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BUILDING- INSPECTOH FECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS 0\\ Nr:R llr rr r,r.]R r)lal { .\k \'I I()N
<br />I h.icby alirnr urlcr p.. ry (, Nrjury rh lNcx. rl, n.rn rhc Conkn.rtrc Licc.sc u* nrrhchllo$insr'n-tr's"7olll
<br />Irusincs{ rfrt Pi{nrs\i( Code) Atry Cny .r Cotrnry qiich rcqunc\ , tcruir lo connto.r. ahcr, i,nProrc dtnn i\h a /cf^'t rnI
<br />\rrucrurc. pri(tr t, irs irsu{Nc- rl\. rcqnics llEnPplicanl ntr \!chrnnillo lllc rngtrcd sl.lcnEnr rhrr hco.\hc is li"nsdd luruu r
<br />t) lhc rori\ioos of rlt (onlmcrois I icdh.d ris (Chrln.r I Connncffio8 *irh sc'rnrn ruxl ot Divi\i :1olrhc B!\tue$ rio
<br />Pdc\si{NC.dc)orrhrlhcor\hcncxc plrhdcnomannl[chr\i\lorrhcollcgcdcxc.rrriur.AtrvvnrhrnrtrolS(rio!70:]l5byrnv
<br />Jnrricair ror n pcmir sul,jcck rhc +tli.inrr.rcililPcntxyor ur rmrcrhan fiv. hundrcddolhB rs5u))
<br />I.r.osd$olrltr|[,|In!.oruycnr0lor_cc\!irh$astsr\rhdrvrc.nDr.trufotr.Nilldorhcsorkridrhc(nrhcn'ur
<br />rhcOUIEny *ho hild\ or Nlrovcs rh.rcnr. wli)d,{\{([unk l,iu\cll or hcrclfor rhn)u8hhi\ or hcr owtr cnllnov'c\'
<br />l. r\ osrur or rlr pn,p.nr. rm c$lu\ivcly contr&r ils $ irh lie.ns.n conr(us n) ..nnturr rhc l)a,iccr lse 71ll-1. Irr'{nc\\
<br />nDd ft.rN\hnCodc IhcConrrrrr's Li.ctr\c Llw(loc\ mr amlyro rno$rcr ofpr.l''nv *ho huikk or n\rr'rcs rh'rcof.
<br />.nd *ho conrrrc( r(n su.h pr+crs wnh 3 (irnn.tun, liccn{d nlr\urnr h Ih. Cofkadtr s l-kcn$ ltrs)
<br />I rDcrcnrflun,lcr s.rridr- l] &P( turrh'\rcn\{r
<br />Dore: O*ner
<br />1!ORKER\1*OMPFnISATI(lN
<br />DECI,AEAIA!
<br />I h.rchy,mnn undcr pcn.lryolp.rjuryoncotrh€ idbwin! dccluolions:
<br />I hsvc 0al will minrain a Ccniric.rc of Consnr ro scltl nsu( ln *orkeE com!.nsalnnr.!s Povid.d tor t'vS&rn'n 17{x) orrhc
<br />Labor Codc, ror rhc pqfomkc or$c w inr stichrhcpdmr is hsucd
<br />-l h0vc and willnri.r0in wo crs .o'np.trrarion insuro.c.- as rcquncd bv S.cri.i.rTo0 oflh€ l,bor cod'. for rh' P'rr flrr rcnr
<br />i\isndl. M,workd\-con,Nns,iitrrirNuritr.c.xritrrid|x,li.ynntrfi.r't
<br />/.lqbt Lo
<br />lcrnL[rhaiiIthclx.rt) r ccorrhclqk|or*hi.hrhnIt' rir \ i\{nl.l drlltror ctrrPlov My n{r$n i.rnv trrrrtrcr
<br />r, i\k)b.con* subi(1hihc $.rkcA.ofrPr slii hws.i (rlili)n,in. trdll8rccthrr if l \htuld h(.om srh,,]trd rorh'
<br />*orkc6 .onrpci\rrtr rP.ovisions.fSc.rnnr:l?noollhcl]lsrCodc.l\h.ll.lnnhslh$ rdv qirh rlFq rnivi{ons
<br />wARNTNG i.rihiN nr {cur. sorkcr{ c.mncts iion rolcr Fc rl urlx*tul. rin \hrll \uhjc.t r c troycr n, di'ni'i,,1 ncMIri.\ 3nd
<br />.n I ln]c\ up k, uN htr rl'cLi rllrtr\rtri do lxr (\l(X)(xl)
<br />Sc(ltri 10T6,,lrln l nlxr CoJc. dcr e\r nlxrrrny\ltc\
<br />drnnsc{ ,s trovjdcd Ior rh.
<br />1.[.to.
<br />I(h fld9((otrnncncnrgwirhSccrior70Ol)rof Dirhi .l, hcruhy llnn'utr crrctrrlryotpcrJrr! rhrr I on li.dnsod trDdfl
<br />of Ihc Bu\nr\snnd Pn,{cs\i,,n\ C.d.. rfrl nry liccr\c i( in fillf(Rrd clli.l
<br />b lOotl9L
<br />L I oo rar,-
<br />C(TNSTRII(:'ImN I }NDIN(i ACNNCY
<br />lhc{bvalltundcrrinallyofpcl]u'ylhdlhtrcisi.on{flcrt)nlcndinsrscNylh.llrPcrfulnutrccollhc*orkfolshi.hlhislj.nnilis
<br />issucd (Sc.. :1097. Civ. C )
<br />lxtrl.is Nr tr
<br />-
<br />AELICANLDECI.ISA]ION
<br />t h.Eht iilhn uMcr Fnrll, ol n r.,ury onc ol lhc tolb*inA d(l$at ions:
<br />D.nn,li!ion P.i,hnrA\bcsros Norifi.rrn r F{dcrol Rcgrlariotr\ Irilk 40. Pan6)
<br />_R.quncd Lrrlcr of Norilf, di.n
<br />, ccnilylh rhc fcdcrdlrc8uhri,rn\ tog dntg iltr{osrcnx)nl rc norrf|licrhfu t) rhir Fq.cr
<br />r...\ itrd shlc Lrws rldirg i. huildins condndn,n. ukl hcrchyrulh.rizc rcflcscnrnnr\ orrhr! Cirv rnd Contrr! h cnr'r uFnr rh'
<br />rho\c nrirn,icd t) ,!cny lir in\pc.ri(nr I,urtrir.r
<br />,\Dpli.nnt o. Asrnl siSnxlur
<br />r4'r'>
<br />?'C./%
<br />Fo rm s/Stee l/ Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf loor/Ve nt/ ln s u Iatio n
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq 4lb/t'6 9t\Et
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Depuly Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL Io /Ll/tc 5\q{t
<br />Certif icate ol Occupancy
<br />Notes, Remarks, Etc
<br />Set Backs
<br />UFER Ground
<br />q
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