|
BUILDING- INSPECTOR HECOHD
<br />SITE-WORK ID/SIG.COMMENTS OWNER BUTLDER DT'LCARA'I'!ON
<br />I hcrcby 0fllrr utrdcr |Emlry.l |crjlry rhrr I anr crcn,pr lmn rtc Contactn Licctr\c Lrw Lr rhc lollotrir8 rc,vnr (s.c70:11t
<br />Brsinc\r ann Pu'ltsio C.dc): ny Cir! .r Coutrry shi.h rcqunc\ r txiinii h conslfl,cl. xllcr. inpn ., dcnFlidr or n|[n m,
<br />fl.iurc. rid k, irs isurn.c. aho rcquics rhcntllicrtrr,or such |xflnirro nbr rigncd srarc'tunr rhxrI[or shc t liccnscd lUnun.r
<br />t' rhc pRrvhion\.f rhc Conkark, \ l-iccn\cd hw (Chaflcr 9. Connftmir8 trilh Scflion ?0U) of Division I of rhc Bu\inus rnd
<br />Pturc{sn l Codc).rrhdr }rurshc iscrcm lhcrcfronaklthc h0\is turlhc.llcscd $cnllrt'n nyvn,hlnnrolSccrionTlrll5hyrn,
<br />,p,'licrtrr ror.lcnnir iuhJcrh lhc aprlicrnr ro acivilpcn.lryofnorflErc lh,n fik htndrud d.llr\lS5(x,
<br />l. rs oNncrol rhcprol)cnl. ortrrycnflor.c\ *irh!r!.r r\ rhcn {,1.$nrl[ \nrn , silldo rhcsorki rh( ! ruto n mr
<br />intcnd.J.rollrrcdl(,rLtrSLrTlI-{,Au\i'r$rndPr.f.\\nnr\CodclhcC.nrracrtil.i.ct\clrw,l.c\ or rt,Dlv t in oLvrr .r
<br />rlr |x),r'ry wh.ln'lkl\ or inl|n(*r\ rhcr.on. trnd sltu d(rs su.h tr.'k hNrcll.r hc'{!1or rhrough his or hcr oen ctr\r.y.cs.
<br />ofronDldil)n, rhcO*mr Buildcr will hrv. lhr l nhnolF,virg rlrrlror{h.dklnolhuid or inrprr! rh. pn,pliy turrlENrtF{ol
<br />L as o*ncr ur rhc pnJl)cdy, on crctu(nrly corkidirs uirh lic.n\Lal conrrrrir n, conntud rll pmj..r (S( 7(!r. Bulnc$
<br />and Pdi$inrG c:ThcCo rrcktr s l-iccn\c l.r*docr dor r|rlyro u o*mr or nropcay who nuildsor inDn,vcl rhcr.oi.
<br />dd *ho onkds f.r su.h l)ml..is sirh , conrmcrort s) li.crNcd puruonr tu rhc Conr.doir Lt.n{ tjs ).
<br />I rtr,.rrnrIl undcrSc.riinr
<br />""-E',.L&i l ,rlr&<
<br />DEIIABA.IION
<br />I h$.hy afftm und$ p.nrlry.r pcrjuy oR olrhc lolb*ir8 dcchnri,,n\
<br />Ihrv.an{lwill rinrain n Ccdiltrrc .f Cofl{nt ro Sclf-lNurc tur s orteN corrpcnurion. N prolidedfdhyS(lrn1700.llhc
<br />LIlxtr Gxlc. lir rhc pqlbrmtu! ol rhc ,ork r(r shi.h rhcr.nnit i\ hrucd
<br />I hdvc ond sillrliint.ir workcF conlic.solion insurrncc.0\ rcqutcd hySLrrn)n llTmof ihc LahorCodc.ld rhc Frioanin.col
<br />rhc *ork for shihrhis pcflril is nsucd ily nukcrs comp.tr\orion iNurmcc c8trid and !.li.y nunrhcr irc:
<br />P.lryNunrhcr-
<br />-lccdi!rhrinrhcpcrlormrnccofrhcso
<br />furhi.hrhn p.nnir is Frucd.I$ill Dor.DI'k,y.tryn.r{'n in xny ih. $
<br />*) Nhhc..nr \uhJc.rrr rhc work.6.onDcn\di(nr lNs of Crllli,arir. {trd ircNc rl l ifl\horkl hc.o t\uh.,..rrolh.
<br />qoikcs' coDrf'ctrsrrt F)vi\iotr\ol sLrri 1700olthc Llhr Co(lc.I \hrll. nlnh*irhcomdtN'iltrhorc [.v^ions
<br />IVARNIN(; Flihtrr t) {crc qorkc^ .o rtrr \ritr c(rslc s u.ln*lul. ud shlll suhj.rr nn cnrpbrtr 6 dnriral J*trihas rnd
<br />:r1,,:H#l,I;l"i.,l,T'JriJl:*7g zf-
<br />)r. n r(l(lfidr r) rlr ..{ ol !B;;Lt'.--tr^,L (.\
<br />DICTAf,AIION
<br />Ihcrchyamrnundcrrcnallyofpcrjuryrh,rI!mli&ntdund.rtiovti.nofCnnptc!9(ommncins*nhSccrn'n7fim)orDivi\io.1
<br />oi rhc Businc* 3.d Pmfc$iorsCodc. and nry liccns h in iull forcc o l cnccr
<br />AIEUIANLIIEIIAAAIION
<br />I hcEl,yallr.undcr ncnalr, orFrjlry utu ofrh. folk,wing d(lnr nn\l
<br />Dc!rclition Pcrfln$Astf,stos Noliliclrion FcdcralRc8uhriont('rnlc.l0. Pdr6)
<br />-Rcquircd
<br />t llcrolM,tific{lion
<br />I.cnifyrhar rh. fcd.ralrcgulxlnm rcSddnrg.shc(os rcnFv.lnrc noi applicohh b rhi\ poj..r
<br />-l
<br />lTnifyrhir Ihor rcn!rhn appliclrion aJxl dnrcrhar rhcsh,r. i',lnn,$io i\ .odNr. LFs lo mq,ly w irh rll Cir, and cornry
<br />odimmcs rnd Srarc lj*s reldinc buikling con{ru.ri{n,. xnd hcr.hr"rdhorizr rrn'c\ctrhrivc\ 'n rIil(ilyudCotrfiyu cnrcrLt).Drht
<br />&rvc nrnrioncl ro|En, fn tu ",,"&.2X-Lf,
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SublloorVent/lnsulation
<br />Roof Sheathin s
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />I l \
<br />FINAL C1 oll\,alJ ffYt-/
<br />c ertificate of Occup-ncy 1fI
<br />Notes, Remarks, Etc
<br />DATE
<br />Set Backs
<br />T-Bar
<br />SINUAICII9IT"LENDINC.AOENCI
<br />I hcrch, amrn und.r Fn"xyofFrjury rhar rh.rc is r oniru.rion Lnding oBcNy fnr lhc llcrfo,mncc ol ihc sork Id Fhi.h rhis rcrmn h
<br />hsucd (Scc.1097. Civ. (: ).
<br />kndc'a Nrrtr
<br />-
<br />Lcrdci\ Addrc$:
<br />-
<br />----T------
|