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BUILDING. INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNER BU I t,DF,R DEI,('ARAl'IoN
<br />I hcr.by amrm uMd pm ty o t p€iury thai I m €r.mpr fmn r1r ( onk..ro6- Li..ns. l-^\ for rh. a.llo$ inr r..$n ( Sc 70l l 5
<br />atr3i'r6s od ProrBsion Code)r Any Ciiy or Counly shicn r.lun* 0 Fnril ro c.nslrtrct. ilrd. nnpo\.. &'nolish or r.pat m!
<br />srtu.rur., rior ro nr tsu&cc. alsJ r.qutd lh€ aDplicanr ior nrch p.nnir to filea sisnedsril€mcnr rhnr h.or she t li.cNed puBut
<br />lo lhc rrorisions of lh. Conlmclors Liccns.d LaN (( n!l,d 9. ( onnr.n.in* \ irh s..rion 70u) ol Dnh]on I oi rlp uusin.s and
<br />PolcsionsCodc)orlharh.orshciscr.mprlhocirou rlrhclEsis ld th..ll.rcd eranplion Anj \nnaiid.fSecli)tr70r15byany
<br />aprlici aor aFmi n'lr<rsrh. atpl'r.nt ro acnilFnahyofnor nFrcrhan fi\. h Ddlen do Llffi (tir)01
<br />I.sowneroflh.prcpcny.ormtcmployB\irh$a8sGrh.irnn.c.rn|xnsalion.silldorlr\orkMdrh€snNuri\mr
<br />inrdddl or oll6.d ror $1. (Sc.7044.lrusinBs ond holssiotrs Cod.: Th. ( ontracff s l-icms Ltrs do.s nor aprlr lo atr oNntrot
<br />rhcpNrdy*hobuildsorinpror6lhm)n.dd\hddo6suchqodhinNclforhe'.eli.rrh'otrShhtorhros.ri{],,rot.
<br />,mvid.d d,al such imFovm.nts & 'rl inlerdcd or oirud ntr eE Ia. ho\!€r6. rhe h,llii,B or irnro\ arR isRndtrirhi", 'c,@ofcon'pkion, ilE ()"nd Iruildd *illha\r lhc hkl6r .l Dlri.F rld h..r sh.iid nor tn'ild or i'nFo\. rh. Fnldlr" ntr rlF N4rsof
<br />I. a o*nd (lth. tmr.nr. m .r.I*n .ly ..ft^chg wirh hcEnsBt contackrn n, conrrruct rlE Ir)iNI l S( 7(r-1,1. 8 n c
<br />andPDr.siionCod€:lhcContracloisl.ic..scl,asdo6trotoppltloanosndofpl.perl!\hobuildsorinpro\eslh.rsn,
<br />and who.onlm.kforsu.hp(!dsuirhaContrado(rlre6dpu6uMlnrrh.(.nlrado'sl-rc.nscl.a\)
<br />I dn.r.mfl undd sdrfun
<br />\oB!!tI anu[!.rfllot
<br />D!'C! &!1I(A
<br />I h.r.by amirn undd pdrlr! olp6jrn onc orrh. rolh$itrs d(l.r.lnrns:
<br />Ihav.uds,llnaintamsC.nrfical.olConse loScll-lnsor.lorsorkqiconrExalion.as po\ edlortryScdi,,nl7(x)oflh.
<br />l.abor Codc. for lhc p6 lor mancc o f ihc sod( for wh ich rlE Frnn is issurd
<br />I havc lnd *ill nEinlain workcts comp.Galion iNur anc.. 6 rcqot.d by S(tion 1?u) ol thc L.b.r ( ode. lor llr pslomsc. oa
<br />th.N*torwhichlhtF.mitisisu.dMy$orkdcornpadioniBuhncrs.rmdFlicynurnb.rflcl
<br />,*;., Zt|ry{z- €e,rb t
<br />""n"r*"-* 1lLllQQa hptres
<br />Icenifyrhdinrh.p*loijndm.ofrh.\eorklor\hichrhisDcflhir ir rnrd,I shall drd pbr- anrp.'n$i..nrnrrd.r
<br />$6toheco,nesubjcllolhc\o*sJcornp.nslionla(s.l('.lilortrii,.trd+reihdillshouldh..oncuhjedrolhe
<br />*orr6s'composarionporisionsolScctionlT0Oofrh.t-.ln(td..lsh.ll.fodh$irhconDl\\rirnrho*pro\kn$
<br />\T RNINC Failur. t, *cur. \rork6 ro'iprtrrarn,n co\c'a!r i\ trnlasi'l. sfd shrll {,lrrr a', 6npl,,u' n, o nnnrl FTahi6 d
<br />civil fins up lo on. hdndr.n ihouend dolltus ($100.000), r ad i.nt,rh..onoi.o \'ensa(k,d. dx nses as l)ro\idrJ a.r th.
<br />S(rlotr 1l176.frh. I .ln (nd. id.rAr o+-(z*4 1/w":2 - ?l-17
<br />UCEISEDIONIAAC.IOB
<br />D}IIABAfI!)!
<br />I hqcby afiirn und6 Fnahy ofpojury rhar I am licdsl und( l,orisid ol( nap{6 'r l.onnnetrcitr! $nh Sdi,r 7tr00)ofl)nision l
<br />ol thc BBind and Poldions ( od., dd m! lic.nsc is in aull ror.. and .ffd
<br />t.i,-,,c',* G'V cl
<br />*",2':ZT:' / 7
<br />CAIiIAIJEIIOII.IINI)INC-ACET(I
<br />I h.E5, rmnn undd p.nahy ofpojtrryrha hic i! a connrlcrior lcndinr ascncy lor rhc rElom.ncc !lrh.\ork fttr \lrl(h rhd p6nn n
<br />kso.d(sc 1097, civ. c.)
<br />A.EITI(A.NfDIU.A.BAIIQI
<br />I hddry afljm unds p€nahyofp6j!ryoncolthe lollosin! d..lar.li.ns
<br />linnlilion Pdmic.Asb.stosNolificalion F.dd0l Rclular ft {rnb40, Pan6)
<br />RaNircd L€n.r oi Notific.rion
<br />I cEl iry rhal lh€ fdml rcsulil ions res dinr asb6l.s rcnu aL fl. trol afplic.Uc k' tht nn in-.r
<br />I cdliay rhar I h.v. r@d rht.apli.arion dd srar.rhd rhc alln. intonnario. is corsr. I asr€ n, corply\irh all('ir).id ('.u.ry
<br />ordinrn.6 and srar. tr$ ahtins b l,uildihs c.n.rrucr tun. .d hftby aurt{,ri7c rcrr6dn arn 6 r'r tht Ci y end ( ourr} kr . rd ulln rtE
<br />ab.\. mdrhrn.d prorEnr for m
<br />^ppronr
<br />or
<br />^E6r
<br />srsn'rurc -,/L :!-rr'. -Z - 2/ - tf
<br />pem,,enrm.rpr,n,,: .'[ai1-44 -Z lf
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf loor/VenVlnsulation ln
<br />Roof Sheathing i/z/tt .a +-#71
<br />Shear Wall /\L
<br />Framing
<br />lnsulation/Energy
<br />Dryvvall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL
<br />Certificate of cc u nc
<br />Notes, Remarks, Elc
<br />SITE-WORK
<br />,tr.nr.Nu,b.r' / O o ;2E q,,.-^"@
<br />UFER Ground
<br />Flood Zone Certif.
<br />/7 /21/cl K-.7 7,/ L4/
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