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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNNR BUII,DF:R DEI,CARATION
<br />I hcrcby rtfirm und.r Fnnlry or ,rrlury rh,r I n cxcnipr ,n,n rh. c nkdoN Lien$ ljw fo he t llo*inE rcas. (lcc 70l l r
<br />lrusincss.ndProfc*ion(odc): nyCilyorCounrytrhicnrcquncs0p.nnirk,conitocr.slrcr.inrl6!..dcnDlishMtoJ',;xi;l-
<br />nructurc- Irinro irs issuncc. rl$ rcquirs rhcaDplkrnr t slchnermir o ilcn li8ncd slrcnrnl rhd hcor shc is li(un{tl nururnr
<br />n, rhc povnions of r,E Gn rici, r Liccnsn ljw (Chrprc! 9. ComnEnciis sirh Sccrn,n 7{D0 or Divi\tun I oi rhc Burims !.d
<br />Pn,r.ssi.nsG c) orrltur hc.r\hc ir.xc,nnr rhcrcrio trdrh.h ris r(r ihc al lcgcd .rc nlrr ion Anyviol0lionotScclion?0ll.5byo y
<br />rrpli.xnrrornr.rnrirsrbjNrllhc,pllicitrrtotrcivil,'cnrlryoltror'norcrhmfi\chundrcddollrs($5m).
<br />-1,0r.$nc,oillrc
<br />pron ny.ortrrycrDbyccs *ilh w ges!\ricir \olc .oniI)cn\iri{u. silldo Ilr *orkr t{mrurci\nol
<br />i'cndcdorollcrcdf{rslc(S.c7{}}l.Bu\inc\\Mdti,fc$n,n\Codcl'hcCir[fu.t/-sLid.nsclrwd!.\notdnllyrortro*Dcrol
<br />rhc ln{Eny $ho hoild! or ir]]1etr\ r}Ermn. xtwhld,${ichqrnthir\.lrorhrrdlorrhn,ushhi\orhcrowirnrtl.ycc\.
<br />pn)v idrd r h{r \uch i p(Mnrn( n. ior i'n.'rlc o' ullaul tur v'L ll h,ru cr rlic btrikliq or inp.onnrnr is vikl wirhin ,,nc )rxr
<br />ofcolnlrLrion- rtr ()wncr lluiklcr willhlr rhc huilcn ofpnxing rhnr hc or shc did dor biild or i'npmv. rhc floIrny litrllE puF)sol'
<br />_1. &r ovn$ of rhc nDp.ny, e.x.lusiwl, conrra.ring wnh liccn$d conrr{ron ro oDsrruct thc pmjct (Scc, 7014, Busirs
<br />!!i EDGssbn Codri Thc Conlrerols Liccn* ljw docs nor sl)ply ro !n own6 of rmpeny *ho builds or imFowr lhdcon,
<br />and who @nEucrs ld su.h pNirk *nh a C6nt6do(O ltcnsd ptrF@nl to ih. C.ntraclor's Liens b*).
<br />I m.rcn r und.r S..ri.n , B. & P.C. r.rlhisrclson
<br />Dnl.: O*rcr:
<br />]!!8f,885:COM[ESAI,ION
<br />PECI.AMIIQ!
<br />I h€rcby afrrh u.dcr p.mlty of Frj!ry onc of lhc follo*ing dcchralionsl
<br />-l
<br />fiarc od will eintlin . C.nifdrc of Con$fl lo Sclf lnsuE for *ork(c orrEnsbn. a prcvt.d for by Sdrion 1700 of llE
<br />L.bor tu.. for thc Fraornw of lhc *o* aor *hich lhc lsni is istucd,
<br />-l hrvc und will roinlain wo*c6 ontEn.arion iNuBEq &\ rcquiFri b, S.clnn 3?00 of lh. L5bor tu.. tor llE p6f!,il1!@ ol
<br />thc so* for which rhis pcmlt is htu d. My erlc6' @nFnslion insulaN @ir !d polky ,umbcr e:Coh .,
<br />i . t.tt,/ LJ co
<br />-l
<br />ccniry lhlr in rnc rerformrcc of lhc *ork {or whi.h lhh I*ln h is$cn.l shall @l cdlloyoy pcMn in nny mnrc.
<br />so N to tEc.m slbJccr ro rhc worler' conFn\drio. hws or Cdlironia. ,nd rEE rh.l if I should bccom subjcct to thc
<br />workcG'c!flrpcnsolionpmlhionsotS<rionlT00olrh.Lnr.rCodc.lthnll.ronhvirhconplywilillssrrcvisio.s..
<br />WARNINC: Foilurc to BU.c workcn conrpcnsolion colcnsc is unlawtul. and rh l s,bjc.r an .nrployci o rinrinul Fnahies lnd
<br />civil fitrc\ up ro orc nundrcd rhouu.d dollur (Sl(x).fix)), in rddnion i, rhc cost of.orlEnsllion. &magcs as Ilr)lidclj Lr lhe
<br />4.
<br />L$o, Cod.. iorcesr Dd.nocy r les.,c
<br />Ihdcbydfltr r unJ$ pcnJry .l Frjffy lh lrnlicctrEdu cr pnvision oi Chlpls I (conrnf,h-'in8 wirh Sftrk,n 7fix)) oI Divistun ]
<br />ot rhe Blsirc$ lnd Proltsioni C{ntc. nni hyli..n* ii in full n'toc aril cllacl
<br />9at Ir
<br />COISISIJ!:UONIf,II)IN(j.ICTNCI
<br />i\\!cd ls.r .l(D1. ('iv C I
<br />SIIUCANLTIC! BdllQ!
<br />Ihlrlty t'nundcr p.nrlry olpclJry onc otiltr Ioln'qirE dc.l!tur10tr\:
<br />Dcu)lirn,n I'crnrirs Aslf,no\ Noiilicuri.i lr.dcrtrlR.!ul"ri{n\ ( Iirlt rg).l'nr6)
<br />R.qtrncd Irn.'of N.rilidi(
<br />, Lcn yrh rhr lm.n'l rc8ulft.tr. rccord nB i.h.en.afrrJl. c nnr nnnli( l(torhnpmrdta--
<br />--r4ccnilyrhrlh.'v(rc0drhnJmlLdn,rntl{rrrhnrhcrk,vcinr{rnrdi,,nis.onc.rloErmroco,nnlywilh!llCiry!idCounry
<br />odinaE_cs dSrlrc ltr*\ EhrinE b huildiic lurhoria mpEsc ativcs of rhis Cny lnd County lo.r!c, uron th.
<br />lhovc mnriorcd pmtEny for inslelion
<br />AppliGnt o. AE€nl Siamlr a.6./Z
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />I nterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing 7/rttlc 9\\trt
<br />Final Gas Test
<br />Meter Release
<br />lo/H/x 9bcc
<br />Notes, Remarks, Etc
<br />Gas Service
<br />FINAL
<br />Pemil€. mme (prlnl):
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