cnrh,\clrln\lrc(trwurkc^ co,npcnrarion. rs rmvidcd lor hy SEl bn 3'Tul of rhe
<br />L,atxr Codc, n,rhc pc.fomuiccorrhd w6& n,*hi.hrhc pcrnir i\ t\ncd
<br />I hntr rnd will minr0in N.rIe.L .omp.nqrion insunn.c. as rclnncd hy Ssrn,n l7(n of lh. I ibor Gdc. nn ltu pdfor.Ene oa
<br />rhc *ork ntr trh'ch rhtr rnn( r\ s$cd My tr.rlcrr cntrll{n{rnn rn\urotrcc !nn'c, nnd Flic} ndmhe, m
<br />-/lc*", COUP/,|/5- /a1>J[,/tso z9 or 5--?-zozo
<br />_l.cr,ify rh4' in rhc ltrfor@m of'hc woil lo, rhich rhi. lcrnn h isscd. I shellmr.mploy rny lcmn in !r, roflrcr
<br />s trslo b.$m suhjlcl ro lhc wr*dl smFnsslion la*iofcolifotni!. md rgE ltal ifl shorld tt@ft subicr 16llr /
<br />Norlcd conf.nsolhn pmvkions of Selion 3?00 of lh. titbr Cod.. I sh8ll. lonh*ilh s ply qnh lln* Imvhio.s .
<br />WARNING: Failun lo $curc wo.k rs' comp.nsaln,n cowhe. ir un
<br />civil 6ncs u,' lo onc hu rcd thoumnd dolltrs (Sloo.lDo)
<br />Ssliofl 3076 oflh. t tor Codc. inlcrcsl lnd lllormy\ tes.
<br />IJICI.OSAfION
<br />I hcEh, rfltD, u dcr pculry of p.rj[, rhd I d liccn$d ridcr pmvi\tr .l ChrrrLy 9 {.onnrkNirB wirh Ser hn ]U)0, ol Divtn,n I
<br />of rhc Bn\in ss lnd Prolc$ii,ns Codc- dd tr'r liccnse i\ intulltuNodcrtc.r
<br />7/5 7
<br />'7^ )a> z-O cotrr*.1o. y'\
<br />!:ONSII!J!:E}EI!NDII!G.EGE!!:T
<br />I hcrcby orfirn uMcr Fnrlry of pcrju.y rnar rhsc is a consrruclion hndin-! oscmy for rhc rrfomufte ol rhc sork ao. ehkh fiii Frmn is
<br />issu.d (Scc. .)097. civ. C.)
<br />AIIIIIANLD&CLAAAIrcN
<br />I )Erhy llfnn uidcr pcnnhy offijrjury oft of rhc nrIosoS dc.lmrion\l
<br />DcnxninrnPqfri( Ashc{olNorifi.rtbn Fcdchl RcglhrionsrTirle40.Pin6)
<br />R.quncd l.rr.r of N.rifi .ari)n
<br />-l.crriiyrhar
<br />rhc lcdcnl dslllrion\ resudins &\hc!r.s,cmrvll urc nor 0npltahl. h rhis poj(r
<br />T,ccnilyth.t I h!\r rcad rhi atllk.lion ond inrbtmin'n isconcct. llgreroflnnnlr*irhlllCiry,ndCou.r,
<br />odin0rccs and Slurc L.ws mhriry ro buildin8 r.lr'c{ntrlivcs ol rhirCirr rnd Counryb cnrd xF,n rtr
<br />rhov. mnriomd pDFny for i,sFclion
<br />Appuont or lgcnt slemrorr-{
<br />UNDER GROUND
<br />Waste & Vent /?1/s-n>, nlfZj 9r/
<br />Water-Under lloor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area,/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />Main Drain/Pool Piping
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing
<br />Final Gas Test
<br />Meter Release
<br />/,,t-oo ?r* ro,
<br />Notes, Remarks, Etc
<br />APPROVALS
<br />FINAL
<br />o^",tLl:aQZo
<br />L.nrlcr\ Addrc$:
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