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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SJQ.COMMENTS OWNER EUILDf, R DEICANAT|oN
<br />I hd.by altm uidd FEty of Frjury 6,r I m .rnpr tom rlE Co r.c1o6 Li.or tiw for rh. follosine uh. (5...7011 5
<br />Susin e6 ad tmfB6ion Cod.): Any Cny or Colnry enkt r.qund ! nnnn ro onqruc( !lrn, io{lmv., .kmltfi or qrn my
<br />.roclu.. tlrior ro irs iiluaftc, .ls r.qniE! llE lppli.et for ieh ,.mir to fi|. a si8,Ed sl.l.Mt ll[l h. or tt is lic.ded plN.nr
<br />ro rh. pmvleioN ol rh. Conlhclolr Li6$d tts (Chq,r.r 9, ComminB wnh S.flion 7000 ot DivLeion I of llE Blsi&a 3nd
<br />PDlcsioii Co&) or Oar lE 6. dE is q.6Pl dEEnoo !d lh. hsii fo, rh. dl.8.d ddplion. Any vioLlior or Sc.lhn 7011 5 tt lny
<br />applic..t lbr . p.mi! subjels rn aplliclnl to ! civil pcnllry ofml mE thd fiv. hrndi.d dollln (S500).
<br />-1,
<br />a oaM of rh. pmp.nn or oy cqllotlq wirh wr!6 er $.ir $L @np.ns6tioG wil .tr ttE md( lod th. $flde ir mt
<br />inr.id.n or ofd.d for sL (Se.7044, Bucirc$ rnd PmferioN Cod.: I he Coi Eddl Lhd. Law do6 mt q'ply ro .n ow6 of
<br />th. Frcpcny who hlil& or iopovB rtEFi. aid wlb dos @h ft,k hih*lf or n rllor ltm4,l hi, tr lEr oM.ntl,ort*,
<br />pmvid.d lt t ruh i,pmw.rr E hr i dd.d orotu for eL. lt tFltq, ft &ildiog G ilpmwF.il t $U wnhin o* r@
<br />ol6n!)hi6,\ $c O*G BxiLt wiu ltrrc tlE buid., ofpmvin8lh{ lEordBdn d hild or inEmEllE |,Drdry tui0E Flro*of
<br />_1.n owm..flh. lmrcny. nn.xcluiiv.ly co Ecrinswirh licnr.d codrocroN ro @.nrucr rlk Do.r.d (se. 7fi,1, BBincs
<br />ajd PmEaiir Cod.: Thc Coorracrcls Lic.nsc Law d.* mr arply lo eoo*m, ofpmp.nyuho builds or impDv.r $.r6n,
<br />and who 6dhq. h. dch pD]..r. vith a Co 6cto(s) lic.n.d DurNanr k, th. Conlhcrols Lic.tr* Law)
<br />-l
<br />d .x.nfl u.d.r S6rio
<br />l!!I85E8!:C0!!lE!SAltO!
<br />DICIJAAr]A!
<br />I h.Eby irli.o trnd.r l.Mlly ofpEjury oE oflt followin8 dalamlionsl
<br />_l h.v..rn will mi.rain r C.difa.r.ofconrnt ro S.ll'lnruE lor*o d @nDdslion, 4r ,mvit.d 6r ny Sethn l70o o I th.
<br />Labn Cod., ao. rhc pdfo'I1@! of ih. wo.t for which th. pdril is ic$.d.
<br />I hsv. and *ill mainrsin wo.kcrt com['.n$r ion inru6m.. as i.quiEd by ser
<br />'on
<br />17ff, of rh. Lahor Codc, for lh. p..tu@.c. .f
<br />6. qhkh
<br />'ha
<br />p.mi B Ba.d Mywtr.r 6mp<Bd5n 'Blffi ffir !d Flky NEbd eqo&, F^wd
<br />I lo -ol tq
<br />_l cdily $.t i. rh. p€rlormft. 6lrn wo.t lor which thir !.mn is h$.d. I rlEll ml mploy 6n, p.N. r. dy sm*r
<br />$ as b b.sm rub.ier to rh. vo*6'om!.nsar ion laws otcaliao i.. rnd a8e rhat ifl slnuld h<oG flhJ.cl tolL
<br />mlteR'mmFnsli.nrmviiiorsofSetion3T00ofthcLahorCodc,lilDll.fodhwihcoodywirhtl[spmvhions.
<br />WARNINC: l..il!E lo Kurc wortcB' @mpctrstion ovmsc ir unls*f!|. f,nd shsll shjer an mplor.r lo ainiml p.Mlli{ ed
<br />civil nn.s up to onc hu.d!.d tholsond dolla ($100,000), in sddnion ro lh. cos ofcomr.nElion, d.mr.r os lhvid.d hr Ue
<br />Serion 10?6 ofrh€ L.txJr codc i .rcst nnd fiorncy's fccs
<br />!l.1^-(a"-J N
<br />uc[lsrLcaNrSaglaa
<br />ulcl,a.BAr&!
<br />B €
<br />""., ll -L l, - 14 .*"*",,
<br />COI5IAUCIIQNIT'!ITX(i.d(;I,ICI
<br />I [cEhy amlouds peulrtolpe.Juryrhd rhs. R a Lr6rtuLlk,n lsxlfS a*.ncy for rhc pcrhnnarce oithe *.lk litr wh'ch riir rdnrir is
<br />hocd (Se.30r)?, Civ C.)
<br />ATTLICANLD}]CI.IIEAIIO!
<br />I hdd'y Diim under pcnahy of!.rury om ofrh. foll.wiu d(l&dions:
<br />Demohion femrirs'Asbesros Norificrdn l:.de.ol Res!ldrioni (Trrle 40. Pan6,
<br />-Requt<l
<br />tct.r ol Norifi orFn
<br />,"Ltrrt r,.t,.,td, r"r . r 1 , '(!.tr.I,n! .^h(n". ,"rln , rrr.-.,rrl ,,F"I,t,\r,1Jt"I
<br />fdI' h",Il*'.*-l,h.,nflci,tr,ninJn r,l'J,h.xn(c nlnnn (ns.or..r Ir!r'ck,.oDrny$irhrr (,r!rn(r( oudr!
<br />ahov. tr.rio..d Dmr.ny tor itrl|Etion pqns*.
<br />Applicsnl or /\Ecnr Shtr.lurr;*a^.-l N
<br />x-7? -I 1,1 VAd
<br />l(
<br />UNDER GROUND
<br />Waste & Vent 4lnlu Ti qq.^-!:
<br />Water-Under floor JI
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Water Piping
<br />Gas Piping +lvlta t Vtt^-,.-, ll u
<br />Roof Drain I Ut
<br />Tub/Shower Test
<br />Rough Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />IVain Drain/Pool Piping
<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 />Rough Plumbing 9Ahq mt lu,*'tdZ )
<br />Final Gas Test (r I tl
<br />Meter Release
<br />FINAL qlvtla 1 Tlwt+'t {q,a )7 -r..Notes, Remarks, Etc
<br />-+
<br />,,,,", IELL - rg
<br />I heEhy amrn und.. r.n.lry ol ncrjury th.r I0m lic&sd un.Lr Dnrv$r,. ofcha e 9 (coDr*ncht urh Sarion ?000 r or D isioh I
<br />of
<br />'hcBusrmssaM
<br />Pmfasiotr C.de, and mylicc.r h m tullforcemdeltecr
<br />x/^)
<br />N&sY tr=
<br />.&
<br />tD)
<br />Waste & Vent
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