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PLUMBING-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DI]R I)!),C RATION
<br />I h.rchy rriirnr u c, Il..dllyoi!.rjuy rhd Iinrcrnrtr ri.rIhcCotrirdr\'LiccflscLawrorrhct)llowir8rcrs.lscc?0llJ
<br />Ilu\nrc\\ lRt Pof.\ri,)n Codc) Any Ciry.r Colnry shich rcquilc\ a Fnni! t' .on{rucr. rller. intn'!d. dcmolish ur rctut rn)
<br />indurc, prtu ro ir\ i\sorkc. dls r.qunclrhc JltlicJnr lor suchpcmir k' llld r sis.cd n,r.rftnr rhrr h.dr shc Lr li.cnscd pursurdr
<br />r{' rh1 prxisions of rhc Conrrs.roi\ t-icenscd h{ (Chrrrd e. (i,nnn nrnrs wirh Sc.rtD 7lx$ or l)ivi\ion :l oi ilr Bu\inc$ r.d '
<br />Pn'lc$i,nNA c)orrhrrh orshc i\ cirnrlr rhrrclnnn t rhchr\i\lbrrh!rl[[rdcidEpri(r Aty vt,lari,,norSc.rion 7(r.]1.5 hyr.y !
<br />r,t)li,'.trr ft!rn tr t \uhit'._. rh. rpfli.Jr'ri. ' 1\illcn'l)',.+r' ! r rhtr n\r hur'lx 'l 'lrllr'. 'l(rxrl(
<br />j.,n."u.,,rrr'.p1"n1.,trtrDcir o)R\* h qJ!c\x\rhcn s,h .omND{rl irin. silldo rhc so,k Jrhc{rucrurcismi
<br />irrc'xk oroflclcd l'or qlc (Sr-' ?0,14. Dusinclsand hrntssidN ( odc I h. Conrrucrq \ l.icco\c l]w docs nor lPplt h ni owncr or
<br />rh.,ln'trfy *ho huild\ or intn)vcs rh@)n, lld ili, d,r\ fl.i s('* hnn\clror tur\clfdr riR,ulh h,\ or hrr own cnrdoycc\.
<br />pnnidllrhd su.h nnl)rinmNfrs m nI inrc cdorrffcrcd lir\rk ll lr,*c\rr. rhc huildii! or nl1l)mvc'nm,s qrld qiihinoN ycrr
<br />ol con0Llirn. rlr O*mr Aui .r sillhnrt rhc burdcn of lxNin! ihr lf,rr\hc did rt huild or i'npn)vc rhc poFny lor rtu purlx,e ol
<br />F
<br />-1.
<br />3s owrcr ol rhc l,!!cny, nm cx.luaivcl, conrracriog sirh licen{d .onr!.tu6 lo @nnocl llx l,.iel (Se. ?044. Eusims
<br />ad Eotusnn Codc Tnc Conrscror's Liccns. tjw dcs mr
<br />"pply
<br />ro !n ownr olproFnyvho builds or nnprovcs lhden.
<br />trtrd trho .o.h.lr lnr slrh pn,jccr\$irhac,nrrucrir(\) liccn$d nursuril hlnc
<br />ion- B. & P
<br />L1
<br />UE.rtrll]lllt
<br />I hcr.hy amrf, u.dM ,..olry of pc,ury om or lhc rollowing delararn,ns
<br />-lhrvcrnd$illnuinrrh{('cnifE_xrcofc(u{nrhscllln\ur.rn\ulcrrconrrcrsrrion,J\!n,viJ.drorhysc.rionr?urotlhcLnhor Code. ftrrhcr^-rhnnin c ol rlr sork ror shich rh. rcnnt is i$ucd
<br />lhrvcrnd eillrrinrai,r {orkcrr c.nlin\rrion tNtrrnn... r\ r.quircd hrSc.rnrn.rT(Xrofrhc l-rhor('odc. turrhct ohnnn.cof
<br />rhc sork n,rshichrhi\ pcrnir i! isucd My$orkcn con,lcnsrion i'r\urm.c c,Fi.r id lx'li.y numh(r rtr ]
<br />y rny prrvrn rn rny,nrtrncr
<br />so.tqs.ndpcredonpovisionsolSdrion3700.frhcLitsrC{nc.Isrull.aodhwnhcomplywilhlhospmvkions
<br />WARNINC. Ftrildrc t, surc sorlsB cn'Dpcnerion.orcr!!c i\ uilawrnl. nnd shrll suhr.{r
<br />rh.lrand d6ll.6 (S1tu.000). in sddrr
<br />b
<br />r)l( r \R r I l()\
<br />hy oi lcrjury lhtrl l6m licensd under lDvnion ofCtaplc.9 (mmring wirh S*rbn Tuxl) ol Dpisio. l
<br />ol rhc Busi.d* rnd Pft,f.\\nris codc, rd myli.cn\c ii i. tullfttr c.i .lfftr
<br />Licnrc CLs:-LieN Nlmbcr
<br />DrlE (:onlncl.r
<br />{:OIIIBIIqIIONIEPINIIAqIICI
<br />I hceby 0tfiirnund$ pcnohyorp.rjury lh lhsc k. on$ru.lion lcndinB lgcrcy for lhc lcrfolrutue .l rhc work for whkh rhis fcmn b
<br />iss{ed(s(.1097, civ. c ).
<br />AIPIICANLDECLINAIIAB
<br />I h,$y arm rhder pcnah y or pc,jur, onc .r rhc f.llos ing dLrlid nrnsl
<br />Dcnblilion Pcmil*AslEstos Norificorion lidc.ll Rc8ulr hns (lirlc40. Pan6)
<br />-Rcquncd
<br />L.ttcr ol Norific?lion
<br />ifyrharrhctadcrrltugrltrrion\rclrnnr! \tino\rc.$vtrlm f.rrfpli.$lcro rhn pml.d
<br />rnd I hlvc Eld lhir q,r,licarior a srsrc lhar rh. aholc
<br />odiflamcs and Slzrc tiws ElarinS lo bu
<br />ohovc nE,rbocd pmFny for inspedion
<br />Appliunr or Atenl SiAmru
<br />rl
<br />b r
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildin g Sewer
<br />Area/Storm Drain
<br />lnlerceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<br />Tub/Shower Test
<br />Rouqh Water Heater
<br />POOL/SPA
<br />P{raplDrain Line
<br />Main 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 />Sanitary Sewer/Cap
<br />Back Flow Device
<br />Rough Plumbing tltt[tE-.4.Lq(D
<br />Final Gas Test ,t
<br />Meter Release
<br />FINAL 7/7"lrq ,.,1,12€6)
<br />Notes, Remarks , Etc.
<br />P.oll4 mn€ (print):-
<br />UNDER GROUND
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