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PLUMBING.INSPECTOR RECORD
<br />APPROVALS ID/SIG.COMMENTS OWNT.]R BUI LDER DEI-C/TRAIIoN
<br />I htrch) rtinn utucr Ni.lry orpcrjrrt thll I .m cr. Dr rrorn lhc Conrm.rol Liccnr trw tur ih. t tt,sin8 rcav'n (sc..70.I5
<br />ausr\r ! Pr)fc$ion C, ., try Cil, or Counry shic! rcqtriEs r lcrnrir x) consrdcr. ,trcr. nnriovc_ dcmri\h .r rclnn my
<br />{rucrurc, Pri,r b ir\ is{r.Ec. als r.qunc\rhu xtplicanr for !u.h Frmirh tilc r \i8md (dcn*nr rhnr h..r shc i\ ti.cnrd pu(ulnr
<br />nr rhc pn,lisn,ns oflhc co kr.rtr s Liccnsd trw (chn[.r 9, c(nrruNins wirh sc.rirr ?oo0 or Dilisi.n.r otrhc lrusilcs.nd
<br />liofcsshnsa( c)orrhrr hcor rh. (cxcnpr rh.retromrtrd rh.lx[is forrhc alqcd cicnrnriotr. Anyvntnoonofs.dhn?0.]156yony
<br />applicn ,nrnpcmir suDlc.h rhc {pli.unr t' advilpcnrlrrolnor n}r hi. fivc hutrdrcdd.ttrr\ lS50O)
<br />-1.
<br />!\ ostrcr olrhc F,,rny.,tr myempby.cs sirh sasc\.\ rtct \rr. c.mr.nsJrid'. sittdo,he *od( nn lhc slnErur r R
<br />irncndLal oroficrcd ior elc(sN,7(}1,r. Dusincs Md ftori$ionsCodc l h. CoDk*n-s t-irci{ I !w dc\ mr lPrty h nn owmr of
<br />'hc nn'Fdt sln) iuikls or ir{n)v$ rhcr$n. lnl s.ho drB \e.h *l.l hi,n\clt'or ncRl or rhbuSh hir.r hcrosn employccs.
<br />provnL.d rhrr nrh i,npnknr snrcfrr inrc'rlcd or o nirt fo! \rh ll. k,k\.i rhc l,ui[ir8 .r ir4ri,E,ftm is $H trirhin nnc )urolcotrDLriun, rh. Osnq lruild$ sirl hrv h. huftlcn ot l)rovo! rhd hc or shc did lol huitd or imrn,v. rhc mrr.nr li,rrhc purrDs or
<br />-1.
<br />as ovncr .l rhc lotoly. am cxclusiv.ly ..nrsdins *ilh liccn$d conm.rqs ro construct tlE lmjccr (Se. 7044. Burirc$ad Anrcssb. Cod.: Th. Conretor'r l-kctrsc Law dcr tur api,lyto,nowmr oapmFfly who blilds ot ihrmlcs thcr.on,and who $mach for slcn poirls *nh n Co @ro(, ticcnscd l)u(unr to rheco rrcrols Liensc L.w).
<br />-l
<br />d cx.q,t unds Sdlion _. B. & P.C. for thi* E&en.
<br />wot(f{s.coMPFNsa,noN
<br />Dr,cl .ataftoN
<br />I hcrch, amrn undd l.Mlty of psiury om orllE folhwira deluations:
<br />_l hlvcnnd wrlln n iriCcnricdcorcon\r r ro Scti tn\urc li'r $ur[.r{ cotrrpctr\rrior. us ntuvidcJ r(rb} Sccrn,n.]70{)olrhc
<br />ulitr C.dc. f{rric lEtmnrEof rhc s.rk ror *hichthr p.iinir i\ i:\ucd
<br />-l
<br />haec nd will mdinrlnr workeri compcns0lnrn iNutuncc. ns rcquircd by Scction l?0() .f rhc kbor Codc. for lnc p.rformeu ol
<br />io. insurm ffk. ard Flty rumb.r N
<br />-l
<br />ccn'fy lhll in lh. F,for@rc of lhc wort lor whah ttis pcrmit is ksu.d, I shatl ,or cnploy a., pcson in any nume a\ ro ttonE subicr ro rhc w.rkdc $mpcn$tion law$ ofcdltomi!. oid aErc rh if I shoutd tr.om .uhjcct to lhcwolts cor{.osarion pmvisn,trs of Serion lT00 of thc Lrbor Codc. t 3hrlt. tonhqidr mmFly wnh rhoe poviiiors..
<br />WARNINCT ,:0ilurc !o knrc wrtc6' compcnrdioh corrusc is mluqlnl. ond sh.lt subjN un cmptorr. lo aiminat Fn lrici lnd
<br />.ivil fiic\ up
<br />'o
<br />onc hxndrcd rln,u$nd do
<br />s.crn,n 1076 ofthc Lbor codc. i' .rd and
<br />in lddilbr ro th. .os of.o8lchstion. .l,m8cs 0s provilcd t6r lhc
<br />frtlr0
<br />l)I]( I \RrIt0\
<br />I hctby rfiirnudcr pctrllryol r.rjnry rh l am li.ctrs.d utrdq provnion of Ch$rur 9 itumftn
<br />'ns
<br />wirh Ssrion 7(x)rl) o! Dn isi(,r .1
<br />oi rhc Rusincss,nd Prdt$i rsCodc. ud n:ylic.n* i\ in tulltnrcc aixlrffccr
<br />[ot o\A1
<br />(IONSTRUCT(TN I
<br />'NDIN(I
<br />A(;I'NCY
<br />I hcBby anirm undf tcmlry o,'p.rjury rhll lhcrc h !d,nnrudion Lndms recky ror thc pc.tonumc ofrtE work tor whichrhis Frmir is
<br />issucd (se lm7, ci! c.).
<br />APPI IC NT DECLAR,ITIoN
<br />I hcNty uhnD uM.. r.oiliy.l tcrjury orc ol'hc rolk'wins dcchrlri.ns:
<br />Dc bhi(r Pcrnirs Ashc{os Notiticarion FcdfiatRc[utarion\ fliltc 40. pd6r
<br />Rcquircd L.tr.r of Noritkrri,,n
<br />-l
<br />cniay ihar th. fcncd rcgularions ESrding astcstos lcmvtrl {rc mr rp/i.dhtc 16 this lrcjcr.
<br />_l eniay th.r I h.E Bad rht !fltltltion .,n srrt. rhd dE shoE ir(onmtion is ctrer. I ugE lo conpty with rU Cny and Couity
<br />ordimnccs md sfurc ljwrrchti lio.. rn hcr.by aurktir! rcl,r*nrutiv.s oflhh Cirydnn Coonry lo cnrcr upon rhcahw mnrioned tmpcny for '5/7/ dAppliunl or AXctrl SigNt t-(
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildi Sewer
<br />Area/Storm Drain
<br />lnterce r/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Roof Drain
<br />Tub/Shower Test
<br />Rou h Water Heater
<br />POOL/SPA
<br />Ptrap/Drain Line
<br />Ivlain Drain/Pool Pi pins ll ?ns 1lYlL=-;>L-<*
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn S inkler
<br />Back Flow Device
<br />Rou gh Plumbing
<br />Final Gas Test
<br />Meter Release
<br />FINAL 4lvql,l ?uaa
<br />Remarks Etc {
<br />Water Pipinq
<br />Gas Pipinq
<br />Fill Line/Back Flow
<br />Sanitary Sewer/Cap
<br />/f7.,
<br />Notes,
<br />T dr\41_
<br />r<. A^nfrk< ^-
<br />(_
<br />DATE
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