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PLUMBING.INSPECTOR RECOBD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />UNDER GFOUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipinq
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouoh Water Heater
<br />POOL/SPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Pipinq
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitary SeweriCap
<br />Back Flow Device
<br />Rough Plumbins S/La lr 5.w E-ru g{)
<br />Final Gas Test
<br />Meter Release
<br />FINAL b/2+tit >l rrt
<br />Notes, Remarks, Etc
<br />O\YNllR atlII-Dt:R Dt:I,CARAI ION
<br />I hcrch, rinf, utrdcr nculry ('r p.rlury rlur I rncrcnfr rion rhc Gnricttrr l-icctrsc lrN nn rhc tulk,sne rct{r rS$..roll.5
<br />Bo\irc\\ r d n(fts:i(n C(xlcr A,r, Ciry ot (outrry shi.h rcrltr c\ r ,{n r t, coi(tu.r. dlr.r. irnntovc. dcnxni\h or rn3n Jhv
<br />b rhc ,r,!i{.n\ oi rh. C-otrrn.nn { l.lcc.{d lis lchlln[r 9. Conntunrin! $irh Sc.ri$ ](xD ol Divi\irnr 3 ol rh. ao\idr\\ ntul
<br />E,'lc\siu{Conc)orrhnrhcor\hcisci.mprrhcrcfrofxndrth'snftrhcnllcScdcxcr|nioD. nyvidtrionofS..rt T0ll5iirty
<br />applic!Drn)r!pc.rnir\ubjccr\!hcrptli.anrn,rciril|rcnlry!rnornnrcrlmIlvchutrdrlyldolrrslS5lxD
<br />-1.
<br />&i owsr of rlE nDFny. or nycmployes wilt wag6 s tLn sk @dp.Mrhn. wiu do llE wo.t sd llf, srn$@ n mt
<br />inrc.d.d or ofcEd for $h (Sd.7044, Bosiftss ed Prof6rioB Code: TIE &nr.dtr s Liensc Lle &r.s fr, .Ptly lo e o}ffi 6l
<br />lhc tmreny ph6t ilds or irprc$ tlEm( &d whn dod Mn mri hitu.lf ot hcrelfot lhrculh hh or her ow. e'rFloyccs.
<br />tmvi.led rhr sh irymvff sG ml irad.d 6ofi$<l t, $t, Il. hoM. tlE hiildds d iiErcEGm h eld sihin m J@
<br />olconphdoi, 0E OwNr BriLla *iI hlw ltE b{dcn of FDvinB tlEl lE or shc dij ml tlild d irpmE lhc Imp6ly fot dE FrlDs ot
<br />-1,
<br />as o*mr ofllrc pmp.iry. sd cxclurircly .onusring ualn li.cnEd co.rEdon to on$.!cl tlt Eoirl (56. 7044. Bucim*r
<br />snd PDfsi.n C6rhr Tnc C.nrmlols Lic.nr L.w dG ml .pply lo s o*ncr of PrcD.ny who builds or imPov* lhtun.
<br />and who .onlE.ls fd such tmlrl. wirh ! C.nttu$(O lkensd purlu.r lo lhc ConrEclor'r Lt.nrc tlv).
<br />I lhcxcmor unds S(lion . B, & P.C ror rhi, econ
<br />IITBf,EBI:IIIMPJISAIION
<br />DECIAAA]JO!
<br />I hcrcby alfirn und( Dcnrlry of ncrjury oe of th. folLwine d..lmlions:
<br />-l
<br />hlE.nd will minr&i. a C€nifratc of Cons lo S.U-IBN to, m.t6'6np.nsdior, a prcvi(lcd for by:alion 3700 of llE
<br />Lrbo, Codq for rlE perlomEc of lh. wolt ror whi.h thc !.rnil b hsucd.
<br />-l htrvc 0nd will ,n,inhin wor&c6 cohnensarion ins!6rce, as EquiEd by Serion 3?00 of ltc La6or Codc. tot lhc lcrfornlmc of
<br />l-rrtrt
<br />My w6r*c6 comFn\rid insnrdmc caRtr ai policy Nnb.r e
<br />IUU r (tsrt Ltr<.
<br />o
<br />-l
<br />ccnify thd in rhc llcrf.rmne olth. wo* for which fiis p.rmil h issucd, t sholl ool enrPloyrnr rEson in 8ny mnrcr
<br />s s ro b..oft slbJc.r ro rh. workcs' $mFnslion hwr or Colilomi.. s.d lge rh,l if , shou[ bccom slbif,l ro $.
<br />e,h^ orqosari,n pmtLions oI S.cl ion 1700 of lhc L!tx, Codc. I slau. fonhwarh €mply wnh thos pmlisionr..
<br />WARNINC: Failu'c ro scN *mkcr' co$IE.srion ovcme! is unlNtul. and shau subr.i tr cn lorer to ni'ninal Ftulrix {d
<br />.i!il fi.cs u! 16 om hundEd rhousnd dollaK ($100,000). in addition lo lhe.on ofco
<br />SNrion !076 ul rh. Dbor Codc inrn$atrd
<br />."MAY 17 2018
<br />^
<br />DECLdTAIION
<br />I h.rcby rfinnu cr Nnilry of pcrjlry r hd I ru li!,-nvd nndcr pn'vnn)n ofL'h0prs 9l.oNNncing wirhSt.ri,n7(xD)oll)ivnion3
<br />or rhc Businc\1rnd Pn)rr\\ions Codc, url my li.cnsc is in llllrbre dcrilcl.
<br />o./ 0eq, c 4.
<br />fiAY IJ 1018-Eo.
<br />coNira!!:rla LEND.tNcJttiE rI
<br />I hcEh, allirr utrdcr Nnrllroa!.rjury lhd rhc'c i\ a con(tucrk,n I dirg,Scncy ior lhc Dcrfonruncc orrh. wotk nn whichrhn Nrmir i{
<br />k\ucti {Sc. :10q7. Civ C.r
<br />AIILICANIDDTIA&I.IIAN
<br />I lrrhy!flimund.rl.nrlry olpcrjuryorc ol lnc nnhwnrs dcchBtins:
<br />Dcnnlirion Pcrmir\ A\hnos No'ifi.dn)n l:.dcrnl Rc8ll,rio.s (Inb 40. Pan6)
<br />_Rcqlircd lr .r.tNolift ion
<br />I ccnify
<br />'hol
<br />thc f.dcEl rc8llarions Egudins drbcsxx icrbldl dc nor 0rpli.ubk lo this pmjccl
<br />-.4efilry,h!r t hlvc (!d rhnupnlicd
<br />fordmmcs lnd Skk L.*. Ehl'm ro bu
<br />sbov. m.riorcd pop.ny for insperion
<br />i, aln,crh rlr b.vci lonndior
<br />rhk Ciryand Coutrryro c.rtr uFrn rhc
<br />,\pr,liunl or {,lMl Siurl
<br />II
<br />t.(./q.
<br />Lcnd.r\ Nam:
<br />-
<br />L,ndq\ Ad(tes:
<br />-
<br />Gas Service
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