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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE tD/srG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Underfloor <br />Gas-Underfloor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ ClariJier <br />TOP OUT <br />Waste & Vent <br />Water Pipin <br />Gas Pipein <br />Roof Drain <br />Tub/Shower Test <br />h Water HeaterR <br />POOUSPA <br />Drain LineP- <br />Main Drain/Pool Pipi <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Misc <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rou h Plumbing <br />Final Gas Test I <br />Meter Release <br />FINAL SAMC <br />Notes, Remarks, Etc <br />Ownr.Build.. D.cLr.rion <br />I h6.b, rmm rd.r pa.lty of Fjry thr I h d@pr fm th. c6r&rqr' Li@. t * fd ln. folowin8 @o {3a 703I j Buin6s <br />ed Pbi..rion Cod.): Aiy Ciry or Couiry wthh Eq!h6 . pmn to .oEnucq sltn, imp6r!. d.notish or rcp.i dy Bradw, pno, !o iljis@*, .ls rcqutE rhc spplior fd ruclt Fmir ro 6lc ! si8r.d n.!.tM! lhlr hc or ri. it licas.d p6uet b ln. pDvitioi of $. <br />Cont&rors Lic.6.d hw {Chr9i!. 9, ComocinS wirh Sedon ?ooo of Divilid ! of 6. BBh6 .id prof6liw Cod.) or Ud hc or <br />ihc ir qdpr 0!ftfts and thc bait f6 t. dlc8.d qrnpti@ .Aiy violdin of Sedoi 703 r , by ey appliclrr f- . p.mn iubjd! $. <br />lpplidr ro . civil pa.lry of.d mgt tu fiv. hudrd dollM (t5oo). <br />_1,s oMqof ll'c p.o?Grly, ormy ploy@ eith w.g6.! $.ir rolc cobFnsadon, willdorhc wolk ed $. s1ructur. i5 ior inrcidcit <br />or oficEd fd r.l. ( Sc ?0.r, Bsind sd PDfsid C.d.r Tha Cein.rd'. Li.d. L.s d6 sol .p9ty lo & om- ot th. prop.ny <br />who buil.b 6 imFoe6 lh.r.on. ud *ho &6 such wqt I'iroqlf 6 h@lf 6 fircuSn hir d hr os hptoys, Fovid.d rtd suchimpr@66r, E nor i.ra<Ld o ofid.d 16 sd! rt, trovoa. fic buitdins d imFo!ftar ii sotd wirhii o; yo;otchd.ri@, thc <br />owtrd-Builda *ill h.vc thc bud6 ot prcvin8 ll!.t h. or lhc iot blild or ihFlv. for $. plrposc of 3ak) <br />_1. a Md of rh. propory, m dcluiv.ly @llelt wnh liccns.d @t *to6 io cqltrucl rhr pojccr ( S.c. ?Oaa, Bsio6s aodPrctsion Cod. D'. Cor&@?t Lrca. Lts .los nd oprly !o x oMa ofFopdty who buil.b q improvGlh@on . sd aho <br />m!r&r. fd 3uch Fojelr wnn . c6rdo(r) lic6r.d p{Mr to rr. coiurdort Li@N. rrw ). <br />WOIKERS COMIENSATION DECI-ARATION <br />I hftby .flim !.d.r pa.lry ofFrjlr, on. ofdE foll@in8 d.clsrioB: <br />_l hav. Md will h.inkin ! Cmincr. of Cdst ro Sclf-lrsu. for *orlcr. cfrp.ni.tio., 6 providcd td by Sario 37OO ofth. <br />Lthtr Cod., ftr lh. pdfmdc. of th. dt fd wbich di. Fmn is isu.d <br />_l t.v? dd will roinEin d(6' @rn}.rosdd in @c., c r.qu'rcd by Sdrcn l?oo of $. Labo (!dc, for fic !.rfoll@e of fi. <br />work fd wh,ch tha Fhn ii '$u.d My *ort6' cmp..euon r^!ur&e cs6 $d poti.] numb.' r. <br />Cs6 <br />Policy Nsba Bxptlr: <br />4,.^,,",,.#...*ir*,.'r,. <br />b. compla.d il th. ptun is fo, On. lundrcd dollsE {Slool 6 <br />p<fmee of i.h. wdk foryhich i\is p.mit is i$ucd. IwdL6 ' mFBrrid lsr of Cdif6i., sd trrE <br />@opcnsltiotr prcvisio.r ol S*ton 3700 of $. kb6 Codc, I sh.tl, <br />WARNING: FailuE lo seur work@ comFns{rion ro criniMl Fo6hi6 udcililfin.! up ro @G h6rh.d thouud &U6 {lloo,ooo).in addi <br />th. l-3bd Cod., intcEt 6d nEyt 16, <br />dd.86 s proid.d lf tn. Serion 1076 of <br />I h@by .f6m 6d.r pa.lty <br />lh. Bsire dd PmfaiN <br />ol p€jury thrr I D li@.d un&r provisio of Cl'.prd 9 { <br />Cod.. sd my li@i. is in full a@. Md.Sccr <br />.f6m undd pa.lty or pcjury rh.r lhd! ir . cdEEuctid $. pdfofuc. oa t. wolt fq *hich rti! p.mir is <br />is!u.d(S.c 1097.Civ C.) <br />APPLIC \TIS DECI.AR rION <br />D.Eohio. Pmill-Arb6re Norincldd F.d6d R.rulcims (Tirl. 40. p.i 6) <br />_ RcquiEd t na ofNodfiolior <br />-ty{u^n <br />rn -trior Esldins <br />-/I qrit ur{ t h.v! E d thir .Dghcsidl sd l cmpl, *ith dl Cny ed County <br />ordan&c6 ed Scr! L.s,.l.rint lorlown id.d Flrcny ftr iIlperio of 0i! Ciiy od Courty to nar upoi $. <br />IED <br />rEE =| 4rll, <br />_l h cxnpr s.d.r S@tid .8. & LC. fd 6ii !!&n. <br />tr---t