PLUMBING.INSPECTOR RECORD
<br />APPROVALS DATE tD/srG.Omd-Blilda DelE i6
<br />I hatD,.6im@.t pe!.lry of Fj!r, tlt.r I @ adF fm llc C6t do.t' Li@E l''..w fGll'. foll@ina lt&I (8.?o! L5 B6in&
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<br />Cor..ld! U@*d L.s (Ch.Pl- 9, C@drs witL Scdio 7m of Divi.i6 3 oI d'. Butitr . !d ftd6rd Cod.) a ttd h. a
<br />fi. h qmF lh@ts! od lt. b.rt fq th. .ll!8d qopd@ .Ary viol.ri@ oa Setjo ?ol I 5 by sy +clic{ll fq . p6rn iubjalt lnc
<br />lpplic5rr to . civil FBlty ot n r nc dE nE h6drd dolld (S500).
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<br />WORKERS COMPI]NSATION DECLARATION
<br />I hftby .liim mdd F..lry of p.dury o. of lh. followin8 d.rledi63:
<br />I twc od eiu roinkjn ! Cdtiljc.r. of C@@r ro Sllf-lns@ for mrko cmFB{im. e Fovidd fd by S6ri@ l7m of6.
<br />r.Df Coda fc th. Ffme of th. wdt fq whict lh. Fmi ir isu.d
<br />_lhw.&deilln aralsdld cmpari.lio iNlmcc, e r.qurql by S!.!o r?0o of dE tlbd Codc fa 6. pdforit.e of th.
<br />**l fd which lhh Fnit ir i.su.d My *616' cepdBiid iaume 6i6 ed poli.y ,mb6 &l
<br />Policy N6be expicr
<br />(Thir siio nc.d no( bc omplclld if O. Frn i! fd On. tudld &llu {ll0o) o. l*)
<br />_l cdify th.r in lh. Ft@ae ol.h. *ol f6 vhich rhb Fmn b isuc4 I 5hdl .or orloy ey pds6 in my runs s a to
<br />ha@. rubrd ro $G wtr[6 cmFu.ri@ lam of Cdifmiq Bd oAr lt.r if I should bdft $bje1lo thc *at6'
<br />@mFft.Iid pFvili@ oa Sed@ 3700 of tlE L.hd Cod., I th.ll, fqrhwilh @!ly with lhs. Fovisids..
<br />WAnNING Fdlw !o .e rrrd' .dnF6li6 cor6zg. ir uletul, &d rh.ll tubjd e drtPlora b diniid Fdt€ Dd civil
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<br />ucIlt D-co!flaacrots-oDcldaAxloN
<br />I h@b, .fim ud( Fmlry of pdjury dta I m li@d unda prcvilia of Cltaplq e (.om6dr8 silh S+li@ 70m) of Divkid 3 of
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<br />,e-,2-2,/a/
<br />OONSTIUC TON LENI'MG AGf NCY
<br />I na*, dim u!r'a lady of Fjtry lir 6@ i. ..(.miirdicr lardiot .3aEy fd rL Ffare. of dE r6t fa ahicn id. Frnit t
<br />iurd (Se. 30Yr. (}v. C.).
<br />AEUCANIS.OISdAAUqN
<br />Damliri@ Poftjs-Alh618 Notificrid F..Ld, R.Suldd Girl. 40, Pdr 6)
<br />_ R.qunld Ltrr ot No.ificltid
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<br />c6dry thal lh. f.dEd Ggddrois r.SlrdrnS lb€ld t!@v.l N sol +tlicdlc to lli! Foj.d.
<br />_ I cddry thar I harc rad $i3 .rplicde od !m. Od $. $or. i.f6nni6 b coG1 I .sG !o .@ply wnh dl City &d ctuty
<br />odi@6 ad Sl& t,M tdairy lo bsildirS @i.ud@, 6d holby urhci& EFFaLliv!. of lhis Cit, Dd CMt, ro 6rd upoi th.
<br />.borc tEddcd Flpaty fa aEpcria pl F.B.
<br />r,wriqrqasarsle.: :4 /1*:p.,.' 9-4 /tZ-zz,z -/27-<.;
<br />Waste & Vent
<br />Water-Underfloor
<br />Gas-Underfloor
<br />Building Sewer
<br />Area/Storm Drain
<br />lnterceptor/ Clarifier
<br />TOP OUT
<br />Waste & Vent
<br />Water Piping
<br />Gas Pipeing
<br />Roof Drain
<br />TubiShower Test
<br />Rough Water Heater
<br />POOUSPA
<br />P-trap/Drain Line
<br />Main Drain/Pool Piping
<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 />Rough Plumbing EXPI ?ED
<br />Final Gas Test
<br />Meter Release FFB O I ?019
<br />FINAL
<br />Notes, Remarks, Etc.
<br />Word\wps1\Forms\Pemil lnsoection Forms
<br />UNDER GROUND
<br />COMMENTS
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