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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />-2.44Roof Sheathinq q/7/IY v/
<br />Shear Wall
<br />Framinq
<br />lnsu lation/Eneroy
<br />Drywall
<br />Brown Coat
<br />Ir/asonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />-.--7aaY ZFINAL* ''Lrt6Z
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />OWNER I}U!t,DDR DNLCARATION
<br />I h.rcbt .lilnn trMcr Fmlry ot lErjury rhd I un .trmtr ftonr lhc Co tucror' l,ic.n\c ljw Lr rhc iollowing .cr$n (S.-! ?0:ll 5
<br />Burincss .nn Prclcssion Cod.): ny Cny Dr Cdunry which !cquir.\ r ,lnnir t, .on{dcr. rhcr. inll)rorr. &m,lish or rcFt nnv
<br />drucrurc. priorb ir\ isurn.c..ho rcquncslhc nDplicrnr n, su.hFnnirr, filc 0 sisncd sllrcn$t rhar b.dr shc i\ li.ctred P nuunr
<br />t) dc t'r,rhi.n\ ol rhc C.ntr.ror'{ l-iccn\cd hw (ChaPrcr 9. Connmnci',3 *irh Sccrion TIrl} of l)ivi\id I ol rlr Busincls and
<br />Prncssi{nr Codr)or rhar hc.r\hc k cxcnur lhcrclionund lhc brsi\ lnr rhc ullcBctl .rcmo i(,n Any vn'hrionolSecrion 7o.ll5 httrny
<br />rttli.itrrlM a Frnrir suhrccF rh. lprlicanrt, rcivilNnrlryormrnnlerhnn l_'vc l[.drtd dolhn(S5ftr)
<br />l, !s own$ ofrh. 8,pcny. or nrycmplotc.s sirh wsAc. N rlrir {rL co.Urcoslrion. willdo rhc *olk lrn lhc \rtuim n '*iicndL{ orontrl\t li, sk (S.t.7044, Businc$ 0M Pnnt$ions C.de: Thc Conti.ror's Li.cnsc l,* doca no' nl vhanowncror
<br />rhcp6Fny wlx, ttrild{ or impmlcs rh€mn. and wh) d(Es (uh wo* hiDs.laor hcrsclfot rhmuah hh or hcr owncnPk'vccs.
<br />providcd rhlr such imao\mnh m rct inlc.dcd or ofcrcd iq sh Il l[*ts. rhc huildins or inPiov.mnl is erld wirhin n' r )td
<br />ofc.n{krbn. lh. owncr Buir.lcr will h{\c llf, hrLlcn dr rovirr! $,1 tr or shc {til nn buiu or nq,turt lhc Pmfny for rrrl)u{nt ol
<br />t. a\ otrn$ of rhc Dro,lcny, !r! .rc,usivc ly .o r..ri'rt q irh licctr{d .oMr.roc k, .ondtud rh. Imjcl ( S( 7ll.l,1. 3u\ir'!s
<br />aBl Pnri$i C.lc -rhcconracro.s Liccnsc l,r* docs nor rlplrt) owncrol tron.nywho huilds or imlovcs rh.r.on.
<br />rid sh. cofltmcrr for {uch ltr+.h wirh d c, hci,nl [.rtrr punurir I' rhr C.nlr :Iclols l,iccnsc t:*)
<br />I rn.xcnrpr undcr Sccri0n
<br />llaarElls:loua[N .rIaN
<br />DIILAEAI]AN
<br />I lNrcby rifirD undcr prnrlryor|.lury otrc oirhc iirllosins dcchrori('n\:
<br />-l
<br />havc -d will minrain r Ccn ilcalc ot Conscrr b Srlf lnsurc for wortcN or.l.neri,n. as Providcd fot l,y Sdnln ]7m ol th.
<br />L3bo, Codc. Ior rh. pc ormftc of rhc wrt for which lne ,snrir i\ is\u.d.
<br />Ihrvcand\illnmirn.in$orkcraconD.n\ariorin!orrncc.,\rcqutdhyS..ri,n,:17(X).frhcl-$otCod..forrh.f.rfonninccol'
<br />rh. soik ntrwhi.hthis Dcflnir is i$ulil Myworkc( .u rfctr$riqr inlutan.c crricr tr lnicyflnmhcr rc:
<br />I enil-v rhdr ir rhc DcrLr.Enccofrhc sork for shi.hrhis Pcir.il is h\uc{l.l \hrll n.r cmfloyonyr.ron i'r ntry.utrrc!
<br />$ $ h hcconr \ubjcd t, thc sortcr( conr|rcnqlio, I',w\ or Cllirohir. .nd urcc rh il t should hcconE sutjcd brr*
<br />*o*cr' ..q.ns.innlmvisions ol Sc.r ion :]?fi) of rhc ljhl Codc- I rhlll. fonhsirh .!.ll'ly wil h rhot pr,lkk)ns.
<br />WARNINC: Fnihrc r, $.ur. s.lkctr conrFnsllion .orc.!gc is unlrwful. rn sltrll {'brd dr .nplqq ro oiminrl ,..rhi.s rtrd
<br />civil 6ncs up tr onc hurxlr.d rhols.nd dollar l$100.{xu. in addirlo. ro thc cosr or conDtn$riotr. drnrEcs r\ Pmvi{lLrl tu' rh'
<br />Scclion.ll)76otrh. tjhrCodc, inrcrcn rnd on.nEr's lccs
<br />Dsle:
<br />-
<br />Appllonl:
<br />r-rcrlsno colrn,rtron
<br />DECI,ASAIrcN
<br />I hcrcby Inr undcr pcnolrt orFqury rhar I t,n liena{ undcr Imlisimorch,flcr 9 (ommEins wirh Scclion 7d)0) orDirhnrn:l
<br />or rhc Busims od Prcfcsio.\ Cdd..,rxl my liccn€ r in lullrb,cc 4dcffdt
<br />Liccnsc(lassr-
<br />D!(e
<br />-
<br />-
<br />CONSTRIICTI(N t TNDINC ACIJN(:V
<br />I hcehy xrfinn uM.r Fn.hyoilcrju,ylhd rh.rc i\ r.on(flclion lcndin8 lscNy rd rhc rcnbirtmcc.llhe work ror which lhis F,'nir is
<br />issucd rscc 3(D7. Civ C )
<br />Irtrdci\ Nom:
<br />-
<br />APPLI(:ANT NF(:LARA'TloN
<br />IhcEbyafimuldcrpcnaxyort rruryoncollhcn'lhwirr.lccldaln,ns:
<br />DunDlilior Pcrn h-Asbc\ro\ Ndrifi.son ItdcralRc3ullrions lfirlc 40. Pr 6)
<br />-Rcquircd
<br />lrlcr of Norii..ri.n
<br />r,. ,t rtDl.ihr. r,n,i\ InE(r
<br />rr nurnr i(.otr cr l rBrNn,.onrplysirhaU CiryrddcouDry
<br />y Nrlbrnc rcprcscnliriycs ollhis Ciry Md Countylo ciler ulx)i rh.
<br />\l'AM -,., r/to/rr
<br />Set Backs
<br />Ext./lnt. Lath
<br />Pool Fence
<br />(-rnrcr-
<br />I
<br />Itt
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