Form Co2 - Plumbing Certification Form printable pdf download

Form Co2 - Plumbing Certification Form

BUILDING DEPARTMENT

VILLAGE OF GREENPORT

236 Third Street, Greenport, NY 11944

PLUMBING CERTIFICATION FORM

TO BE COMPLETED BY A LICENSED PLUMBER

…………………………………………………………….

BUILDING PERMIT NO.

…………………………………………………………….

SITE ADDRESS:

…………………………………………………………….

OWNER:

THIS CERTIFIES THAT THE SANITARY PLUMBING AND WATER SUPPLY PLUMBING WORK INSTALLED UNDER THE

ABOVE BUILDING PERMIT:

COMPLIES WITH THE APPROVED PLANS AND APPLICABLE REQUIREMENTS OF THE NEW YORK STATE FIRE

PREVENTION AND BUILDING CODE, AND

THE SOLDER USED IN THE WATER SUPPLY SYSTEM ASSOCIATED WITH THE BUILDING WORK UNDERTAKEN

PURSUANT TO THE ABOVE BUILDING PERMIT CONTAINS LESS THAN 2/10 OF 1% LEAD, AS REQUIRED BY

LAW.

…………………………………………………………….

NAME:

(PRINTED)

…………………………………………………………….

ADDRESS:

…………………………………………………………….

SIGNATURE:

(PLUMBER)

…………………………………………………………….

PRINTED:

(PLUMBER)

…………………………....

DATE:

……………………………

LICENSE NO.

Form CO2

Form Co2 - Plumbing Certification Form