|
BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE IDiSIG.COMMENTS
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/lnsu lation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing / -ro'-zoz"'zl t.7
<br />lnsu lation/Enerqy
<br />Drywall
<br />Ext./lnl. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL A.'2,lzD (LL, e,tteZa.;2.r7
<br />Certificale of Occu pancy
<br />Notes, Remarks, Etc
<br />4)
<br />ra -.2c2
<br />aK-
<br />'L-Z-.vP
<br />OWNDR BUII-DER DIiI-CARA'IION
<br />I h.khy affirm und.' fnahy ot p.rjury rhar I m.r.hpr h,m th. Ci'itrctrr' Li..n{ Lrw tu rh. f(nl,)uing rm$n lsec ?lrll.5
<br />Aurin.\r aid ltof.si,tr Con.) Any Cny or Counry which r.{uia\ r Fmir ro $n{to(. ahn. imFn,v.. d.,mlish D rpn in}
<br />,ru.rur.. prirh irs kunc.,,lq) rcqtrircs (hc.ppric.nr fi, \uch D.rmir r) Iil. a \i-gned {ar.,Enr rhd h.or\h. n ftcntd puhumr
<br />b rhr pmvhirN olrhc Coitr.r.is Liccn\.d lje lchrr(.r 9. Commcn.in3 silh S.cr;on 7lxx,,, Divisi()i I ofrlE Bu\i'r.s rnd
<br />Pnr.($n(C.dc)n(hatlt.rshet.r.nrr"rhmfiom,ndrnhostforrh.all.Bed.x.mflion.AnyviolartunnfS.di).7o:ll5hyrny
<br />rppliranr fi, rn rmir ruhj.ci\(h. rmlicrmhaci!ilpenahyofnoimnerhiilikhuidr.ddollrrs($5m)
<br />Lar o*n.rofrh.Dn,rrny.or ry.dplorr.( rnh waSes i\ rh.n ('k ..n[.nsr nn. willd. rh. wolk 3nd tlt vduG i5 n
<br />inr.id.'l or orf.r.d ntr vk rs( 7rx4. Busin.s and Plof.s$ns Cod. Th. ttnkacrn 5Li.nr bw d .r nor q'rly rosnown.'ot
<br />rh.rm)Fny sh, huikh oi nqrr,v.srherDn, rnd lhod*ssu.lr krl hinr.la.r h.n.lfor rhnuehhk,n h.r own.mthy.e\
<br />phvil. rh.r srh imlnrvoEns .B mr id.nd.{ or .rLEJ li{ ek. Il hJq'.w, rrr hdkliry or iqmkrnt ir q,ld *thin on. }rd
<br />ofornFlcri('n.rhcoen.rauilkrwillhaErh.tDid.i.lt'nvins d h.oriEdil nn tuiU or i'nl,mE fi.Im!.ny for rlE Brlneof
<br />-1,
<br />asorMorrh.t oFny..,n.r.lusiv.lyconrdnB siih lr.nerl.on(rtn rn conrDd rlE I'n)Fd (Sd 7()1-,1, Bu\ift\t
<br />.n Pn'ft\\ni (nd.: Th.C.nta.tn iLi..nEl-{wd..( n ripplyr) {io*i.. olproFflyrho tarilds or im[ov.! rh.r.o..
<br />.nd who conrmrs itr suchrn,j..F wirhrc.nrmdo(s) lic.rsl ru4unr n)rh.Conurdoi\ t.k.ns. tir).
<br />I.m.r.mnr und.rSdrion-, B & P.C. fir rhis tsan'n
<br />Dd. a-l - oin.r
<br />]tlrS[lrllSqMlElsAru!
<br />ltECLASAlIOA
<br />I h.rby atfiro u nd.r p.nalry of p.ilury on. ofrh. finhsin8 delihrinnr
<br />-l
<br />hav. ofrl*illmainraii o C.niar3re o, Corsrr D Self-lnsur. Ltr wnl.r'conrptn\abn. es nnrvid.d Lt byS.crion l?ulotrh.
<br />Ldhr Cd., fr th. pdfdro*. r)f !h. rork ltr *hich rh. ,'.nnk is k{.tl
<br />-l
<br />hav. and vill miniain work.N' smp.nsai ion iosumB.. ir EquiEd I'y S.crion 1?(x, .f rh€ tihr Cod., f.r rh. Fr.mnc. of
<br />ih. pork f,tr whkh this Frmir is is$ed. My work.N smo.nu i.n ins!runc. wi.r a policy numh.r .:
<br />lc.nifyrhar inrhr p.rfonhMc. ofrh. wnrk nr whrchrhi\ fr.rnrir i\ isn'.d.lshnllmr entPLyany n.ison in mymmncr
<br />{,ast)h.com\uhj.c(hrh.wo*.r'smp.rsxri.nlaws.l(rl'Lrni,,indagr€.rhdillshruldh.cdmnthi..rrorlr
<br />w *.n dnlcnsdnrn lln,visiDN ol S6n.n l7(x) .l rhe l rttr C'rl.. I shall. fodh$irh comnly * ith rh)r pn)ltion\
<br />WARNING: Fdlur. n, r.ur. qnt.n .omr'.isdi,,n $v.h8. i1 uiltrwful. 3n,l \hall {'hi.cr an e'nploycr n, fiiminrl ncnilrE( ind
<br />civil fin.. u,' n, dn. hondred rhnrnnd olla ril(x),0(x)). m rddirir( b rh..on ol cohFnrarion. drmas.\ a( Fnrride{ nnrhe
<br />s.cri)n 10?6 ofrh. L.trn cdl.. inr.Es and itrorRy \ rc.s
<br />5 t -l 1
<br />I herhtlf,irnrtrnd.r|tnahyolntriuryrhd I nrlie.nwltrndcrn inx sith Secii,,i7(rrr) f Divni.n :1
<br />D.re 5 l- \9
<br />I h.Ehy atlirm und.r p.nahyofp.duryrhd th.rc is...nnrucrion hndi.a a8.ncy f(tr rh. Il<rform!tu. nf th. work lff whichrhit Firrii k
<br />i\su.d (Scc 1097. Civ. C.,.
<br />AIII,ICANI-DIICJ.ASAI]O!
<br />I hd+,y rnim uid( FmhyorFrjuryon. of rhe f{'llo*ing J.clTaiion\l
<br />Demniii.. P.rmirr^sh.nos Ndrificari,)n rrd.'!l R{urdi')ns (l tle 40. tan6r
<br />R.qun ,l t t.rofNorilrarnn
<br />lc.nilyrhd rhe lcdrrrlrcsulnrion\ Fs din!i{h.{osr,r)!rl.rcn!ril|1|)li.rhl.hrhnl^ii.cr
<br />_lcd'fyrhd lhiv.r..drhh.pDli.di..ind{.r.rh..ti)!.rnitrft ionircor.d IrgrEhconrrlyqirhallCiry.n'lCourry
<br />rdinrncc\ and Skre l- *sBldn,!r,h.rt.l,] trilr{r.'e c\.nhr'v.\olrhn('ryrn{l(i)un(r-!). rrtrfrrrk
<br />11!)vc rft iri(n. pr,ncny n, iir|)ecr$i
<br />5-t-l?
<br />EI
<br />Forms/Steel/Holdowns
<br />oI rh. ausine$ rnd PioL$i,,nsCod., md n,y lic.ny k in fullf{irce and.ffccr
<br />!
|