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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS I hcrcty allirm un,lcr p..aky oi pcriury rhal I ur crcnfl iiom rhc (-onlr..r'a Lictnsc Lrw for rhc i{n!,*m8 rca$o (sLc ?ojl5.
<br />Buvn.1\ r,rl Proltse.n Culc): Any Cir, or Cou y whi.h rcqutcs r Fnni nr colrslrucl alrer inDn v.. dcmolNh or Nlair lny
<br />nnr.rurc. !fltrlo rr\ i\sus-'., alnr rcqurcs lhc appli(lnt Inr sulh Frn r r.l'lcJ \'qn.J {rrcmnr rh hc r \hc n lircn\cJ tunu.nr
<br />b rhc fl)visions ol Ih. Coor!3ctr's Licc.{d l-.w (Ch!pr.r a. C,,n'ntrtu'n! w h Sc(r!,n rr[lt, ID'vr.n ] nl rhc AusinAi and
<br />Pdtsn,ns Co'1.)orrhir hcor shc sctcnnr rh.e,ion Md rh. bnst li'! (hc rllclcJ.(nfl6n Anyrirhi{,nofSccronT0ll5bv y
<br />"Ftli..nl lnrr|f,mi sunjcch rhc apPli(dot b acivrlFnallyoinor mor.rhM,rvc hu rcdJollrs($500)
<br />t. !s own r ol rhc lr)lEdy. or my eny'l,,y.cr wirh qlscs r{hci $lc con0.n\ on, wd dn rhc woll ,nJ rh. {tutm s nor
<br />dtc, .J olollcrcd ld sslc (5&.7044, Bushcs rnJ Pdi$b.\ G .: rh.Co rd.toa s Lrucn{ trw docs .ol rmlv b an owncr of
<br />rl..IruFny wk) huilds.r m{r)ws rhcK)n. anJ wlb des such u).k nmxcllo. hcrtlfurrhfl,ugi hir or h.roa..mplovccr.
<br />pr.vi,lc'lrMrsuch,nptuv.nEnsmr urc*l.J or o[.ft] l't sh. ll, hoMv.. rlt bu Jiry n inu&vcEnr is $ld wihm onc vc{
<br />Dl complcron. llE o*ncr Bliner will harc thc hslcn oI lnrvins rhar lt oi shc diJ tror tnriu or in{ft,vc thc nmFnv lor ihc Erlx,s or
<br />l. N o*ncr ,
<br />'r
<br />rhc tln)pcny. in c\clusivcly courrucri,rr w h lrcr*d ..ntr.t,F b connrud rrE P!+.r 1scc 7G4. Busu'c$
<br />atul Pnrc$in Ordc: Thc Conkdck*-r L,ccnsc Law io$ nor lprly k, anowncr ofPrcPcny {ho builds or mpnrv$ thcrcoi
<br />,nd who co tr.B lir su.h rlijc.h wnh a Co.r.a.h(s) li.cnsq.l Pursua n,rhcconlr!.k, s Liccar lja)
<br />I Jn c\cmprunJ.r S.r
<br />ItoSrcBlcolltENlarll)!
<br />DECT,ABATION
<br />Ihcrcbydltrmundcrl,cnalryolFduryoncof rh.6llorin3nc.l arioh\:
<br />-I
<br />hrwlilwill mmlain sC.nilic,r.ofConrnl k' Sclllnsurcfor workdr ompctrsarion, r\ fn,viJ.d tnr ty Sc(rion.l7lo.frh.
<br />tlbor c(d., lor rhc peritrmn{ of rfic work for whi.h rhc lcmn n hiucJ
<br />I hrvc !n l will nr'nrr'i workcF .omFnrlrion insrhtu.. d\ rcqurol by Sernr .17{D ot rhc Lnho! Codc. lor rh. n rfomu.e .1
<br />rh. work li)rwhichrhlr p.m i\ issucd. My sdrkcn' .omfnsdt on iNurnnuc carif drl f$licy nun$cr n:
<br />o t 242-4
<br />I ccnilyrhrt inrhc |f,rlarnrne.ollhc wor[ nrwh'rlr rhi\ Pcirnii r iss'crt.I \hallnor cnl|1 any IE6on in anY m.trrc!
<br />$ r\h h(om \uhiccr k' rhc v)'icF (ohpctr\"lon hw(olCr[ti,mix. rft]
<br />work.r( co Nn\rllotrlrlovstr)rsolScdn lTt().l rhc l-alir CoJc.l \hrll.
<br />cnDl,'ycr n) sim,nrl lcmlrcs,nJIVARNING: Iirilrc t, :ccurc w.*c .omFnsdit)n.o!cn!c N trr
<br />.Nrl iinc\ u, h onc hunJrcJ rhotrsaftl Jourh lslm,000), m lddiror J,mr!c\ a\ !n,vllcJ l(n r1[
<br />SNhotr :1076o1rh. trhtr Ci c. tr crn md arknncy's
<br />/ - 6 ' 2a24
<br />DEC!,AB{IION
<br />I hcrchy,rlt'hr dcr p.nnlryol pcrju,, (har I a lrcn*l urJcr t'n,vnNn ot ch nrk 3 wtIs(.rx{ Tlxxr).i l)'vBr)n 1
<br />ol rh. tlurin $ a ProLssiors Codc, trt! m, licch\c 6 in tull lorcc all el,c.r
<br />c---5 lo q o-{ tt
<br />- 2o?nt""l 6,4 o-ql 6^sT*^ c t't o"-r
<br />I hcehy ailirm unl$ Fn.lryol friury rhar rhd. t..on{rucrr)n bn,ln3 rtcncy for rlt l]crli'rmrcc ol rh. w.rk lor *hrh rhh lf,mn n
<br />isucd (Scu.1097. Ci! C.)
<br />tJnJ.i< AJJF$:
<br />-
<br />APPI,ICANT I)ECLANATION
<br />ll.nty rllimrnnrr pctrrlry ol pcrjury onc olihc folk,wtrrg Jc.ldrir!)ns
<br />l)ctrr,Irn)D P.nn \ nx.jo\ Norrluri'r] lic'l.n'l l.{.!
<br />R.qlmd L(.rol Noril.ir0n
<br />_I.Lrtilyrhlr rhc Irlrrrl tolulfons Egdilrne nor iml(ihtc r) rhn riR,j.cr
<br />_l ccnifyrh l hrvc rcil thk .pphurtr'n rd {xl i('n i{ coN*r.I agre i' cohrly wnh rll Cnyrftl Cooiry
<br />o.Jn*nc.\ x d Sr c tiwsalarug broc rcprcsnrarivcs orrhn cirya Counry k, cnr.r uB1n rlE
<br />rtmvc mcnrr,tuJ lolcdy lar
<br />,\ppliLnnr 0.,\xr l Sit.ilrr
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation ,{a
<br />Roof Sheathinq lllqq/u {x,fiM oa.s-t /
<br />Shear Wall I
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />Masonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certil.
<br />I I
<br />FINAL tltfli/4/,a M ffi
<br />Certif icate ol Occupancy I
<br />//)-4 rl Ifl tr/ 3,t 2n 1l
<br />T-Bar
<br />EtC.
<br />l/
<br />Dil.:-
<br />- ,- 1!- zo2J
<br />Drt. '
<br />--r
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