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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS (^vNUR IrUll_DDR DELCAT{A fl ON
<br />I hcrcby rlftD utrilcr pcnalry (,r rcrlury rhJr I r dcrpr irenr rhc Co ldoF Liccns ltr* nn rhc lnln,wiil{rs,r 15670.11 5
<br />&rrir.ss itrd I''olts\im Ct c) ry C[y or Cou.ry which rrquirc\ ] p$n1ir b con$tucr. alrcr nnpn'rc. dcnxnnh or rcFlt uy
<br />lo rhc [ovistrnr or rhc co nr.rtr \ l-i.cn\.d liw ichrni.t 9. Conu*Nins sirh Sccri 7([]) ol Divni{!' I oirfu llusirc!\ nnl
<br />ttolt\\ions ('odc)orthd h.orshc Ncxcrpr rhc'clio rtr rhr hi\h nrrh.nlLlcd.kcruii,n Anyri{nJrionolSc.ri,)n70.ll5hrrny
<br />rPnli.d lnr xpcnnir s,hj$l\ lM rnllicrtrlb r.iviltcnrlryol i.r rorcrh hvc hundrcd doll.rr (S5U))
<br />-1.
<br />rs o*mr of lhc poFny. tr my cmplolEs wifi w.8c. {r thct sk @dlEnrariotr wiu ilo tlE w(t and lhc nnale ii mr
<br />inlq'(h or oltccd fd sb (56 7@14. BosiBr od P,lfelsionr Codc: Th. C.nrru.roas LicM l,w 6e not spply to ows of
<br />rlE DFrEny *1o lnildi or nq,m6 tlEmc {n who dG sh slt hiGelr or heMlf or thDtrdr nis or hd own .npkJre3.
<br />prolidcd rh{ such imptuEmd. G rct hr6r.d doltu for eh.lf. ho*6. rlE hriBilB or irrrcwEir is sld eithh om yqr
<br />ofsdpLrion. E OwM Buitlr sill IEE rl.E hordd ofFovirE th.r lE or sn. did mt hild d inpok rh. FDFry aor dE p,po€ of
<br />_1. !s owncr ol lh. p$tEny, am crclurivclt conrr.ri.g wirh li.{nrd conkddn b co.{rud rL pDjd (Se 7044, Busircs
<br />arl hD6!r\io Codc, Thc Conlllclois Liccn\c Lr*docs mi !!rly to.n owner oflnpcnywno builds or imlmv.s rhcrcon.
<br />and Nho conra.ls for such Fslrk wirh , Co.rBcbni) lien*d purtur ro rhc Conrracroas Liccns L3w)
<br />--J @ .rcnpl urd.. SeioD . B. & P.c- for rhis llen
<br />roxaDf,s:roMPEarlt()!
<br />DECI,IIAAIIO!
<br />I hcEhy !fln und.i p.ndlryolpcrrlryorc orrhc lollowins d(larolions:
<br />fl hlv. lnd will ntrinkif, 0 Ccnilsdrc of Con*nr ro sclr roslrc ,nr so*e^' oq,cnsri.n, as Fovidcd ror b, risxo, :1700 of rhc
<br />Lator Codc, ior rhc pcrf.@nccor{hc s6* i, rhich rhr pcrmir h isslcd.
<br />,/havc and will moinraii wo,tcrs compcnsarion i.su.dn... as tqnircrr by sdl.. :r7ou .r rhc tlb., cidc. r.. rh. F!ro@@ ot
<br />,hc wq I nr c hich rhr ncrmn ,r h*n-My w.r[c^ .uqEnvr
<br />'on
<br />rnsur de rmcr alt Jhli., rumh.r m
<br />,,-",, .gik?A- h-,^,r.) -c{-(q.
<br />-l
<br />ccnirylh0l nrlhcr.rfornrnccofrh. work for qhich thh Frmir h nslcd.l rhillnot employsnypeNn inan, hanncrs s lo h..otu slbjc.l lo ltc !orkc*' mmrcnsar ion hws of Crlir'ornk. md 0gN ihar il I should hccoft sub.ic.l ro
<br />'
<br />h.
<br />sorkcr' ompctrsolion pmvnions of Sdion l?0o of ll! Lihor C.dc, I stull. ronhwnh mnply with thoc pevisn,nr
<br />WAkNINGT F lld k, rccurc sorkc 'conpcnsarnnr covcriSc is unlautul, ond shall subi.l on cnr,)lo,tr lo finrinll l)cn0ltics and
<br />.ivil
<br />'inrs
<br />x,, h onc hlidrcd rhorsand dollm (lilllo-ux)compcNdion. damScs as pmvidcd for lhc
<br />Sc.ri,nr:11,76 ofrh. t-rhtrO r,i' rrcn d
<br />",,"'4-Y-lg
<br />![sLaf,Ara!
<br />I h.rhy rllt'n trndcr pc !lryofprrj!ry rnurI nn li.ctrsuJ undcr t'n,vi\n[ of Cha!ler 9 (conmcEing virh Sc.ti 7fil(J) ol Divirirr ,t
<br />ol rtu lrusin.srlnd ProtusshnsCodc, {xl nry li.ctrsc is iI lnll ror.r dld clla.r.
<br />N
<br />ct lNsrBlJsllQNrtitDncileENcl
<br />I hcrchy lltrn undcr Nndryol|l.fJury lhrl rhcn n, c.ndtu.rion hnding alctuy for rh. pr.a..tuftd orrhr wo i(rwhichrhis f,cmn i\
<br />ir\u.d rscc 1097. Ci! C L
<br />AffUl;ANLDI;grrMII9!
<br />I hoEt'y nfinn ufticr t*trrlry ortcrjuryotrc orihc Il,lk,wins dccl!,rti{,ns
<br />DcnblirionP.rmir: A\hcno\Norificarnrn licdcrrl Rc3uhrions(lirbr0. Pana)
<br />Rcqunrd Lrroof Norific(ioh
<br />-l.cnifyrhor
<br />rh.lcdcml rc8ul.rions nsrdillg.striu\ rcdovrl @ nor Jppli.abk 16 rhir pmjrcr
<br />-l
<br />cdiry rh,r I h,vc eld lhis .flrli.ar i,rMddri.ihJr rhcrhivc n,orauriqr il..trsr I rge to comdyenhrll CitYsnd Counly
<br />ordin!trccs lnd Stut. t w36L1rin8 3,xl hceb, lurhontu rcprc*nrarirrs oa rhn C yflndCounr,r..nrs uF'"rhc
<br />lbow nEflliomd pop.rly ror
<br />-Y-(
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under f loor
<br />Building Sewer
<br />Area,/Storm Drain
<br />lnterce tor/ Clarif ier
<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-trap/Drain Line
<br />Ir/ain Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lqu/n Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />A
<br />Rou gh Plumblng lctn Y4(1-6-ls NWa)
<br />Final Gas Test
<br />Meter Release /,2
<br />FINAL 7_to1g an q,)
<br />Notes Remarks, Etc.
<br />D.,, q- Vt ( g
<br />Gas-Underfloor
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