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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OTVNIIR B(III,D!:R DEI,C.\RA'II('N
<br />h^inrs rn(l ltonsi,D Orl.) Any ( ir! or Counry *l,i(h rcquiics :l,cnnir tri on(tcr. rlr.r. i'nln,rc. dc mli\h '{ r.t'.rn int
<br />rpt'!irrnr 1,tr r Ii.nnirru6Jc.rlrhc rnpli.itrrn)rci!il|tnilrvol' nntrrrl f livc hrtul'.tl dolll^ (55(X)r
<br />I.i\r'trtrcrolrh.foFny.ornrvctrUoyccs*rh\rr\r\rhctqrc.dnrrn$ri.n.\illd.rlxtr,]nrtr' r&{mrurcisndr
<br />l. ,s o*n.r oa rlE !rcFny. am.x.turntly co.rEdh! wirh lkcn$d contmdon lo onnrucl llE pmi{ (Se. ?044. Buiims
<br />lnd hDfessih Codc: Thc Conhcroir Liccns. L!* docs not apply ro an owncr ol poFn, who blilJ. o. impotd rhcron,
<br />a.d wk! co mcts for such l,mick *iln . Conhc'ods) Ii.c.scd !!N0.t to rnc Contn roas Lian* L!*).
<br />-l
<br />am.rcftpl undcr S.ctiori , B. & P C. for thn m$n
<br />traaffi&::(aNflN$Ial
<br />I'ECT,A"8AIIUT
<br />I h.rc$y !flirr undcr pcnolty.lpcrjury orc oirhc lollo*irr dccl0rarions:
<br />I hnknnd trill nbi ri', rCcnillcrrcolco {hr t,Sclatrurnn$orkc* .o 1)cisdion
<br />Lrtntr a,,l(. 1( rh. Nrl,1n', (. nlrh( h,k li *h \ rh( fc'nnr tr'.\ h.'l
<br />7Z Ihx\.x 'l$'ll Ei'1rin rnl.'! !iin'rtrnlrrit,n in\u'a r. n. ,cqri' lh\S,ari$17lX).
<br />rl.. trf'rh{ shLhrhr pc,nnr'.ts.drn Myuu'Ir,\"r,t tr\iriin 'adrJr..ridtrl rltnl
<br />^ l' /, l
<br />,..,-,..,'Lt4 l, fv'r,,1 lL4
<br />L.$ pmvid.d fo. by Scclion lro0 of lhc
<br />flhc Llhor C.dc. for thc D<rfomkc of
<br />uuvtq4?---)ol lo 1)
<br />-l
<br />ccnilr rhrr in lnc ocrforroncc ofrhe *ork r'or qhich rhis p.rmir is trucd. I rhall nor cmplot {nylc*oo in rny mnn.rs b b.com rub,{ i. rhc work.u'.om!.nsarion lnws orcsliromi,. and agN lhal ill should heo E subjet io ltE
<br />wortda .omp.r,iion pn,vhbn! ol sdion -1700 .i rh. tjtrtr Crxlc, I shall. fonhwnh conr y {ilh rho* Fnvisn,ns
<br />,"..'>l
<br />-..r
<br />lurc ro EUE wortc^ m6pcn\art,n corcrlr. n rnh*fxl, and \h!ll subj..' in .'npl.tEr ro aimi.ol !.mllis.nd
<br />d@ hund'.d ihoftand dolla^ (slm.(xx)). in addirbn b thr c.( ofconp.ns.rion. d m8cs 0s !,rovdcn fn lhc
<br />hc Lathrtod.. inkE{ $d stronw rf-lza no,o$.-
<br />I hcrchy rlfinnund$ lcnrhrorf.ijury rhnr I .n lidnwl undf In,vndn ofChnprn I (conrmncir8 sirh Sccrion 7mO) .f l)ivisi{'n 3
<br />oi rhc Bu\ines ud P,olcsiorFCodc. o.d.rylic.nr n in tullfo,edanfttd
<br />t:5], v
<br />our"( 2 1)
<br />I hcEhy lrfinn uDdcr pcmhy,l!.rjury rh{t lh.rc h a loNrudnrtr hndi!'s lscncr l, ihc p.l{onMicc.l rht $nk r.r shich thi\ lxnun h
<br />hsucd(SN 1097. Civ.C.)
<br />AIILICANfIIECI.AIAII{I!
<br />I ha$, altm lndd ,ci6hy ol pcrjlry oft ot Ihe following dcldlioni
<br />Ds'mlition Pcrnih-Asb.sros Norifi.srion lidcBl Rcpuhrn'ns (Tirlc 40. Parl6)
<br />It(ltl,,L i.1r., !lN,i n, rr,
<br />'
<br />,L.r'r,l\ rh, lr'!dctul'Lrnl. r'..Frt:rd rri.h.i,\'rn[r,'l:rcr.{.'fl,r'hl.r,rl-\Inr.
<br />,Z't..rrjrtrtr,,'.rc,,urttrtrnnL'r r'rJ{ L,hr rhrrhrc i'rnnft nn, aronr.r I ig(._ ro.otrDlt riri rll CilJ {tu|(.unry
<br />ordi',3nc.\ r tlSrrrc li*\ rclrriig
<br />ub{'vc nrcnriotrcrl pftipcny lor in
<br />Applicsnl or A8enl Signnlure
<br />,_--r..,::. ,:)i/l_
<br />UNDER GHOUND
<br />Waste & Vent
<br />Water-Under lloor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Rool Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />[\4ain 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 />Rouqh Plumbinq 2-14-zo .,
<br />Final Gas Test )te---,.'
<br />Meter Release
<br />FINAL t-N-zo '
<br />Notes, Remarks, Etc.
<br />l ."J.a . {, r
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