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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS Omd-Buildd Delnrid
<br />I hcby ifrim uidd ,@.lty ofpdjlry thAI I m d6pt fm lhc CdE&loB' Licolc Low fd lh. followios Bo (t4.?01 1.5 Busind,
<br />od Preaqi@ Cod.): Any Oty - CoBty *hi.h EquiB . Fmit 1o .drtu.( !tLr, inptov., ddoli$ or EP.i. sy nrudur., prid lo iE
<br />isB@,drc Equi6lh. lppli@r fdt$t,Emir ro fl. ! risDcd rt &lMt t[.r h. or th. i! lhot d puE6t to lh. prcvisioN of thc
<br />C6t&rdt Li6rcd r3 (Cn p(.r 9. Cqtl'llein8 sith S..ti6 ?000 of Di !i6 ! ofth. Bu!i..!t ad Prcf.Bi6! Cod.) or rtn i. d
<br />rh. qcnpi lh@lim ed tll. bsn fc $. .tl.s!d qmli6 'Any vio!.li@ of sccrid ?0,l.J by ey ipgliol am. p.mn $bj.c! th.
<br />lppti@r ro . civil pollty of nol nd! tlu fiv. tundld dollll' (tJ00).
<br />_1, ! omr ollhc Frpdrr, d my nployd *ith *186 s 0!Gir tolc c@pos.tio,r *ill do $. wGt Md th. it!.or. ir Dor iit nd?d
<br />6 olfcFd f6 rilc ( Sd 70,l,l, BuiB !d Pref6li@ Cod.: Tt. C6tr..ror! LiclM Le <to4 noi !ppl, to 6 oetr( ol ltu prop.ny
<br />eno buildt d ihFou lna6, md {ho dod rE[ *dk hi@.lf d hdda o thrcu8l hir or bd oM .hployer, FDvidcd thl suct
<br />imprcva!.nB !ft nor inr6.t d d or@d f6 i!lc. Ii hd.q, th. building or iBprovmcnt t told oilhin m. yor of cohpl.rion, dc
<br />o*n6-Buildn *ill hlE lh. brdo ofprwi,i 6 h. q rh. nol buid d ihpfDv. fd th. pt,p6c of !.1.).
<br />_!, E omE of 0E tr.,pcny, 3 Nlqiv.ly 6nrn {n8 *irn I@.d @E&6 b cdrtn r tt. proj.ct ( S.c. ,Oaa. Buiner &d
<br />!rof6!id code tlE C6lr&tor! Liffi. L.w dc not lpply to u om6 of propaty who build! a iEprcva Ihd.on , ed who
<br />contrdi fo. iuch prcj4t witt . conh.br(3) liccB.d plnu&r ro th. cdlodor'! Li..ns. L.*.).
<br />_l .h .xnpr undcr S.ctid
<br />If, ORXXf, S COM?TNSATION DECLAII TION
<br />I tfrby aflim undrp.n.lq oap.rjury@c ofrnc toll in8d*lelio"r:
<br />_l h.v. 6d *iU D.jnrjn r c.nifi@ .f CdMt to S.tf-Idur. f6 wdkBr' .6r6!.tio, B rrovid.d fd by S.aio ,700 ol th.
<br />Llbor CodG, lor lh. p.rforBe of fi! eort fd *hich $c p.nnn is ia!.d.
<br />_l hrw.rd will h.iiriir r6t6i @rpdsti@ iNuMe, a rcquiEd by S..dd l70o of tu rlbor codc, ftr lhc Frfomrn@ of lhc
<br />ed( ftr dich thir p6ril h in!.d. My wqtd' .ftFndion irolm@ trid ed policy numb.t rc:
<br />Policr Nunlct1 E PtB:
<br />(Ihir !6ri6 i..d nor bc @nplacd lfrh. pniil it fd or. hultld &lla l3l0o) d 16r)
<br />_l cdiiry $!t i. ttc pafmlnc. o{ $. *o* for *hich (i3 t(,nir a, inll.d, I rhdl not anploy Dy ,ElM in uy men6 30 s to
<br />b..@ ruliet to 0E rqtd ' c@pctr!.li@ l.*t of qlifqti4 md lsE rh.r it I lhold b.ffic ibj.C1 to $c wakd'
<br />c.',np.Narid provitid ot S.ctio! 3700 of ttu lrbo. Cod., I rlEll, tonhwith conply wirb rhorc provilioo3..
<br />WARIIING: Flile to ttr wortE ' cmFn!.tion .ova.8. ir ullwful, ed ih.ll lubjdt e nployq lo diminal p.i!hi.! ed civil
<br />fin6 up ro @c i!n&.d lnNmd <hll6 (tl0o,00o),in .dditioi ro rh. cd( of.onpdraiid, d!m86 a Fovid.d fd tb. S.ai6 30?6 or
<br />rh. kbor Codc. inrdBt ud .n@.y'! f.s.
<br />LTCT{SED CONTRACIORS DECLARATION
<br />I h...by rfiim undd p.n lt, of pdjury thd I m licd.d mda prcvilio of Chaptd 9 (@.ncan8 witn s.dion ?000) of Divicid I or
<br />ih. Buti.6 D.l PEf6rid Codc, ed ny ,ictu. ii in full for.e .nd .ffc.i-
<br />Lic.e Cle:- Li6rc Nmtd
<br />o*, S-t a? i c^*"^,
<br />cq!flaucr0!-LllD.BctcENq
<br />I h.rcby tftifr 6dd pddry of pajlry tut lh@ n . cosmcli@ la.lins .racy for lh. p€ftu. of rhc qd* rc whi.t thir p.mit ir
<br />iBEd (Se. 1097, Cie. C}
<br />Lddd t Addrsr' _
<br />AP'IJCANI'S DICI,AR TION
<br />D.mlitim P6h!-ArbBrq Nolificliim F.dd.t R.Bul.ti@ (TitL .0, Put 6)
<br />_ Prquidd L.nd ofNo{li.lti@
<br />_l ..nit $d tn. f.&d l.8!hti@ rg.nlins 6b.3to! rsnor.l @ ror ipplidbl. lo 6tu prcjcct
<br />_ r .dit lhn I h.rc Md lhtr !!plic.d6 ad t . th.r lh. .borc iifmtion h 6Gr I r8rt ro cmply *ilh dl Ciry ed Co!m,
<br />ddindB 6d st r. t,B r.ldi8 b boildirr cdrucion. ed hdby erhdir r.pEal.drB of rhit Ciry m.l Cdnty lo nrr upon Ih.
<br />!bov. n nrion.d prDp.rt, for inlpelim flrpord.
<br />t//> t-zt t .1L'i4
<br />-./4
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Su bfl oorlr'enVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Handicap Requirements
<br />Deputy Final Report
<br />Engineer Final Report EVItrbE
<br />FFNNI 't,q
<br />FINAL r\, o-+.r, zt o, !56, 667
<br />Certiflcate of Occupancy
<br />Notes, Remarks, Etc.
<br />Pool Fence
<br />T-Bar
<br />Flood Zone Certificate
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