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PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.olvtuR Btr[,DER Dxr-cARA]loN
<br />I rrcrchy riltm undcr NMIry ('r lcriury rh l inr .i.nrPr lro r
<br />'hc
<br />contN!^ l-i..n\c ttrw tur rh. irllo$in! r.awn (1..7031 5
<br />Itusinc\s und lrolcsi({ Codc): Any Ciry o' Counry shk[ rcquncs ! Fnnir ro .otr{rx.r. ulrcr. inP'ovc. dcnnnirh or rcFrt !f!
<br />dtucrurc. prin r) n\ is\urDcc. r(o rcqun ( rhc trftlic{n! Ii,r such Pcnnn b [tn si8trcd \lalcnr''rr rh]r h..rshc i\ liccn\tJ ,uNmr
<br />h rhc ptuvisi,'n\ of rlf, Conridois Liccn* l.rw (Chrlrtr 9, C.'nntocirrS *irh Scdi, 7(XD oi Division.l olrh' llr\nrcs rnrl
<br />otpn.rdlnr!plnnir$bjccr\ihc,mlicurroa.irilpcnnlryol or nxtrcrlrn lilc hu rcddollnrl$stx))
<br />-l.
<br />r\ osncr ofrhr ph|tnr. or nryctrDl(Dtc\ wirh walcs rs rhcn qnc colrPcn\,rnnr. \'illd, t[c *ork xid r,f, sltrrurc i\ nor
<br />ntndcd or ollcd tn elc ( S( 7(},l, Itu\i'rcs\ and Prolcs\ids C.dc Th. Cuikr.kx { Liccn{ I i,* doc\ nor iftllv ro ii .*nd ol
<br />rh. poncdy sl$ huiu\ or i'rymEr rh.ro.. Md who dm\ rkh $orl hnns.lf.r htr{ll or rhmush h i\ or hcr oNtr c llnovcc!.
<br />,,n'rid.drhdsrh imnmvcnrnrr c no I inr.idcd ,t o lic,lal l'r)r {t lr, h)t!v.r. rhc ttrillinA or nviovcnrnl h {,!rl sirhi'r ' tr }.{
<br />olc.mplcrion. rhc Oqn$ lluildcr *illhrrc rhr htrd.n ol flrrinS rhar hc or sht did nor buikl o! inDtrNr rhc rt,ldy li)rrfu purlrM of
<br />-1.
<br />$ owmr ofllE I,opdly. !m cxctusit.ty conltnciinS q h !ie.*d.oedoF lo.o.srocr llE Psj.cl (S(. 7014. 8n(inxs
<br />and EDfcsi, Co<hr Thc Conlre.lol s Liccnsc L.s docs rel apPly lo si owno.f prop.ny wno builds or imprcEs lhcmn.
<br />an.l sho conrsds for such rmjccB wirh a c.ntEclo(s) lien$d puFunl lo lhc cnnr*l6cs Li..rs Law)
<br />-l
<br />!o ercmpi undcr Selion- B. & P.C. lor thir E&so.
<br />I{OIKERS' COMPFNSANON
<br />PECI.ASAIION
<br />I h.rcby ortrm undct pcnalry ol p.rjury o* of lhe folloqin8 drldllio.s:
<br />lrlrtr C.d..,ir rlI psl(rnrnrc olrhc $M[ Lr trhi.h rhc rrnn i\ Anr.d.
<br />rhc No,k kr$hi.h ihis frnnir i\ i\s(d nlyBorkr'\'ro rrcf\rrion nr{mn.r.rtri.r nnd |nli(yrunrbrr c
<br />Poli.,Nlmtcr: EiPirs:
<br />-l
<br />ccnify rhlr in rh. I*.forntrRc ollhe wort for which rhh p.rmil k isslcd.nor .mntoy ooy IcB,n in rny rmtrN,
<br />if I shonll Lcom sDbj.{ lo llt
<br />..mply wiih thos p$vision .
<br />$ asro tf,.om suhj.cr lo rhc sorl(c6 onP.trsthn hws .r cllin nii.ond
<br />npn,visidnsorsc(rn rl70Ool'lhcL!tnrGxlc,I sh!
<br />WARNINC: Flihrc b {cuB rortcn ompcnsarn,n cov.ESc is
<br />civil r-rtrc\ up t, on. hun r.d rhou\and d UxB ($l
<br />7-rr I
<br />I h.Ehy liftrh hder pcnalty ol Frjury that I am liErcd lnder prevision of i,rg wirh SEtion ?fiD) olDivision 3
<br />of rhc Bnsift* 0nd Pmfcssions Cort'.. ,n my li.cnsc is in lnll forc afil
<br />I hcrch, sftir rxidcr Fmlty of pcriury rhd rhdc ii, snsruclion lcndins aE ky for rh. I'c {omEn e orrh. work for wiich rhis Fr,hir h
<br />dIPIISAIIIECLAEAETN
<br />I hodry {trm undn pcnahy of pc,j!ry onc or lh. follovitrS dccludi.nsl
<br />Dcmlnion Pcmnr-Asb.$s Notifi.arion F.dcBl RcSulalions (Tillc,l0, P{n6)
<br />-l
<br />enify thd lhe acdcdl E8rlhlion! eSatding ue Nr ,mli..bk lo this pmrctl
<br />I .diry lhal I havc rc&l rhh amlic,r ion ond shtc ti,mrion iscoflar. l!s@ b.omply*ith rll Cirydnd coumy
<br />ordimnccr lnd Srlrc tis\ rchloe ro buildinS €onsI snrarivc, .r lhh Cny and Coury k! cnrd utnn rhc
<br />olc nEnrioned pii,rcnt 6r 4
<br />Applico orA8enlSisMloE -/t
<br />UNDER GROUND
<br />Waste & Venl
<br />Water-Under floor
<br />Gas-Underfloor
<br />Buildinq Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pipinq ,il",thY h ,
<br />Gas Pipinq ?tiHr* z 4./n,lLla
<br />Rool Drain
<br />Flouqh Water Heater
<br />P{rap/Drain Line s4"r<l*-,tuualL /l)
<br />It/ain Drain/Pool Pipinq Z /l-l/ro-A+'\rr-/t
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn Sprinkler
<br />Sanitarv SeweriCap
<br />Back Flow Device
<br />I
<br />Rouqh Plumbinq
<br />Final Gas Test
<br />Meter Release [/,tr^t
<br />t7/ttll{5r\k{
<br />Notes, Remarks, Etc.I
<br />(
<br />'l
<br />COMMENTS
<br />Tub/Shower Test
<br />POOL/SPA
<br />FINAL
<br />L _Rcqutcd trtr.r of Nolilicarbn
<br />-,+d /.
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