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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Water-Under lloor
<br />Gas-Underfloor
<br />Buildino Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq
<br />Gas Pipino
<br />Roof Drain
<br />Tub/Shower Test
<br />Bouqh Water Heater
<br />POOL/SPA
<br />P{rap/Drain Line
<br />ItIain Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitarv Sewer/Cap
<br />Back Flow Device
<br />Bough Plumbinq -l t-/rs r>.UFXA&
<br />Final Gas Test
<br />Meter Release
<br />b/L71s ib6'b
<br />Notes, Remarks, Etc
<br />OWNER AUII,D!:R DI.:LCAT TION
<br />I hcrchy afinn xndd pctulry oI Frjury lhal t on denlPr rtd rh. ConttIon Licci{ Ljw r(, rhc followins rcN)n (:cc70ll5
<br />Bu\ir.$ i,rl Pnlcssion Cdc): Any Cny or County ahrh rcqnncs a rrhir b .onsrrucr, nltcr. imPlove. d.molish ur r.Nir utr)
<br />shrcruc. o,roils is\! cc. tLo rcquncs rh. apllkml |or\u.hlidn b nLlsi8rcdsltmnr rhlr h..r shc is li.cn*d Pusui '
<br />b rhd ln)lisnns olrh. Cotrrrrcktr s Liccnrc ljw (ChaPr$ 9 Conmcncins Filh Sccii{rn ?ffn ofDivision 3 oflhc 8u\incs,nd
<br />Ptur.{sn,nsCo c,or rhd hcorshc isei.mpr rh.turrom ain rh.hrrsh ior rhc allcscdcxcnfln,n Anrvnrhln,notSerion?0:ll5l,yrtry
<br />0nrl(rnr tur ! |trmir strbjc(rs rhc rnplicinr ro acivilpcnolryaimt nn.rh!tr livc hu rcddolhn(S5u))
<br />-1.
<br />$ owncr ol rhc rnrF-ny. ," nry cnlro)tcs wiln *!sc\ r\ rh.n v,h conwns|(nrn. will no rhc work drl rlt irucNrc i\ ton
<br />ini.rthl orofl.tod n, $t (S&,i!,1. tJu\ircr\rnd ltofcs\ioN c.dc rhc Conrnctn \ l-i..n\.Lrq doesnolmplyn, d.a,rtof
<br />rhcpmltn, who ttriils or inf(,vc\ rh.rmr. xl who docs such M& nin$clf nr ltrtll or r hn
<br />'Ah
<br />hil or hd ortr cnTi,vccs.
<br />pnrid.d rhrr\urh n\mtcmnh uc mr i.rcftlcd or orcfrl r,tr qk It h)scvc,. rhc hxildire o, r{,mtcrrnr is s,kl sirhn.nc rd
<br />otcon!.lclion. rhc Ow"cr Builllcr will lrvc rhc hudctr ol'lmvina lhrr hc or shc dil nor ttrild or ioProvc ilt ln'|xny ln, rhe ruqxrs ot
<br />-1.
<br />iso*n.rof rh.t ofkny. a c\.lu\ivclycontrrin8 !irh li.ci\cd cotuero\ h coni .rrltfm+dlscc 7(114. Bx.incs
<br />md Piitsskr Codc l hc Cooracn, \ l-iccn{ L0* docs .or rrnly lo m .w tr or prcEny who hu ilds or nnptulcs rhcrcon.
<br />a $ho s'nt r\ r{n roch pn,F:ts silh r Conlroclo( n liccn\cd Nrsuntrr b rhc Co rncttr l Lkttr\c Irq )
<br />-l
<br />ancxcf,fl urrhr S6rioo- B. & P.C. fo. rhn ,len
<br />Owner:-
<br />l!08f,E8S:.C0Mt!!SArrON
<br />DECLIaAILON
<br />I hcrcl,, amrm under pcMxy of psjury orc ol rhc following d6ldarions
<br />-l
<br />hivc and will @a.lail a Ccn iaraic ol Cotrefl ro Sclf-lnrurc for wortc6' o'llEnsalio.. as Imvid.n aor bv Sccrion l?00 of tnc
<br />L,hor Codc. fo. rhc ldrormre oa ttc qo for wni.h rh.,.mn ii hsucd
<br />-l
<br />hav. uad will.uinrdin work.R .onDeNolion inru,atuc. !, rcquit€d byScclion1700ofth.t bor Codc. for lhc lolomm. ol
<br />Fmi is Gsxn. My wortcF odn nsltio. insurarcc cdi.r ard FIky nunb.r N:
<br />\^,0+7t
<br />-l.cnify
<br />th{ an lhc pcrf.rmre of lh€ ,ort t6r ehth lhis Frnil k issud. I shau @l snploy lnv PcMn in uv Nnrt
<br />s 6 to hcom slbfd ro rhc wrts otrTfns kn l,ws of Crlitohi!, ald og@ lhrl if I should b.@m 3ubjel lo llE
<br />wort6 mmFnglion pDrtioni of Sedon 3rm of th. llho Cod.. t .tEll. fonh*nh omPlr qnh rbs pbvi.ioB..
<br />WARNINC: Flilurc ro sm vtrtcd ompctrsdion @th8c is un,!Ntu|. and shau .uhr.cr o .mPlovs lo iiminal Frollis lnd
<br />ciril finci up io om hundrcd lholstd dou6 ($loo0oo). io.ddilion lo lhc co$ of comp.nslion. dlmges t' pmvidc'l
<br />'or
<br />rlt
<br />"':': l''l;'''1"+'"*'drTnrmJrmE'
<br />\rs'
<br />D,,LVI ', _ \pplonr:
<br />I}TIIIA8^IIAN
<br />I hcEhy sfllrnundcr lcn0llyofpcrjury rhm l m licnsJ udcr trcvision olChlPr$ 9 (comfl*ncins wirh sNrion 70s)) oIDili\ion l
<br />of rhc Burin*s dnd Pblcssiors Codc. snd ny li..n* k in tull lbre lrd elTrr
<br />",$1F. .- '- .'. conrrndor
<br />(l()NsrRtlcT(lN I ItNDIN(l a(iENcY
<br />I hdcby rm.nurdcr lcMlryorFrluryrhal rhcrc h ! c.nslruclbn Ln,lin! ascrcy ror lhc lErfinnuh.c otrhc qork for $hich rhis Frnn i\
<br />n\ucd (Sc..l(I)7. Civ C ).
<br />Llnda 3 Nm
<br />-
<br />APILIIANI.DECIAEAIIO!
<br />I hott, atrm un&, Fidlty of pcjury oft ot lhc lollowing d*bElions:
<br />D.mlnion PcrmirvAshcsros Norifiqliotr F.dcrsl Rcalldions (Tirlc 40. P.n6)
<br />-Rcquircd
<br />l.rd of Norif$lion
<br />-l
<br />cenify rhul thc f.dnrl rcgllatiotrs Eg&ding {elEsos rcn$vdl aE not it tliclbL lo Lhis Imjcd
<br />tal anily th.t I hsvc rcad lhi* applicarion oln slolc lhit lhe aboec i.fo.nDrn is consr. l roonplywilh ![ Cny!.d C.unr,
<br />r rhh Ciiy and Co!trry ro cnrc ul[n llfordi,amcs and St.rc Li$ El,ri.e b 6lilding coNrruclio arn ltrcby aurbti?t re
<br />.hovc mnri.rcd omncnylor insn crn,npurros.s.
<br />Appllcrnl or Agot Sle,.IuE:.d'HAY 17 2018
<br />I
<br />\1oqtryA.
<br />I (nJur'\ d,l'r'
<br />Pedlle Mo.lp.i.l):
<br />UNDER GROUND
<br />Waste & Vent
<br />FINAL
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