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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS (,WNER BUILDER t'ELCAIL{TION
<br />I hcrch, umrfl under lcnrlry of tcrjury rhar I nn cx.mpr ln,m rli. Conrdon l-iccnsc lis n, rhc f{nkrwingtr.rvrn (scc70:ll5
<br />Bu\ihcs\ lBl Prolc$iotr (-idc) Any Cily oi ('onnl, whi.h rcquncs i pcnnit '. .onnrucr. .lrci. nnprovc. dcnolish or hprn ,ny
<br />(ru.trrc, J,rior ro \ i\sutrn.c. uho Equtcs rhc lpplicinr lor\r.n pcnnjt ro filc si8ncd narc.Etrl th.t lEor shc n lic.n\cd puGu.trl
<br />r. rhc F)ltions olrh. Conlmcrofs Liccnsd ljw (Chaptcr q, Connncming *irh Sc.rioi 7fiD of Divtiotr I ol rhc Bu(iic$ rnd
<br />Pmrc$i NCadc)orrhrr lrorrhc iscr.mpr rhcrlromand rhctush ior rhc alLscrr cxcnpri.n Anyviolori.nofsdbnT0ll.5h]lny
<br />rptlicant lar a p.irnit sunjcch thc 4llicrDt r. !.ivilpc.rXrofnor frtrc rhM firc hundrcd ddllr\ 1$5ff))
<br />I. rs uvmrorrh. !tuNny. or n'y.nll'lotccs ki'h suscs r\ rhcir {nc conrpcn\{i,nr. willdo rhc *ork 0nd lh. nrucrue i\ nor
<br />i cndcd .r olitrcd ior slc lSN.Tol-l. Busircs rM Pn,tu\si{nN C{xlc Thc Contacktr\ l -kcnsc uw do\ ior rlrly ri r .wncr .f
<br />rhc pnFc y llkrhuildsori'nnr)arhcd)..andwhodes\uch\orkhimsclforhcrs.lforrhmughhisorhcroqnempn,ycc\.
<br />tr,vidcd rhnr ru.h i'nFovdtun( rr frn int.ndln or oficRl fitr strL lll h)ecvcr. rhc hoikliry or impnr* rnr is vrlt rirhinnk Jrr
<br />orcornphlion. lnc O$rcr Duik+r rvilllurc rhc l{nlcn ol pmviq rhnr rr or \hc drl tur huild or intmrc rhc tmtEny l'or lhc lDrloc ol
<br />L n\o*ncr olrhc pmpcnv. rnrcxclu\ivclyconrrlcrin! trirh li.cn\cd c.nrachs ri..n{flicllhc nr.,i...r lScc.7ott. uunnc\\
<br />rtr,l lltrtl\\i Cod.:ThcCnftact r Lic.n\c l-a\edoc\ norrpnlyh !no*n$ofpi{,pcn,qh(' htri \ or imprcvc\ rhctuon.
<br />an{l slD .o rocrsior ch pr.F-ls sir[r cotrtrr.rodn ]icc scd lur\ur r k)rhc cifitu(r's Liccn\c tjtr)
<br />I r crcn,pi trndcr Sccri{)
<br />rc!&:8[!alllrNs lloN
<br />DEl.L/$IIlaX
<br />I hcrc$y rllntrrund.r p.nJlry ofFrjDryonc olrhc tull.wlns d.chnrirrN
<br />lharrmdwillmain'rin!CcdilicareotConsnrroSclilnsurcfttrworkcnconDcns.rion.0s[oridcrlforhySccrt'n]7(xroirhc
<br />Inlxx Cdc- lo rhc pcrfonnrncc ofrhc s.rk lbr which lhc |trnrir ir i$ucd.
<br />_l hr\c nnd willrrn ninworkcN .orlJ.nsdrnr in\rran.c. rs rcquncd byScrrnrn.lT(X)ol rhc ljlxtrG)dc. f(r rhc f)tJfrturtu. of
<br />rhc suk lor*hichrhis p.nnir is issucd. Mtw.rtch .omll.n\rridr i'rsuo .c. ri$ r Fni.y nui$.r *cl'-l-ra, .,< [c.S
<br />L-l 155tart 5trq r.1 JL(,qlarlrs
<br />I ccdili rhar in rhc p.rr.nron.c orrhc $o.k r& *hi.h rhh r^-nnil i! nn'cl. I nrll tror cmploy.ny p.rso! in lny mrnn.r
<br />w r\ ro h..otrrc subJtrrro rhc workcn ..nltlcistrrbn lrw\ ofCalilanrir. rrl +N r]rr il I \h.ukl h..onr suhrccr k, rhc
<br />ro.[c6 $mncn\iri$ pn,vi\iofls olS(notr:]7n0ofrhc Lrhn (,)d.,lslalll. f(llhwnh.onrlry wirh rho{ r,rovision{
<br />W,{RNIN(; Friltrrc r{, {curc workcr .onrpcn\dion c.vcmsc is unla{tuI. rn(l \hnll sul,jecr lrr cmplo)r! b cri'ninrlrrtrrki\ md
<br />.Nil fi .s up b oic hrndrcd rhDrun{l dolh6 (Sl([).(xxl), i[ rdnilbn r. rhc co( otconrFnsnri,,n..ltr'nugcs trr nrcvidrd fin rhc
<br />. Sc.rn :1076 ofrhr If,hr C,nlc- inrcrcd rn,lrtronE,
<br />!.,. c tl-t6
<br />^ppric.n,^^*,U- (0-!-^^'l-{
<br />DIiCLABAJ]ON
<br />Ihcrchyr,tuDundcrlIflrroltujur!rhniIanli.cnscdundcrpolisionoiChaprd')(colncnciigwirhSc.ri.n7UD)olDivisoil
<br />of rhc arsind\rnd Pnrri\rion\ cod.. ffilnry liccnsc is ir tul| rirrc rnd cilicr
<br />/\"
<br />t3\q6t b' c-3,; c-q. (r-7 c-r3
<br />6..^-., tdcrs(.i-t 3-l 6 sAanc'Al
<br />CQNEIAI]SIONIENDINCJ(iEM:I
<br />I h.rcby amrm undcr lcmlryotFrj!ry rhrr lhcre h ! cotr(mrion L inS s8em) for lhe pcrfommc of lhe sork for which l,rh pcmi n
<br />hsucd(sa. -1097. civ c ).
<br />AIIII(;ANLDDIIASAIIA!
<br />I hcmby afiim u ndcr pcnalr, olpcrjryonc ollhc n'lhwirE dccl0nlions:
<br />Dcmoliliotr Pcrmih'Ash.slos Noliiicoliotr ljcdcralRCEUhlions (Iillc.r0. Pan6)
<br />-Acqutd
<br />lrttsolNorili.{rio.
<br />I Ndil,vrhrr rhc lidflrl rc!!hrn)ni ruSeling h\1.\r..x,ulrr. rorafplicrhlc nr rhi\pm]ccr
<br />-lccnilyrhd
<br />I lnvc rc rhisaurli..riotrn stdcrhd rhc trErvr irnnnnnrnr N.onc.r lagrcioonplrwirhallCilyrndConnry
<br />ornimn.csafldSt cLrwsEl in!lobuiUnr8.onslru.tion.ddhrr.hyrurhoiizcrctrcsctrrolivcsorrhhcity,ndCountylocnisuronrhc
<br />i215:15
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq Phaf B4lK 1l y*lteW
<br />lnsu lation/Energy I
<br />Q4rwall 1 r(la Tn ,n^*<lrr/
<br />Ext./lnt. Lath 'r I U
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL it^*af,)
<br />Certif icate of Occupanc t- r UJv
<br />Notes Remarks EIC,gl
<br />t
<br />Erection Pads
<br />T-Bar
<br />Handicap Req.
<br />Flood Zone Certif .
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