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PLUMBING-INSPECTOR BECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Water-Under Iloor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent / ^r "E)Water Piping l|)l//It6 |"0*l-
<br />Gas Piping
<br />Roof Drain 6;)
<br />ahzl,s'n t\4.2r
<br />fila*lv
<br />Rough Water Heater I
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Linei 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 />-f>rvrtary',Rough Plumbinq tolzrltQT ?h)
<br />Final Gas Test IJ
<br />I
<br />Meter Release
<br />UlWF4t/,FINAL tlTt 2a )
<br />Notes, Remarks, Etc.
<br />,JI
<br />-t
<br />OWNEN BUIDER DEL( XATION
<br />I tercby rllnm undcr pcnnlry ol Frjury iha' I m cicn!, fnnr rhc Contr.nn Li..ne tiw rn rhc folk,winB rc0Dn (S.c.70.11.5
<br />Br{incss n,xl Pn'fe$t,n Cdr.): Aiy Cly .r Counry whkh rcqunc$ Frmi' t, consrrucl. lltcr, iryoE, dcm,lnh or al)!i an,
<br />rucrurc. nrid b ns h\u,n... rk. rcqu'EsrM ppli.{ nn such lf,nnn b ib . sisncd sralcBnr lhlltuor\hc ii li..n*d puN{r
<br />ro rhc lrovision\ ol rhc ConrEdofs l-iccnscd ltrw (Chrprcr 9- CodhEicing wirh s..rbn 7UD or Divki.n I ol rhc Bu\inc$ and
<br />Pr,fcs\ionsC.dr)orrh hcorshc iscx.npr rhcr.ri.nrulrhc bl\is f(rrhcalhg.d.rcnplion AtryvtuUn,norScclionT0:ll5hyrn,
<br />lPpli.rm aoru Frnil rubFclsthc ap,,lic{trrto0civilpcn(lryolnornorcrhanfivcnundrcddollaF($500r.
<br />-JJ.*.,"n.or,r."p^,1.uy.o.rnvcDrl..ycc\tr h uip.s.r hctr \olc conl|tr.J '.r. $illon h.tr lJrlrrtn*rM'Ftur
<br />inrcnden orolttsl tor {k (SN 7(}r4. Businc$ Mtl Protcsi.nr Codc ThcConkr&tr s Liccn* L1w docs trot lprlyx'uowmroi
<br />rhc pblrnt who buikl( or inproEs rr4 t *lN de( sEh wo* hnhclf or h.Nll or ihrnugh ht or ho own .rrloy.cs-
<br />provid.J rhrr cu(h impmw'tunk @ nor i' .'ylNl ., olIR{ f(n ah ll lk,!.\ e, rtr htritliq or nr{rorcmnt r sll silhin on }t
<br />ot snplcrion. th. o$ mr aui6s wili harc thc ttrdcn of pmvirg fid h. or sh. dil ml huild o. irnpot rll. ,n,Fny fot ir puqne ol
<br />r \rho.ffrr.l:lir\u.htnotc(r\$irhr(',r[ri.(trr\) i..r\riptr^nxtrir,rh. (n lrrrktr \l-ir.n.lr$,
<br />.LI * *.^pr -a* s*
<br />I}ECI.AAAIP!
<br />I h.rehy aflnn utrdcr Frully of Frtury otu of llE fol!,rinE d(ldalio.s:
<br />Ihrvcdtwillmnna r Ccniarcrrc of(tnscnt 1o Sclalnsrc lor *orkcs ohpcn$rnr. ds ttuvid.d fo. byScction l,00olthc
<br />Ltrhor Cdc, ror rhc p*ro@ftc ol dc wo.t for vhich rhc lrmit is Lssu.d.
<br />_l hnvc 6nd willnuintrin *o cis comrcnid ion insu,urcc, !s .cquircn by sd io. l'7(x) of rhc Lnbor Codc. for thc ltrlonutc of
<br />rhc wo.k lor which thi I,cmir n irs.n My workds Gx.pcnerioi insuancc.dicr srd polhy numh.r uc
<br />$r ".nlty rru ln rl,. p*t,nrtrtr.cof rhc Nork tu *hic[ rh$ trrmir N isqrd.I \hrrrno! cn]pro, rnt l.ry,n n,iy n' ncr
<br />so m to h..onc subl.d iorhc workcn cotrDcnsrrion ln${o, Calilomiu. und4rccrh itl shduld h...N sut'jc.' t'lhc
<br />wo*cr(comrtrsrrion[ovisionsotSccrnr.]71[)olrhcl,rtxtrCodc.l\hrll.ftn1h*nhconuywirhl]a)*Pn,visnnrs.
<br />WARNINGT Frilxt to $curc rorkcr' ompcnsdion c.vcnSc is lnloutuL Md stoll rnbrsl d cmpk)lq x, rininll !,cnllk3 and
<br />civil nn s up (o om hundrcd rhouend dollon ($loo.lxxl,, in addirio.lo rhc co( of c6mpc.sa(ion, danEgcs as polidcd for thc
<br />s.crn,n.1076or'h. trhor Codc. i crcn atrd anonf,rt lccs
<br />",,, - ?-.-l$ tE
<br />DITCLA&UIa!
<br />I hcrciry nilin uftlcr pcnalryofrcrjury rhnrI m liccn\t{ und.rrn,vi\i olchrprsg(conrmcncingsirhst.ri{nr7{xx))olDivriotr:l
<br />ol rlr BusincssnDJ l'trr'.ssions Codc. unl rr li.fsc i\ h riillnx&rtrdcrlt.r
<br />CANiIB!GII(}NID!'UNi.EGI!!I
<br />I hctoby alfirmxtulcr prnnlry oft).rjury rhd th.ro n 0.onsrfl.rion lc.dins.sctrcy tn rhc p.rlffnEtu. urrh. work for which this lemil ir
<br />issucd rscc. :l0r?. Civ C.r.
<br />AIILICAILDDCITIEAIIII!
<br />I horhy lnim und.r pcnolry oa psjlry o.c ofrhc lollooing d.c!4ari.ns:
<br />Dcmhion Pcrmils'AstEslos Nolificarn,n Fcdml Reslllrhns Onb40. Pd6)
<br />-Rcquncd
<br />t.ns of Noifrdi.n
<br />I c.nia, lh0r thc fcdcml resularions rcBldin8 nsbcsros rcmval sc nor d,rpliclhl. to rhis pmir.
<br />JSI ccnify rh, I ttrvc rcld rhtr innlk0rNn md {.rc rhr rh. rboE infomrion k coftc1 I aCx* lo onrply wirh dll Ciry rnd Counry
<br />iiditurc.\ ,nd srsrc Lxw< ml,t
<br />'ng
<br />ro bu rldrn8 conrrrucrnn, { h.r.byaurh.rn rcprcrnl0tiv.i oflhis Cny ed C.unlylo urs lpontl*
<br />-t
<br />t4ffi
<br />Waste & Vent
<br />Area/Storm Drain
<br />Tub/Shower Test
<br />POOL/SPA
<br />C"l"yZ* .7-t7t{
<br />ll,liclNun,h.r lrpirc\:
<br />lf,trdca{ Ninr _
<br />aho\c mnriond nmncnylhr in\Il(rrion !qIIn{\ a
<br />App,ion,orAEm,skno,u*:y .9,*l At [l.J*x ** '7
<br />pemi,E Eme iprin,, ( vs,'" I <al a {2"*a*^-
<br />II
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