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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE tD/stG.COMMENTS OWNER B('II,DI]R DIII,CARA''ION
<br />I h.'chy uflirm unicr pctrllly o, pcrjury rh{ I an crcmpr riotrr rh. CoihtN Lkrnsc Ls fir rh. f{,!|,)sing r.tr\)n ise Tl).115
<br />ausnr\\ and Prorc$ion C{xlc) Ant Ciry or Cou,y shich rLnnncs . l]cnnir ro conslrud. rl($. nnpn\c. dcnrlnh or \-prn rny
<br />slnrchr. [iorro irs is\uin.c. also
<br />'cquircr
<br />rhc lptrli( r fo n'(n pcnniln' t]c! si8ncd (rlc rtt lhat tor shc n liccnscd Dufu{nl
<br />h rl'c ptuvntuns oa rhc Conrrucrois l,irnrcd ljs, lCnnpro 9. Connncncire wilh S.cti.n ?(xx) ol Divi\nnr I ol rhc Busincsr ind
<br />Protisiur Codctor rhd tEorshc iscx.npr rhcrfmmand rhc haris torrlf rttcged crcnDrion AnyvioturionofSdionTr,.rl 5 hy rny
<br />mlicinr li)r rpcrnrir \lhjarrlnc lptlicinr lo ocivllncnnlryofnormrrhm firc hundrod dollrrsl$5rD)
<br />-1,
<br />$ o*rcr ol rhc pmFny. nr my cmnloyfts sirh rr8e\ as rhcir v,l. cnnrcn\.r ior- (ill do thc work !d rhc srturm is n
<br />iircnd.d or offcrcd f{, elc ( Ss.?O44, Busircs .nd Protcsions Codc l hc Conrr.rtr\ I -i.ctrsc hw d@\ nor 0t'rly l. ai owtur ot
<br />rhcnmlfdy wh. build. or nnpmks trrd,n, and who docs such uort hiascll.r hcrrcll.r rhrcush hisorlEr oNnenpl.)ccs-
<br />ptuviilcd rlur such inl!)DrcNtrh m nor ir ctrdL{ or orcftl r{, {k If, h.wdrr, tlr bxikling or irll)n,w'rnr i\ v,kl wirh'n ,,m )etr
<br />o, sfl{ldhn. lhc Own.r Buiucr willhiv. rh. hrd.n o, proving rh{ hcor\h..liJ r hiklorinImErnc polEny for rtE p qn{ oa
<br />l. ^owncrofrhetDpcny. !nexclusivcl),cotrrrr.iin8 wirh liccnsd conlr0cr.mhcotrsrflcr rhc proj..t (S.c 7044.lntrinc$
<br />iM ltoirssim Cod. ThcCont0clor'sLi.cn\.Lrwdo.\n r q,plyro anown.rofp(,rcdywho boildsor i'nFolrs rhcrcon,
<br />dnd {ho conrrlcl\ n, .h rnjecls wnh a Conhcr,(s) li.cns.d punu.nrhrhcConrocror's Liccnsc bw).
<br />l rtcxenpr undcrSeclion-. B. & P.C ro hkrcason
<br />Own$
<br />]1l)4.K[B$!A!lEENli roN
<br />DECIAXAIIg!
<br />I hcrcry !flnnr uiJcr ncnnlrtofnciulyorc olrhc follo*in8 dcchrrrionr
<br />Ilr vcnnd$illnrn nin rCrnilicrrr olCon{nrt, Scli lnrrc litr s.rtcr\' ronDcr\rrion. a\ D.ridd lor hyS.criur.rT(x)olrhr
<br />ljlltr Cixtc. rnrrhc pcrtorn Nc ol thc umk lhr *hi.[ rhc t.nn[ i( n{r.rl
<br />;:':?*i:[ *1"i."'?workns ompcnsdion insunr*e .mi.r erd ,.licy nunrhcr mc:
<br />l-(-t?
<br />I (niltrhar inrhc!.rr.ntun.corrnc wort ntr *lichrhis pcflni is nsucn. ! shllln.r cnrrloyroyPc!$n inanynunncr
<br />n' r t, hcconE suhjccl ro lhc *or*cK cornFnsnri.n hws ofcrlifdni.. aM dBmc thd ifl shonld hcom sultrt lo th.
<br />workcrr compcnsario. prcvhi{,trr ofSccrion lro0 ofrhc tjtnr Codc,I shrll. fonhwirh.omfly wnh rhos pmvisiotrr.
<br />WARNINCT F,ilut rD srrc work i\' conu,cnslri.tr c.rcmsc h unhwlirl. ind shall subrcr !n cmrk,rr lo nidiral Fulris !frI
<br />civil ,lhc\ up lo onc ilndrcd rho!\and dolhrs (.tlo0.txlo). in rddirion ro rhc cosr oa compeN,rion. drm8cs a\ providcd tor thc
<br />Sccrn,i .1076 oithc Lnho! Codc. inrcrc( lnd orro,mt s lNs.
<br />*,., , !-zv Ll n,,t..*:z.J---)'-;
<br />r rfEisr n rrrurut ron
<br />D&CIAEAIDN
<br />I hcrchy!fiirDutucrrcn.hyofpcrjuryllul I rm li.cnwl und.rl,ovnbnolCh.prcr9(..mr m itr! wnh S(ti TUJO) ol Disision l
<br />of
<br />'hc
<br />aDsiftrsjid Pmac$ion( Codd.,nJ 'ntlicdn{ h in aull,nEr lnrl cficct
<br />(i.rn\rNumb., . io-z_<L,qLl
<br />o*" "i(-z x-t x c-turn X.<€? --,,-
<br />CONSItrIIIJIQNIEND.ING-6IiIN.CI
<br />I hcrhy rmrm u.d.r Fnalyorf,crjuryrhar rhft n a connrucrion lcndin[ lscncr lor ihc pcrfomflrcc oarhc $uk ror which rhis Frmir t
<br />is\u.d (S.. :ll)97.Civ C )
<br />fifJt ILDICL AAU()N
<br />Ihcrcnyulftmundcrntnultyoilcrjuryoncollhcnnbwingdkl* i(,rsl
<br />Dcnnlilion P.irnih- strslos Nolifl.irion Frd.rrl R.guhrnnN (Tirlc40. Pdn6)
<br />-Rcquncn
<br />bllcr of Norilicotiotr
<br />I (nifrrhar lnc fcdcral rcsullrions rquiina .sh{o. rcnn,v rirc mr {'fli.ihh ro rhn pror$r.
<br />ftMr-a'rr ,r', r r','. ^l ,r,i\ dmlil. trtr' 8rr ni. ,hd rhc rnN nriomori(,r n conccr I rsrcc r'.onlrly wih rll ciry rnd counry
<br />odirrtrc\ rtrJ SrJrc bw\ rLrin! r'i buil'ling Liinntutrit'n- IhcrchyurhorizcrcFc{ntlrivcsofrhi!Ciry,ndG,0nr,k,cnrcruF,nrhc
<br />rhrc rf, iri{,ncd Inipcnv ttr iNnccrhn
<br />,\ppliunr or l\gotrr sitn.lurr Mor[o s ,"'". B-"8-i &
<br />Set Backs
<br />Erection Pads
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Shear Wall
<br />Framing
<br />lnsulation/Ene rgy
<br />D all
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Itilasonry
<br />Pool Fence
<br />T-Bar
<br />Handica p Req.
<br />De puty Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL
<br />1 *zoltx eMoA-/ ot,
<br />Certiticate of Occupancy
<br />Notes Remarks, Etc.
<br />---l
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />Roof Sheathinq
<br />c.r"yr,.*., . 8L- 2 f"1 bb\-O( -OI e,ni,".,
<br />I cnJcr\ A,ldrc*
<br />I
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