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BUILDING. INSPECTOR RECORD
<br />SITE.WORK OWNTR BUILI'IiR DEI,CARATION
<br />I h6.1ry a,lm undn Fnihy of pdjury rha I m dopl fnm rh. ( 0l,18106' l.k.e I^ for rh. tulh*iI! rcen lsr r0ll 5
<br />tlusin(c crd Profaion ('od.) An, ([y or CoMy $hth r.qut6 ! Fni' ro ..drud. .h6, in rore &oolisfi or rq& u!
<br />eruc'ar, Fir ro ns isumc., rtro r.qur6 th. lpplkd for 3och Fnn lo liL ! t'sn d riffil lhn li or thc t la.rE n tlursur
<br />r. rh. l'ovistuN of tl! Contr.d{r'! L-rd!.d lrN (Ch4na 9. (n@ins wnh Sdion 7( oof Dickion I oflh.Itusindr and
<br />Pmfdnrr Cd&) or rhi h. or.h! a qm,r rha.fhf, d<l rh. b63 aor
<br />'h.
<br />rllq.d (dqiio. Any l nbtion of.(qlhn 'I0! I t b! ony
<br />appliconrntr a pdnn subj<ls't !r,r,l(r.l ro rcirilFMh) ofnor Rr. rh.n i-r\. hulrt.d &,lbs (1500)
<br />L a o*n6 ol'h. D.np.n'. or my 6n[D6 $ ifi s+6 a rh.ir sk NmFBdion. silld, ll. rst an rlt rrure it no!
<br />in'adr] o oltdal nr $l (sa 7ol4, adind dd IrYolBioB C(d. Th. ( ontrclDrs Li.ru L,w (h8 nol rp,ly lo M osn6 of
<br />It. FlFry sh tlill or ursDEdEE( rd uho d6*nN hnrlf or ha*lfor lhru{h h! or t< o*n flplo)6,
<br />Forrlal ln i un imForlEr! e ml iiorj.d r oEa.d for $k. ll ho*d6,lh. t{ildins or in'Fl a6n 6 $ld *ihn ok }6
<br />ofonlpl.ioc tlEO.E B{il,s * nalr llE b.da ol Filr.B thd h.tr JE did d build or imFnt! tlE FoFr}. [x
<br />',E F FEol
<br />l, s oq( of lh. FoFly, o cirluir.ly colnEdros qh li.dE d co'nr*16 ro odtud ilE tmF {Sr 70,14, IiBflG
<br />ud Pm&sm cod. I hc ( ontdoi! l-i..M bw do6 mr .r?lt ro d os.6 olFoFny $ho trild! or improvd lhE6(
<br />lod who codacri tor ru(h Fj.tr3 *nh ! Codcro(r lt6E d Ftfun ro lh. Conrf,roar Lkd4 lls)
<br />I dn.rcmF und6 S..rbn
<br />t rl. Or.er:
<br />ttoRxFRs' ( onrPf NsATior_
<br />!tg.a&trla!
<br />I hcch' ofnrm und( pcnllly o f pElurt oncofrh. tolkr\!n3 d.(lmlFG
<br />I h.rr ed $ ill ritn& . Cslifrer. of CotEar ro S.lI.lMr. for $ 0116 .ompqtsrbn. N Fovidcd fo, by S..lnn 1700 o f (hc
<br />tabor Co& for tlE FfM. of lh. svt f.r whth rh. Fnil i! islai
<br />I h.r. lnd I ill m,inln. $o.t6 conpcMri.n iBumnr., a r.qtrn.n by s(r mn 1700 ol rh. l$.r (-od.. for rlE psaorrrr&----c o{
<br />fi. *.rl lor whirh rha! pcmr n su.d My wortm comFMro. i6ru(. c E .n polt) numbd R
<br />I cdrft rh,r inrh.FfoirM.of rh.rorl for s'h.hrhi! Fni Ls is$.rL I Jdlnot mployey p.rson inany mon6
<br />$ a ro lEoft qbj<d ro rh. st ld cMrFsdion bq5 otcolifoni!. &d asd thd ir t lhould h<oG luhidi t' rh.
<br />u ort6' @trrFurion I*oGbN orsdrion I700 or thc Lxb.r ( od.. I !h8ll, fdhsdh .6mply * nh rlh- FDrsioB
<br />WARNING l_rlluE to s@ rork6' .omFson sr@B. is onldsnrl. MJ shdl 3ubl..l u 6phlq lo m'ul FuhB rnd
<br />cieil fm6 up to .n. hrn&.d rhousnd do,ln (t100,00o), in ldJnion h rhc coi of (onFG.lion, d.m86 d Fordcd ror rhc
<br />S(ri('n 1076 olrh. htn (ilc, mrd<r ond
<br />*-, t lc.tr€
<br />I hq(D .,Im uid.r Faliy ol Fjury rhd I m licoej undd Fovi.ion of (n rid c (commftrn! *nh Sdhn 70()()) .f I r\ lr'on I
<br />of th. Ru'K !,n PrefNioE ( od.. ql nr. liG ir h lull lorc. !d.fid
<br />i,,:," dimr
<br />catiull(]rattlllplac_Acti!(r
<br />I ha.by ,fIm unda Fn xy ol p.rJu, rhd rhd. ir . anstu(hn lddm8 .eft) for rlE FaollM. .t
<br />'h.
<br />troll for u'hth rtil Fmn i!
<br />$u.{t(sa. llr97, C'v. C.)
<br />AITIII;AXLDECIdSAIIA!
<br />I horary,rmudd pdihy olFrjuryoe otrh< lollo*ins d..lr iou
<br />DcdolilFn Pmily&tEkrs Notrfic ion l'.d6!l R.suLli{nr(T'lk l(), Pan6)
<br />, R.qrn.d krl6 orthifi.dirn
<br />I (d i6 rld rh. a.nd.l reuUli1B FgiJins 6h6k's rarn\ 6l d. nor rJ'plral,L k,
<br />'
<br />hE rfl)ld
<br />l..nii rh3r I h.r. Ed rhli qrpl'calntn ad rdcthal rhc ah'!. rnfomdrmn is otrdr I lard
<br />ordiMnc6 r'd Stdc l,ss rclar iry lo huildins conslrucl Fo. ard hd.hy .ulh.n,c rq'.$rd tr 6 o
<br />rin\. nmrion.d propdt aor iNpali,!n lurlrs6
<br />I'emhe nrm. (ptlllr6 a a-.,
<br />h.. rl\ $nh.ll ( ]anJ(r\'nr\
<br />Irhnr' , frlti rnr\ r, dndq.{r1r
<br />,,," s[qhE
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<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 />Flood Zone Certif
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<br />FINAL a \l\o-rY-)L
<br />Certificate of Occu pancy I
<br />Notes, Remarks, Etc
<br />DATE tlD/SlG.t COtvttueNrS
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<br />Subf loor/VenUl nsulation I
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