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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OTVNER NUN,T'F]R DELCARATI( }N <br />I hcrcby 0lliru und.r I,.Mhr .l Frjuty lhrl I un ctumpi ftnn rh. (bnrracn,$ t-ic.n{ U* lor rh. rolhsinS rcrsnn rs( 7rlll I <br />Bu\nN\! !trd Pnn.$rn Codc): Any Ciry or (i)utrty *hi.h rcquircs tr lrnnn !r con(rucr. : r.r. iq,tovc. dcmoli\h or EP.ir nnv <br />ntucror. rrkn ro irs isuarcc. aho ftqutcsrhc r,rfli.xnl ttr \uch l.mi o filc r \iEn d ddc f, thtr lEor nt i( li.cnsd PuNoni <br />ro rhc Dmlisnnr or rhc Contrcroi\ Lic.n\cd trw lchllrcr 9. Comncncing qnh Scdbn TU|O or oivision I .t rhc suinu{ Jnd <br />ftori\\i(rtrCodc) orrhnr h.orshc t.rcnlprrh.rcliomlnJ ihc hrsi\ fortltr nllc8.d.rcnPrtln Anvvi.hlionofS.drilnT0ll5bvatrv <br />rpt'lifltrlti)rrIl..nrir\uhjcdhrhcnPplicrtrrk,r.ivilpcrdlryolrclnnrarhr fiv.hunit ddolh6(1500). <br />Ln\ow.crollhclr{rFny.urnry.nDloycc\*irhsgt\d\rhcir\olccon|r.n\rrii .sillJolh!*ltrk kldrnnEtucisnor <br />i' .ftld or ofictud ror slc r 5(.?044. Btr\i'r.$ rM Prolc\sios Codc: Tht Ci,nkdois t-iccnrc I ]w d.cs not llplrly ro M ownci ol <br />rhcnn)n(ny who bu inls or infn)vot I ltdnr r n,l who doc\ \uch so't himscll or hcrscllorrh(rulh hir or hcr osn .mflovccs. <br />;l..Dtrcri4 rhc O{ncr Bu,l]d willh t llt hurdcn orptulirr! rhsl hc or sh. did tun h{iu or irryotc rh. pm,tcnr riir rhc PU'P{ol <br />-l. <br />rso$ncrnlrhc pn,rcny. rnrcr.lusivcly.otrtx.riis qirh li.cn{d.onrrrrktr\r, connnd rhc pnrid (S.c 70'14.lln'inls <br />!n,l Pn,fssi)nCodc: Thc Conrracnn \ l-i.cn\c,-rq locs nor aPPlyb ano*Nr dlPn)t ywln, huildror imlr(^t\ rhctcon. <br />rnd who.onlmcrsir .hrnoEcr\ qirhnConrruct'n\)li.otscd Ducuinr r{rrh(innrr.ktr'sl,iccn\c La(). <br />'t0'l <br />DECLTXAIIIIN <br />I h.i.by tr|fi nnunds Dcnalr, of P.rjuryonc of rh. i'olldwing d.clarulions <br />-l <br />h.rt rlwillnEinrain!Ccddlc4rcofconscnlloS.ltlnsurcrorworkcB conrlc.srion 0s pmvidcd for hvSslion 3?(xl orrtu <br />ljbr Codc. ro. dc psformnd orrhc wo* lor {hich rhc pctmir h issxcd. <br />-l <br />h{vc !trd *ill minrrin workcF comnco\arion incummc. as E]]uiFd by S(l io. lrm ol rhc tibor cod.. iot thc p.rfoBk' of <br />rhc work for whih rh* p.rmir is issu.d. My e.rkds ompctrstion itrshtuc cmicr {d loli.v iun**. d. <br />Poli.yNunbcr:-rric.l <br />{) r\ r) h..o r subrcr n) rhc tr,trk$ rou{tr\ili,{ h\\ olCxlinmir. n d lllr.c lhn rl I nn)ulti ltconf, subJ..r ro lhc <br />wo'1.'\ co rtrtrr idr floyisi.n\olSccrnrl7(ll).lrhc l.rlxtr a(rlc.l shrll hnhwirh.o rrlyuihthoscn()!i\nN <br />WARNING: Fsilurc lo s@ wo*cm otr]Iffsrion.ov.tu8c is unlawtul, Md sholl subr.rr m cmplovq ro aininal !..ulri:s ond <br />.ivil fims ur ro orc hln.lrcd ihousend douaB (S100.00o <br />scriotr 30J6 ot rhc Llbr codc. inlcrcn and ,nomyt fes <br />.os ofcoqrcnslinn. (tlmgcs !s lrovidcd ror <br />'hc <br />q -to-f 1 <br />DECIABAIIAtr <br />lh.rbrDmnnxM..!,.n"llyolpc,jurrth,ttdnli.cnsnu(lcrpmri\ionofChlllcr9(connEminewifiS*Iir7000)orl)ivhionl <br />of lhc Busincsmd Pbf.ssionsCodc, lnd 'ny <br />li.cnsc G in fullfore ud.fic.r' <br />clldsrBlJcrlQNrEluari-^lirNcr <br />t hcrhynfln uMf Fnihyolpcrjuryrhl rhcrc h 0 cnrxrdcri{,n Lnd,ng aScocy lor rhc pcrrormn.c ollhc *.* ror whichrl,ir pcrnrir i\ <br />issBl(s( .l{l)7. ciY c.) <br />L.ftL Nam: <br />- <br />A.E&UANLDf,IIdSAIIO <br />IlrE$yalilmrund$rcn ryorNrruryoncotrhcrolloRir8delamlions: <br />Ocnr,lrnr Peflnits Astr-d.{ Norincilion lcdctrl Rcrulnrions lTillc'l(). P!n6) <br />-Rc!uircd <br />lrllcr of Norifi c.lion <br />-l <br />cdrify rh.r th. fidcrll eSulalioos nsrdin8 asbcslos remvd rrc ml tmlicublc ro rhh Omjccl <br />,.cnilythor lhrvcrczdrhisapllic.thnaldshrcrtdr lll. abovc hfomlion h codc.l I .8r lo mtr9ly wnh aI City lnd Crunry <br />ordinam.s and sllrc L.wr Ehri.g ro buildinE <br />xtxrc nrnrtr cd Drcr'.nvlhr <br />,\Dpli(!.1 or ,\(rrl SiEnnlu <br />'--l;"?;{. <br />UNDER GROUND <br />Waste & Vent <br />WaterUnder f loor <br />Gas-Underfloor <br />Buildino Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipino <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rouqh Plumbing <br />Final Gas Test <br />Meler Release <br />FINAL il llqil x €tAttNt{v fA-,-" <br />Notes, Remarks, Etc. <br />Miscellaneous <br />O^r,4