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PLUMBING-INSPECTOR RECORD
<br />ID/SIG.COMMENTS
<br />UNDER GROUND
<br />Waste & Vent
<br />WaterUnder floor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarif ier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Piping
<br />Roof Drain
<br />"d.Ja.ATub/Shower Test I olnlaln ,/
<br />Rough Water Heater (,\
<br />POOL/SPA
<br />P-trap/Drain Line
<br />tvlain Drain/Pool Pipino
<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 />Bough Plumbing 4q,?-tl 4^.,.n 4tE -
<br />Final Gas Test
<br />Meter Release
<br />FINAL t0 hnAk(tv)
<br />Notes, Remarks, Etc.I
<br />OWNER BUII,DI,]R DI]LCAIL(TbN
<br />IhcrchyaltuNu cr Nnrhy {,i pcrjury rhar Ixmcxcmlr iomrhcContunni Liccn\c Ix* t{r rhc roln){ins 'cr\nr ls..r0rl5
<br />Rusi'rc$ a Pdisiu Gxlc) Any Cirt or Cotnr, which rcquiBs r Fnnir k' rotrnfl.r. rlrcr. inilnr_c. dcnrli\h or L-.Eri rny '
<br />{tu.ru'c. lrrntr k' [\ i\suJn.c, nk. r.qunc{rhd q]pli.rtrr fin \och pchirh lilc r ngncd {d.nnr rhirh- or shc ir liccnscd nlrlurnr
<br />Piol.\\i,n,\ Codc)orrhrr hc.r shc '\crc r rhcrclnn r.(lrh.lx\i\ t rrh.trlklcdcrcnDrio. An! vi(,lirionolsccrionlrrll5hy 'i) '
<br />rflli. r nn i Nnnn srhjcch rhc rDnlic.nrr) a.ivrrNDrky.l mr nrfclh.n iivc hundrcd nolhr (S5{xl)
<br />-1.
<br />r ownd of rhe prop.ny. or ny .nlPloyas wi$ v!8.s a llEn sb comFns.lion. wil do tlE s6t !,n dt sElite i, ml
<br />hrendcd or of,cEd fd slc (56.7044. Busiftss ed Plofcssioru Codcr Thc Conr...rol6 Liens Llw <to.s not tPply ro u ownm ol
<br />rhe pop.fly who buil& or in$ro6 dEEn, lid who &B sh turl himcltor hcMlf o.lkDugn hh dlE own coploy&s.
<br />povidcd rh sch idre\a@n @ mr hlqxH oroIIcnd for slc. lf. lbEE dE hildi.g o inprorcrnl ii eld wirhii oE ]Es
<br />ofo'rnhrion. tlE OwM Buillr will haw ft hrilq of t'olin8 lhlr lE tr rlE di.l mr ttuild or i,tFor 0E I,oIEty for lhc purDos of
<br />L rs oser or rhc Iln,p(ny, amcr.lu*ivcly.ontradioe wi'h licc!\cd c6nf&M* ro.oneru.' thc poicl lse. ?044. Busirc$
<br />lnd Eofssion Codcr Thc Contaclors Licrnsc Loq docs nol.pplt b ano*nc! of proDcny qho huildr o! nrprovcr rhcrcon,
<br />dnd qho.o.rl,crirorru.hpmlrkwirhacl,ntn.rods)li.cnrcdrurunnrrorhccontacrorsLic..sctiw)
<br />-l
<br />m exemfl und.r Seri6n- B, & P.C. forthii M!on,
<br />uoaf,E8:rcoMtENsaro!
<br />DECI.AMIIAN
<br />I hcrcby afftrm !odc. tEoilry of psjury oie of lh. fol&,wi.8 ddlir{dorr:
<br />-l
<br />h8w dd eill @inr{i. t Clnifi$lcof Cons io SclllNurc lor {ort6 compcnslion. as pmvid€d for 6y Sedon :1700 of lhc
<br />t$or Codc. for lhc Frfollrj,@ ol th. eo* lor shich rh. pcml ir ksucd.
<br />-l
<br />h!rc lnd will minlain wortcN comFcnsation insur,trcc. trs rcquircd by Sdion l'700 ot lhc tjhor Codc. ror lh. poro.rrec ol
<br />work for slich thir lrmil comp.ns ion i.surrmc qtricr !d poli.y numhd m'bls'tr
<br />c 50l(q ?)/-Zo't 7
<br />I NniS rhd nr $. Nlformnc. oflhc wort lor whi:h rhk ncrnri ir GsBd, I shrll nol c.rtloy nnt n $on in any nao.er
<br />so ro be.om subjNt ro thc $orks compcnsrion lass olCllifomi!. lnd l8mc rhai i,I should hc.otu suhj..i h rh.
<br />work* mmrEosari.n n,ovisbnr orsr.rion lT0o ofrlE ljlnr Codc.l shnll. fodhsilh comply wirh 'h.* provkions.
<br />WARNING: l]oilurc lo *c!o eo c^ onDcn{rion corcEsc ir lnla*tul, ud shnll .ubixr e cnplotr. ro diminol FMlriu lnd
<br />.i!il fincs up to om hundrcd rhou$nd dolle (tl0o.lDo). in lddnion ro thc cosr of.onpcnslion, dmgcs as lrovidcd for rhc
<br />CnL inrcr.n and artrm
<br />I]ECIdSAIIO!
<br />I h.rchy llitnruhler Nnalryolri.rjlrr rhur I !n liccn{d u.dcr pr'!isi,,n or Ch|Prd 9 (omntmin8 wirh Scclion 7ux)) nfl)ivi\nnr l
<br />oi rhc Busims u PNfcssn,ns ('odc. ,nd nry li.cnse is in rull lixcc nl cn(l. ,
<br />1L((ebiq
<br />(I(INSTRTI(ITloN I FNDIN(: A(;liNCl
<br />I hc,cb, nmnn uMcr JEnrlrror Frjury lhll thclc is a on{ruclntr lcndins rycnc, ror rit pcrlortui.c urrlt work lu shkhlnn pcrnrir n
<br />issucd(S.c. 1097.Civ. C ).
<br />ATII.ICANIDECI,IXAIIOII
<br />I hor!, .nim undcr Fnally of Frjur, onc ol lhe folloeiry dcclEalions:
<br />Demlilion Pc.mils-A,hcslos Nolifrcdion Fcdml RcBllulions (Tirl.,l0. P.n6)
<br />-Rcqltcd
<br />Lcxcrof Notitrca on
<br />_l c.dify rhor rhc fcd.r,l rcgll ion. rc!&di.g r*b.{os mmval r. nor appli.lbh lo lhis Pmj$l.
<br />I .cdify lhd I h,vc E{d ihis spplicltion dn $.r rhd rn sbov. informrhtr is corr.d I ag@ 16 c.dtly sirh all Cily .nd County
<br />.rdirrn.c\ nnd Srrru Lrw\rldire r ildine consrrudion. ld hcEby 0uthorir rctrc*ntal
<br />lbovc mnliomd pml'.ny ro.
<br />Apptl$ni o. Aa.nr siamltr
<br />%0/L\^/\r,
<br />:':di;:
<br />d,,TEI
<br />APPROVALS DATE
<br />Gas-Underlloor
<br />Fill Line/Back Flow
<br />L!n&.t AddBr-
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