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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<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 I I
<br />b 1)((Jcs?
<br />Water Pipino
<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 Pipino
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary SeweriCap
<br />Rough Plumbinq
<br />Final Gas Test
<br />Meter Release ;*t&-rt ,-A r(i "r/FINAL
<br />Notes, Remarks, Etc.urI
<br />OIVNER BUTLDER DELCAAATION
<br />I hcEby ootm urds Fnsll, of n riury O!l! I m.rc,illl liln ih. C. r&loB Lt€e tre to. ft. tollowing Eesn (5*.70115
<br />Busincss snd Pofersio. Codc)i Any City m Crunty vti.h rquiti ! lcmn to mrnrl dts, inPror, d.mlhh or EIrt my
<br />stocluc. r,rior ro ils irsu!ftc. aho Eqlircs rhc applicd for such p.rml ro fiL a signcd slalmfl rh,l rE o. 3lE is lianscd r,usuMl
<br />ro rh. povisions ot hc Conlmtols Liccnsd Lw (Chaptcr 9, CommercirS wilt S.clion 7000 of Division I of thc Busin.$.nd
<br />Prolcssionr C.d.) o. th:l lE d ,h. is cxctr!,| $.enoh and lhe bcric lot lh. trllcg.d 6x.nplion, Any viouaon of Selbn ?01 | .5 by ctr,
<br />applicul for ! pcdir slbirrs rlE sppli.&l ro r civil p.n.lly of ml mrc lhln tiw hun t&d .rollltrs (Sim).
<br />L nr owncr .l rhc lollr ry. or my cmll(D cc\ a irh *:lsc\ r\ rhcn v,L $ntpctr\arnnr. r'iu do rhc work dl rtr $u1urc is fr,r
<br />inrc L\l oroncrcd,n. ub (s!r 719{, Bu\ituss n d I'rofc\si(rs (odcr'l lt (nnrr&kr's l,rc \. Ltrw doc( nortrnplv r,' atr o{icror
<br />rlr nn,rn), wh, hilds or inUr)v.r rhc(str. lDd wh() dou\ \uch s1)* hnnscll.r hcrcltor rhtolgh his ot hcr own rnrpk)ycN.
<br />l]rcvi,lcd rharrtrch i'npmvcNtrr\rrmr inrc Mc,l or .iarcd lo.nrlc ll how.rcr. rhc huildinE or nntnvcntN issold *irhi"uf )trr
<br />oiconlnlllior. rnc Owncr llrildq $ill hnvc rhc burdcn ,tuvin!rhdIE r\lt id noi hild .r i'rnrovu dr lmrcny tor rtu PurF)* ol
<br />-t,
<br />&s osftr of rhi tftpeny. m cxcl8ivcly.onlreti.s wnh liccnsd conralor !o 6ntul llf Fojttl (Se.. 7ol:l. ABitus
<br />ad PDtrxsio. Codc: Th. Corrrlcroi. Liccn* lls d@s Nr srply lo an own.r of rrcFdy *ho buildr or itpmws lh.rcn.
<br />ard sno 6.tr&K fo! 3u.h FotEk wnh . Conlrulo(s) liccnsd IlRu ro $c Cootrloft Liansc ljw).
<br />-l
<br />ahcicmfl und€r S&rn!
<br />wonKrfs' coMPrr\saTl(lN
<br />DICI,ATAfIO!
<br />t hcrcby lmrh lodcr pcnll, ot frjlr, om of lhc followi.s dcclmdons:
<br />Lrtq (irl..lo (hc t--rli'nrBnr ol ihc \ork f(trrh(hrhc llrnrir ir i\\urJ
<br />-l har {nd will mainrdn wor*6' mmpcosslion intuorcc. .s rcquit d by Sdl ion 37m ot $. Ldbr Cod., lo. lh. Frfolmft of
<br />ttr sdt for shich fiir Fmn is ho.d. Ml ,ork n odp.trelion inmE cuir ed polty .onrtEr el
<br />[ni.y Nun$cr-llxf irc\:
<br />-l
<br />c.nily rhlt in rhc pcrfornEm olrhc wo.t tor whih rhi p.rn n isslcd I strlltul cnploydyFm. in.nt tunrcr
<br />e a\ ro tem rublrr ro rhc mrkm smr.nslion ld*s of Cllitomi!. ..d tsre rhd il I slbuk bcom subiEr ro rh.
<br />*o d, dnp.nelion povkions of Sc.lhn l7m of llE Lator C.dc. I dEll. lonhwirh omdy eilh rnoc Pmvhions .
<br />WI|RNNC: Ftrihrc to scurc worters smp.nrdion .ohDec is unh*tu|. and shnll sobicr r. cf,plorr to ciminnlFtuhi.s and
<br />civil fltr.s uI to onc hundd rholsund d.llqs (Sl(x),o(x)), in 0ddnion ro lhc cosl of.onncr\.rio.. drmBcs ts lrovidcd for rhe
<br />Sc.riotr:1076 ollhc Llhor (irlc. i crcnrndanotu
<br />I hdrcby ellirnDndo |).flrlry of p.Uury thlt I anr li 9(conn*acins *irh Serhn ?fixr) ofDilkion l
<br />ol lhc llusincslnd Pn'fc\\n,n* Co'lc. drd nylicc
<br />I h.(by u,Irm uodcr Fmlly of Frrury
<br />issurd (S<. 309?. Cav, C. ).
<br />rhc rErfffroncc orrhc qork ror *hi(h thh Fanrir h
<br />API'I ICANT NF'CI ANdTION
<br />I hodry dltinn und.r ,cbalt, of r.rjury onc of lhc following dslmlion.l
<br />D.mhion Pc,mns Arbc\rds Nodfi.dion Fcdcral Rqul,lhns (Tillc40, P!n6)
<br />Rrqumd lrtr$ of Norit0rpo
<br />-l
<br />enity rhar I havc Ead lnh trpplication and slalc lhol lhc rholc infomtrn,n h coE..l. I aere lo odply wifi lll Cil! lnd Counlv
<br />Drdinun cr md Srot tiws rl0rin8lo builditrS coflsltucljo.. !d h.rcby rlEriz qrcsent.tives olthh Cilyand Counlyn,
<br />lhow mnrioftd FoFny hr i!r-K,**
<br />?I ?Appllcont or A8lni SaBErrm
<br />Pcmllc Mtu (prlDt):-(.-
<br />Waste & Vent
<br />Back Flow Device
<br />kdat Ad(fs!:
<br />-
<br />-l
<br />ccnify Ihal rh. fcdcml rcBll{io.r rcgrding &sb.n s EnEvol !rc ml atpltable ro ihb tmtd.
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