|
PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS ()wNER al rt l,DuR Dl:LcaRA l-t()N
<br />I hcrhy rllim und$ ltnaliy olpcrirry rh$ I m er.n$ ftnn rtu (.nlra.tors l-rccnsc l-i* lor thc lhllorvnt r.a$n lss?oll.s
<br />Bustrrr .nd I')rolrs$on codc) Any C[y.r Counry whrcl] rcqurcs r lFrflnr k, .-nnrucr, !lr( npnrq de8,l'sh or rcltltr Bny
<br />sNcrurc. nrnrro s usuarcc, rho rcqurcs rhe apdEitrt li[ iu.h r.nn b filcr srynrd srir.nrc rhai htor.1[ rq lrcns&l ,'umrnr
<br />r. rh. tmv'qions olrht (-o ricbrs Liccnscd l-aN (Ch.rrer e, ComnEnciry tri'h S.clion ?(xm ofDiriii,rn I orrh. Arsin.* rnd
<br />Profc$nns ('od.) or ihrrkor che h excnrpr rherelronr rn<l nr hNr fitr rhc ollcBcd crcmrrFn Any vk ,!onolserioi 7l)]l.s hyrny
<br />ilipliclnr li, rpcm ruhJek rh. apll'canrk'.c,!rlpcnrlryolRnnMcrhMlivchu.dEalnolhn($51)01
<br />-1.
<br />as owE ofrh. popc.y, or iy.f,plorB wnh was$.r $.n $1. conp.tr ion, will & lh. aort.id rh. {odm is N(
<br />irndd.d oroll.Ed for sL (Sc.7{x4, BBircs dnd PmGsions Cod. I h. CoolEdols Lk.r€ kw .t B mt lFply lo .n 0*6 of
<br />rh. pmFdy who tnil& or inpo6 i!@q dnd who d.d sh qrt hims.lfor h.Fcl[o. rtmu8h hi. or n r ovn .mPloyes.
<br />phvid.rl rhal flch iopmmnls @ml iiLrxH ffofr.Ed 6rek.l[ tnqfr. $c tuildi.g or in{,mv."Ei n$tlwi'hiioftyr&
<br />ofompldiolr fic Owk. Alil&r viu tbE th. UnLn ofto!,nE $, tE or ih. did d huild or irfmv. $c ,,DDdy lot th. tuqnc of
<br />-1.
<br />dr owB 6f r,E pmndy, 60.xctuiv.ly.onltuin8 silfi lic.nsd co r&rdN ro @ndrucr rl'. pojal {S4. 7044, BBins
<br />rid Pot rion Cod.: I h. Co.rdcroas lic.nic Lo* do6 rer ,prly ro a ownn of prop.rty sho brildr .r anprevd lh.r.on
<br />a.d srb @in6di fo, s.h poj..lr with ' conlmdo(!) lic.Md pusus lo th. conr.tcrs s Lk.M tiw)
<br />_l,hcrcmnr und.rS(rkr a &PC forlhisEa$n.
<br />wol!(ERs, coMPENSAT!orr
<br />DICTAAAlIIN
<br />I h.rcby o,liro und.r p.Mlry ofr,cjlry oft of rh. folloeiig ddlmrioN:
<br />lhita.tulqlllnrinrnrnrCcnrfical.olConsenrh selrltrsu'e liJr \ulers conDcfsalion, as pmrmcd ntr bys.don:t7(r)ol'hc
<br />ljh.r ctxlc, forrh.rrfonn.N.olrlEsnrk forwhich rlEl,.mir N issu.d
<br />I h.rc snd {ill minlai. sorl.ru' comFBarion i.s68q .r r.qun.d by Seriotr 1700 orlh. Llbor Cod., aor rn. p.rform.K of
<br />llrc work for xhich thh ,mi is ic$.d My wmke6 omFNatio. iN6m. sFi.r ad Flicy numho N:
<br />a)la q.zq'\6
<br />-l
<br />c€nrayth m rn. pofolmnc. of thr work for vhich thh n rmir ir isiu.d.I rh.llmr.mPloy tnyp.mn itr6n,Dantr
<br />s N ro bc$m. subj.cr lo iE *olkdl contE.{nrn hws otcalilomi.. rnd ur tnar ii I rhnld hdoft suhid to llE
<br />workrl omp.nsr ion rovhi.nq ofs<rion l?0{ of rh. btn. Cod., I dBll, fo.lheilh @q,ly wrrh rlrt lmvisions
<br />IVARNIN(; l:rilur. ro *.u. work6' co.F.nslion cov.ma. ii
<br />.iil nn.s u, to.rc hundEd lhousnd dnllaB (5100
<br />serion 1076olrh. bb.. cod., inl.r.r ond lnddyi
<br />DECI,AAAIIAN
<br />I [.reby nmrfl undcr pemltyol!.rJuryrh.r I dn ch.ors 9(commtuios $nn s-rbn 7000) olDivisnrn l
<br />of ln ausim,s ond Pmferions Codc. ond ny licms h in tull foc arl .Itd.
<br />?o.{u tu\
<br />co!fl8lclloNlElDlxclcriucI
<br />I hc'chy afirD u"d.r r.Mlryof!.rjuryrhar th.r. r a conqnrcrion Lndins agerc! fin rh. r.rlonDirce ollh. trnrk for shi.h rhh n rnd is
<br />ssued(Sa.:1007.C(. C )
<br />AIILTCJ]ILDECIAEAITO!
<br />I h(et'y!fim und.r psnlhyoln.rluryone olrfu lhlloqll!! d.ch.nriotrr
<br />D.mliion Pennirc-Ash.(os Norificar$n li.d.rdl R+rl on\ ('l irl.40. Pfi6)
<br />-Rcquned
<br />Lelrer.f Norilic.hn
<br />-l
<br />c.nity Oar lh. ledddl .eslldbm Esmdins 0sb.no. Emvd 0E nor attlicobl. to lhie pmjd
<br />t cdifyrh.r I h,v. Ed rhis amlrclr dscro oDply wnh all Cny and County
<br />iv* ofthis Cny ard Cou.ry ro drd uron lh..nlinaocc. and Srrte rjws Elatiry lo
<br />!ir,!e nrntioned rmpcny litr
<br />Appllcrn, or A*rnl Shnrlur.
<br />)cioec\s
<br />'fiit-
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Piping
<br />Roof Drain
<br />Rough Water Heater
<br />POOUSPA
<br />Ptrap/Drain Line
<br />Main Drain/Pool Pipino
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbinq
<br />Final Gas Test
<br />Meter Release /\
<br />FINAL c!1 xrq.lq
<br />Notes, Remarks, Etc aw/
<br />D"", \\' \q'\O
<br />PEMc-o
<br />\\.\q.\b
<br />Tub/Shower Test
<br />Miscellaneous
|