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DATE ID/SIG.COMMENTS UNDER GROUND Waste & Vent Water-Under floor Gas-Underfloor Building Sewer Area/Storm Drain lnterceptor/ Clarifier TOP OUT Waste & Vent Water Piping Gas Piping Roof Drain Rough Water Heater POOL/SPA P-trap/Drain Line Main Drain/Pool Pipinq Fill Line/Back Flow Pool Heater/Gas Line Miscellaneous Gas Service Water Service Lawn Sprinkler A Sanitary SewerfGp\-r{'*leI k"V+:tJ Back Flow Devibe-/ Rough Plumbing Final Gas Test Meter Release A\ FINAL 4-t]'\.V{ro Notes, Remarks, Etc rV olvN}:R BUILDfR DELCARA TIoN I hcrciy ioirD undc. nc hyofpcrjuryrhir I anrercm fmr r[e ConlradoB' Licctrse t-a* f.r rh. li)lloqllr3 rciqr (S( 70]lJ lnsrne$ nrl Proaesnon Codc): ny Cily o! counry $h'ch rcquncs n rmd t) .on{rud. ahe, mpnxt, dcnnn'sh d. r.litr tny nrucruq rin.rro irs FsuMc.. ,ho Equrc! rh. appluni tur tuch rnn h filc ! silncd sraremenl ttsr h€ or sh. m I'c.r{d ,ursan' h rft Fmvisions ollh( Contraclor$ l-'.eiscd lntr ((n.fl(r 0- Commenc'ns w h s.crrn 70lx) ofDivisior I oilhc Busrncs aod holessonsCod€)orrhnrhcorrhc^cx.iiflrlserrdman'lrhchi$slixrhc.llc*elcxcmprilrn.Anyvnnnrn,noistuxonT0ll5bydny rmhcdnr r.r . !.nnir srbjcch rhc oFrlrc.nr Io acrlrlpenrhyol nor nDrethon fivc hundreddollus($500) -1, &s oeftr of rh. pop.ny, 6r ny .nplort . warh wald * ih.ir $l! 6n mslioc will 6 lh. tuIt tld lhc ilndE i! ml i.r.d.d or ofd.d tu $L (Se.7044. BusiIB ord Pmf4ions Cod.: 'th. Colnrlcrd r Lic.nr bw dod Nt q,rly lo e otu ot ih. ,rrup.ny wtn hiil.k or inl{'mrs fida^ ari sls tLB sch rort him*lfor h.Rtfo. ltmush his or h.r ot. .n0lo,€.., pmvid.d rtar ru€h irn mr6FI! e m i cirtcd no,tdld ttr $lc l{ howffi, fi. hoildiu or inpoEmil Lc $U wirhin oft ra ofor{,ldior! lh. Ovm. Buildd will hnw th. burd€. ofpmvins lhal hc or dr dil ml laald or irfmw dE lDl'dy for th. nlrlte of _1. a. own.r olrhe lmpcny, r'n qclusiEly conrrocritrs wirt licdwd coirackJ6 ro c.inrucl rh. Dojd (S.c. 7M4, Dusirc$ ond PmEsbn Cod.: l hc Conk clor'! Lic.n.c L.w do6 mr apr ly lo m.wna of prorc.ly *ho huil& or impmv* rn?r.on, .nd who 6i tuls for s.h nmJdts with ! Conrero(r, lic.n*d puMd h rh. Conklclols Lic.M tiw) _l nm.x.mrl undcr Sdio 0 & P C.lix rhr r.asn :Iaaa!8s:qQulllsarQB![cta84u!}! I hcrcby artrm undd peMltyotpd$ryon.olrh. followrns dccldrarlom' f)f] U'. o.,a *,tt 'nu,mu'n o C.d rfEnrc orc.Rnr ro selrlBtrr. ror srr.B' conrp.nsolion, .s prcrt.d lirr by s.cl ioo l?0o ofrh.r0hr Cod.. lor rh. FcrfoiiBncc or rh. w,A for tr hrh r h. Fmr N '<rL.d _l l8v. ,nd wrU @inr.in mrl(..!' comr.Bdion iBuhme, I Equir€d hy S.cl ion 1700 ofth. kto, cod.. lir rh. ldlomr. of rhc sorh for $ hi.h rhir l.rm(sorksi mm!.nsarion in$rfi.. oricr a Flicy nunbd -.: I /- r.ri"r ru..r, (.,e Qr gJ 9 Cfp tSO/ I *^*^,tZ/(l^3_l.cnrfy rhat ii rh. l.rfolmncc ol th. work for which rhn rernn h iss.d,l{hrllml. e a ro b€om sbj{r ro rh. so*(l comFnulion l.$ otcalifooi,. and aeic ih ial .hould b.oft $bldt tolL sorl6' ompaetion DmvisioN ols*rion l70o ofrh. L!b.r Cod.. I dEll. fodhwid comrly wilh lho* pmvisioht . WARNIN(;T lrrilurc r. *u.. work.n'comp.ndion to oE hundr.d rhouhnd d.llrs (l100,000),ro rfi. cod ol codn.Bdr dim8$ as ,mvid.d tu rh. undd Fmhy o aFrjury that I am licdsd nmvhon olchrr 6 9 i commenchs {rh sd htr 7(x)0) of Die66n l ot rh. Bunn.* rnd fnrssionscod., a l nylic.nst r L // /" )/h7-7 cQNsrBl.tLtutlrtDuili jcti!(r I [cRby alnrn under pemlryolp.rjuryrhal rh.re F a $n{rucrFn l!'ndmg rgtn.y itr rh. pn,irmrnce oliheN.rk lbr *h.h rht p.m ir niud (SN. lo'r7. Crr ( ) arlllcAxl-uiql^aalx)! I h.E$y aiftm und.r pcnalry o f r.rlry oM orlh. lollowinS delaml io.3l D.molitionP.rnric-AshcrldNorilicriion[.d.ralR.sul.rio.r(-l'rl.d0.Pnn6l -R.qun.d L€rr(olNorilicd'$n -l c..riry thar rlE fcdcdt denl'iiois r.m$l .rc mt r!,,lhrtL h this pmj.{ _l carily rhar I hav. @d rhG !!pl k coEsr I lsd ro corDly s rh ill City..d County ordin0nc.s..d siar. t-rwr Ehlin-r llbvc rnron.d pn,Fny Jar .4 rhis Cirvand Counlyto.nt6 umn tlE """? bl " I PLUMBING.INSPECTOR RECORD APPROVALS Tub/Shower Test c-"*.'. < l^-t'y ?r r- f Ldd€it Ad&6!: -