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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS 0lvNltI( B(T .DER I,l]l-( ARA',ll()N
<br />t hcrchy lrlim (n,lcr p.n,lry ot F.riury rhd I d .kcdtr rmfl th. CinrracroF' Lic.6sc rjw lor rhe li)llowsg G,aln (Se 7011.5 .
<br />aosincs mi Profcson C{ric): Any C y oI Counly *hEh rcqutcs a Irmi lo lon(rucr. alrd. inll}hv.. Jcmolish or rctan dv
<br />srflrcrulc. n itrk, ns i\{rdrf,c. ilso rcqutcs rhc ap ica ntr suchFrnilk' lilcs nsncd iarcmnt llrlhcorsh. i\ liu.nsd luBsant
<br />ro rhc pmvhknN ol llE Conrrarroar Lccnrd tjw (Ch,plcr 9, Cdmnctrcrn8 wilh Sctrion 7ur) or Division I ol rh' Btrrin'* 'nd
<br />Poic$nrorCo,lc)orrh h.orsbc,scxcmplthcrcri,nr*lrl[banst(JrlhcallcscJer.q)rion.AnvviohrnrnolSc.rrnT0ll5hvanv
<br />appli.ur [n a p.mit subjccls thc applicanrl{,i.,vnpcndxyofNrflorcrhanrilchundnddollun($500)
<br />-1,
<br />!s owncr ol rnc pn,ptny. (, my cnP!)yccs *ilh *!Ses ar rh.n tr,h conrp.nslrion. will d. rhc wD* anl llE (ture n nnr
<br />idcnLtsl or otlcr.d for salc (Se 71}44. Brsi'c$ ud Profcsions clilc 'l hc Ci,nr..ktr's l-Nnsc Law Jt8 nor amlv b .n ovn.r of
<br />rhc lrnrFny wl$ huiusdr ir'omB rllB)n, anl wl d(s such u'rL hm\cli or h.relf or rhflru8h hi\ or h.r own coplovc$.
<br />lrovid.d lhrr nrch inpn'v.tunh m n intcndcd or oficrJ li)t sL ll h *cvci rhc t{ Jin! or r:o$vcmnl is $ld within "nc F]r
<br />ol oq'kr!'n, rh. Owrcr Burldcr will hze rh. htr&n or PnrvrS lhat hc ot dt Jii nor build or nr{rrt dr ptuFny ror lrx PUrIiJr of
<br />-l..so*ncrotrhepop.dy.rnctlusittlyc.nlncrirrSwirhlir.n\cdco,rr.rl,)Ebconntucrrh.pnrt.l(Sc.7041.BunncsslnJ l\'lc*ion Cl)d.r Thc Conrlr|,tr s l-iccnsc Lrw d({\ n.r apply lo rnoencr otf()Il..ry *h) 6uild\ or inrPrcvc\ rhcr.on
<br />nnJ 'h, ronrr.r\ lor {ch tmFds wirh r Contrbi t I'ccnscJ Nnua n,rkClnntucusl-i.cnscl-rq)
<br />a &P( l! thts,cdjin
<br />I!ORKERS' CON!IiENSATIoN
<br />ulcunauiJx
<br />I hcrchyaltumtrnJsli,nrlryol Pcrjuryoncofihcl,)lLsn!Jccl rrn'nr
<br />I hav. aJrl wrll nrr .in i Ccnrtuare ol Conscn( b S.lf-lnsurc lu *orkcr! conPcnsaril)n. as FoYiJcJ ntrbvSc.rbn 1700ntrhc
<br />L{h{ CoJ., lor rhc trdnrruncc of lhc worl ,br *hi.h rhc ptrmil n issucJ
<br />h,hrlc.kl hllmlrnr.i'r work.ri .om!..s*on insuran c, as r.qtrtrcJ hySc.io! l?00 ol rhc Uhor Ci)'lc lnr(h. p.rlom'k' ol
<br />nrNnsati,n r{trxn c.Mrr rl E,l'cy nunbc! rc:
<br />:L0ql (po b
<br />lcniiylhrr m rhc i.nnrnrrRc ol lhc worl ttr whrhrh's P.lnrir r issucJ.l \hru nur cnll,lovanvPcr.n in rriv manncr
<br />v' r\t,h((n* suhjcd n)lh.k,kc( comP.ns onh*solCrliturnh.dndi3rcclhlrirl\lrrldlf,.orNsutjccrt,rhc
<br />wortch' .ompcrsar i,)n pmvsoh\ o, S.crion l7O0 ol rhc lrrr Codc, I $.ll lnn h*irh onltllv q ih th)s nmviron\'
<br />WARNIN(;] Finurc to scurc sortcr' cont n\.ton udvcnr3c
<br />.ril r'nc. ut !' '{r hud'.'1 h,".!nJ J',llrrs r11u.,0(l'.. 'n
<br />SccLon 1076.frlE litxtr CoJc, inr.tci.rJ alkimy s lics
<br />t utrhvlirl, Md shrll suhjcct rn cn{lt'ycr l(' lrmlml p.naxi.\ , l
<br />rhc ro( ol (on,Fn\rri'r,. dani!.s
<br />*", \{wlt"'p
<br />l.llr!ld!!l!
<br />I hcrhy illnr trid$ pctr lty l trrjory rhd I inr liccnwlutrdc. pn'visi.n ol Ch{'lat I (.oDNnrn,E sir hs.di Tt)(x)rol DLlAtrtrr r
<br />ol rh. B!\ncss.nJ Prnc$DnsCo'tc, trii my ticcnsc i! ir lull ltr.c tull cll.cr
<br />l.hq to44q(o
<br />\ l\w n oLP7I
<br />I hcrchy lilirm nftier ncmlry ot ,.qury rhrr lhcrc is a drnrmcrion kndin8 a8crey tu lhc lcrformme of lhc w.rk ror wh,.h ths P.mil is
<br />hsued (Scc, lm7. C,v C ).
<br />I "ftlc''. J,l'c\.:
<br />-
<br />-l.cnrlylh.lrhcte,lcralrcsxlatonE8dd,ns.shcn.slcnx'rrlftror.Plli.lhlcbrhttn*cr
<br />&,t ilyrhrr I hrv. rcaJrhN rt'pli.rri,)n inJ (rrc rharrhc ah)vc dorn'r! rr(rc bd,mply w h dlCiryrtrd Couniy
<br />s aftl srarc hws tohrin8 ro huilJ ol thicil!rtrJ Counryklctrrcr trr'n rhc
<br />$ovc nrnrtrinc'l F,0t^_rrt l(tr uN
<br />r / lV l?-oZoAppli.Mt o. AAent SiAmlrrc ?o{\-'r-- l
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation I .z-t )
<br />Roof Sheathinq | 2J.7O2o Wr/bg0'tl tr
<br />Shear Wall
<br />Framino
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />a)
<br />FINAL t'2?'u20 Ualhp't >a
<br />Certif icate of Occupancy
<br />Notes, Remarks, Etc
<br />knnq's Nsnc
<br />-
<br />APPLICANT DECL{iATION
<br />I hsrtya imlnnerFnalryol Frjury om oflhc tulhwing Jelerrninr
<br />tumlnio. Pcrmih-Asl,cdos Notdi.arhtr Fclcal Rcslhrnrn. (Tirlc 40, P.n6)
<br />Rcqurcd trn.r of NolUdtl)n
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