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PLUMBING.INSPECTOR RECORD
<br />COMMENTSID/SIG.APPROVALS
<br />UNDER GROUND
<br />Waste & Vent
<br />Water-Under f loor
<br />Gas-Underfloor
<br />SewerBuildin
<br />Area/Storm Drain
<br />lnterce r/ Clarilier
<br />TOP OUT
<br />Waste & Vent
<br />Water Pi tn
<br />Gas Pi i
<br />Rool Drain
<br />Tub/Shower Test
<br />Rou h Water Heater
<br />POOL/SPA
<br />P{ra Drain Line
<br />Main Draini Pool Pi I
<br />Fill Line/Back Flow
<br />Pool Heater/Gas Line
<br />Miscellaneous
<br />Gas Service
<br />Water Service
<br />Lawn S nkler
<br />Sanit Sewer/Ca
<br />Back Flow Device
<br />&Rou h Plumbi
<br />-/(vFinal Gas Test
<br />Meter Release
<br />FINAL
<br />Notes Remarks Etc
<br />()}!Nt:I{ [trrr,DF]R Dul,cARA rl()N
<br />Irrrchylfrilaruidcrpctrilty(,rP.rju,yrharlrncrcnlprlmnrrhcConr,.ronl.iccnkLtwrirrhclolhsirsrcN)n(Sc'70-ll5
<br />Bu\inc* rid ltoltssion c(xlc) Any Ciry or coutrlv *[ich r.qrnc{ I l)cmir (I .on{rucr. nlt'r' inlpro( d' sli\h or rcP'n onv
<br />(ru.rut.prttrl()ilsirsurtrcc.nl$rcqun.slhcrmlic!.rlnr\u.hFrarirk'filc,si8ncd{!'ntrhh'orshcisli'ctr\cdnuisurnl
<br />ro rhc nn;enioN of rhc co.krcrois Liccisd rtrq (ch0ptc. 9. co,n rcncing {iih scdion 70(n ot Divi\i,)n .r oi rh. Ilr\inc* and
<br />Pi.fcsrionrCodc)orrldh:or\hcilcrcmrncrcfromMdth.hirislbrihcrllcscdctdlrn'nAnvvt'hrionolSccrion?0ll5hvan,
<br />rnnlicairr{trrpcrnrilsul,jccrsrhc.!Plic!nrt.rcivilrcrrlrvofnormtthrnfit.huodrcddollu\(s500)
<br />l. n\ owr o f rh. l,.ltny. or ny cnlPnrla\ *irh *d8cs !\ rhcn sh .onlt)cn! nnr' will do rlE u('rk dld lhc (Mrun: n nn
<br />inr.nr.{ o,oflarcd i; s;h (st ro14, Br\inc$ 0nd ftolcssn,.\ cod.r lhccodr ktrsLiccn\ctiwdoc{oorlPllvtoxnownrror
<br />rh.!tuIEny who hoild\or iqh*!\ rh($n. dsll' o.\rn hwo,l(hnns.lforhc cllorrhrotrShhi\orltroBtrcnrlnrr'cs
<br />p,ni,iaia,r," .u"r' inrlnovc ;trh m frr inic' Lrlor.rtNl lbr {L ll h,!cvcr' rh. t^rikliu or i'npn'vcnrnr A rH qirhii onc,t tr
<br />;r$nDLrion,rhcoutrcrBuildssillhNtthuhwLnor|n)viflslhllhcor{hcdid,bnildori.Umvc$'lmFnvturrhclu|rtol
<br />-1,
<br />r\owtr.r.r thcl8'pcny, aN cxchrih l! .onrrrcrirs sirh licctr\cd.onlracr,sh(on$rucrrh(prujccr (S'c 7u1'1 I'u\incs
<br />,r,l hi'rissi'nC"dc Th. Coihcr.i \ L rcn* La* {iocs nor ,Ppl, h un osi$ .f !np' v sho builds or inr[otcs rhcrcon'
<br />rtrd who conm.rr fd such nblcc* virh ! Conrtutn(, liccDscd lur\urtri lo rhc Gn tt'rol s Litcn* L'E )'
<br />I n.xcDrrt undcr Sc.t B.&PC f(rrhist &\on
<br />IAtrf,EBS:IOIITENSAIIAN
<br />D&qLAEAIION
<br />, hcrct y sffiflnundcr pcnahyofPrjuryorc oi'h.lbllowiry dcclMrioos:
<br />-lhllealdwillroinlainac.nilEalcofconscnllosclf.lnslrcforwortcrs..ompcnsion.uslmvidcdforbys.clnl]TmolthcLa&tr Gnc. tu rhc !.rfotrokc oi thc wo,k l'or wnkh thc !.rmir is itsucd
<br />-l
<br />hrlc rtul sill arlinr,i workcF compcnsariotr insuranc.. as nauncd bvsNliotr S?0Oofthr tabot GBc lbr rhe Frr'rruncc or
<br />rtE v.ik tor which lhn pcm'il is issucd My vorlcc mnll{n{rion insure.c cMtr ud Ir']li'v numbcr sc:
<br />Cdici '
<br />Policy Numbcr: - ErPircsl
<br />-t
<br />enirylh in ln. Frformrcc of lhc worL tor which lhh p.nnir is i5slcd l shsll ml eoplov my lcrsr i! ulv mnftr
<br />rds ro *om sutrici o r* workfa snp.nslrion lrM of C,liaonia, lnd trge thal if I should hcom sbi(l lo rhc
<br />sort6 sml,cBaiioi ,tmvisions ofscdioo lrOOoflhc t br Cod.- lsltsll. fonh*ilhdrDlv wnh rb€ psvi3ioi3'
<br />W RNING: Faihrc to surc w.tkcts comlc nsolion cowBg. h unh*tut. ed shdl slbj(tt atr cmPlort, lo $iftiml Foallts ed
<br />civil fincs uF to orc nxndnd lhousnd dol
<br />S(li,rn 11076 of rhc ljtrr Celc. inrcrc{,nd
<br />in .ddilion ro rh. cosl ofcdEp.nsdi.n. d,m8cs as Povid'd ror rhc
<br />,*.--]f"-b,/J.f
<br />DS:IIISAIII)N
<br />I hcrcny.ifrmrnd.r pcnohyoaFlury rhar I s6ltrn*duod$ p;nion olChiprc' 9 (connm in8 sith Sdi" 7uJ0) ^r Diltinn 1
<br />of lhc B!\inc\so d Pdt$io.\codc,ud n,Ii.rtr{ is in tull foE. t$d cllccr
<br />'?o l9 t'i
<br />v, */abl{Qzc.<*-t ?,\e<f,i6
<br />CONS'IRI](: ION LI'NNIN(i A(;EN('Y
<br />lhcEbyllfumx.d.'Fnlll,otpdjuyrhallhcdha.onsrruclionlcndinSng.rc,firrh.,).rfonon.coflhcsorkfor$hichlhkFrolilis
<br />i\su.d {sc.. 1097. Civ. C.)
<br />L.nda'. Nlc;
<br />Lrd.. 3 Addrcs!:
<br />I ccnifylhlr I hlw rctd lnh Drn srurc rhd rhc dhovc inlbrmrti.n hcoftcr' I lgm to ofrnlv wiln rll Cilvand Courv
<br />orditumcs nnd Stllc lj*rnLting lo ildin8 c.nsmcion, &d h.rchy lulh.tiz. rcPcsnlariws of $h Cnv tnd Countv lo .nl6 ulbn 0E
<br />$ovc nHrioncd rmpcn, for
<br />appli.Nl or Agenl SigMlu ^",
<br />-l/z.b/ft
<br />DATE
<br />ATILTCANLDECLASdIQU
<br />I hd.tyam 'und$
<br />pcnehyotp.rjnry orc ofthc aolk*in8 dcclualions:
<br />De@lition Pcmn! AstEeos Norifi.ttion F.deral Regxlaliotrs (Tirlc 40. Psn6)
<br />-Rcqutcd
<br />Lrn.r of Noliff, athn
<br />-l
<br />.cnif, rhal ln f.dcnl Egirlarions tg,rdine asbcsros reevd trc ml aPplicsbh to lhil nbir'
<br />k(a
<br />A7-y-l rql
<br />y-Ll#ff
<br />v-tfifi)
<br />U w
<br />X^du )L\410
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