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PLUMBING.INSPECTOR RECORD <br />APPROVALS DATE tD/stG.COMMENTS OWNER BUILDER DELCARATTON <br />I h4by a,Im uidd podry ol pqjutr rh, Iaaofl ionrhcConr noF Uc6e L!* lor lbc followfu rajr (Se.7011.5 <br />BBiBr .d ftofaioi Cod.)r Ary Cny or Cou y whth r.q!t6 ! Frn ro @i! .l. ,16. itlproE da@lin or i.Fn Ey <br />slrucruc, Fi.r ro it! ias@a .Lo r.qut6 th. lprlica lor 3uh F'on ro 6L r !i8!cd nn.,!r.d rhd lE or J'. is lic@.d plmrd <br />io th. Flviliou of rhc Co.rncrols Lic@.d L.w (CXlprE 9, C.M.ei,g *nh Sdlion 7000 ol Divilion I of th. BwilB ed <br />Ptufdiou Co&) or lh.r h. or ihc ir q@pl th6.fior &d th. bGi! for rh. dl.gcd q@Eon. Any viohriof, ofs<rbtr 70ll.J by ey <br />.ppli.&r for r pa6ir subjd! L\. rrpli.&t ro . civil p@Iy of et horc lhu fiv. hu Lcd dolld (t500). <br />-1. <br />a o*r.r ofthc FlFry. or 6, .nplor6 eth s!86 a rh.n $h oopddion, wil & dE wst Ed lh. !dal@ i3 mi <br />idq{Gd M ofrdcd lor $L (56.70a4. Bsir4 d PmfanoB C.tlc TIE Co'rr&roit Licqe trw do6 nor @ply lo & ou@ ol <br />thc FnFty wbo hddror irprD6tlEa(adst &6sh srt hirelror herlf orlhmu8h hir orha oM atplo,€, <br />povidd tha sch inFoErEll3 @ ml iildd.d d ofrftd fd eL ll hoslE,llE htriBi.g d ilq.lrqd i! sld wahh m,G <br />ofcoriplrb& th. O*!q &dra wi! h!v. llE b6da ofFovtB thi b. or ilE did ml hild or iBFot ll. PrDfdtt br dE Frpos of <br />I. sohsofrn Fwsry. s.rclaivcly codr!.1ing s ith licaE d.oiElcro6 ro o.qrucl 0E Foj6l (Sc, 7044, BIIIB <br />!d E!6isbn C.d.: Th. Con[&rol3 Lic@ Llw do6 @r @ply ro e ownd ofpmp.ny wlE brildr or iaprcld 1hd6.. <br />od wno co.lE le for ruct Prljets wnh . Conr'Ero(s) lkdE d puBullr ro rh. coimdoit Lic@ try) <br />I m cxcmPr ur(k 56l <br />IACLASAIqX <br />I t6*,, rrm un(k pd'rlt, of p6jlry on. of th. lollownu d4l&1io6: <br />Ih!t.ddwillMi 6ir a Cslii{llq of Col@r to S.lf-lNu. for mrk6 ompEslior! B pr.vi&l lor b, S6lio 1700 oftt <br />Lrboi corlc fo! Uc Fforll1lE ol thc trlrt for which $. Fidl i! ir.u..l. <br />_l h4c rnd *ill ruifi.io world comp.@rioD iMc., d r.qun.d by S.dion 1700 of lh. t lor Codc. for rh. pdfdtuc of <br />rh. wo* tor which thi! p6ni i! lsFd. M, worrd' omp@aio6 iEUIec 6b dd poli.y n$bq N <br />I cdiry lhll in rh. ldfo,mft. of rhc work for which this Fnn G isu.d. I shdl oor @ploy uy Fen in .ny men6 <br />e B to bcoe 3ubjdr lo thc sii6' coopqEdioi h$! ofcdifom,& ed rer lld if I stEuld beom subjd b th. <br />wltd' odFB ion pevi.ioN olsc.lioi 1700 onn t,bor Cod.. I ddl. fonhw n onply wilh lhoc pNvilioN.. <br />WARNTNGT F ilB. to sR mrl6' comFMtion @r6a8. n uhwtul. &d ihdl sbjcr u dpk'F to ciDi.rl Fuli.s ud <br />civil aDd ut ro orc hundrcd rhoMd dollffi (l!00.000), itr addilion lo th. <br />inr66r Dd fiorrEy s tc. <br />/1 4 <br />DEcid8rnox <br />I h@by afljm und6 pdrlry o I Fjuy thar I o licoB l undq Fovnion olCh.Fa 9 (commcins f,ilh Srlion 7000)ofDivison l <br />of rh. Busin6s Md PretesoN (bdc. ud my licd* i.s in tull torcc &d .IT6l t <br />----LicGcNumhd: <br />co.NsrauclIlIl.f,tollc_ecllcl <br />I h@by amm unds poallyoIp.rury thal rh6c is e N(rltu.rion ldJins aldcy r rh. patomuc. of lhc lork for shi.h lhis Fnn r <br />issucd (s( 1097. (liv (.). <br />AIIIICAXLDECLI&IIION <br />I h*try affm und.. lEnaxy of Fjury otu of lh. lollowinr del&nriod <br />Dcmoltion Prinn$Asb€ros Norifi ration lcdnrl RcSulllions ('rilE 40, Pan6) <br />R.quircd L€tle of Nolificatun <br />I .diiry rha fi. f.d6ri r.eulllioN Egrding Bb6ro. rdovd &. mt rpplic$L lo thir prujal <br />I rgG ro .6rply {ilh Cny ud Couly <br />i.F.dl6ln6 of lhir Cilyed Counly I <br />!bov. mdlioBl rrroli.n, ior iNF(.lioi <br />Applicrnr or AEml Sipnrttrrr:o.r" - I 4) <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Building Sewer <br />Area/Storm Drain <br />lnterceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Piping <br />Roof Drain <br />Tub/Shower Test <br />Rough Water Heater <br />POOL/SPA <br />P{rap/Drain Line <br />Main Drain/Pool Pipinq <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing <br />Meter Release <br />FINAL 3-tfzt /z /.),tt *vt P;{V <br />-I <br />Gas-Underfloor <br />Final Gas Test <br />Notes, Remarks, Etc. <br />lI