|
SITE-WORK DATE ID/SIG.COMMENTS OlVNER BUII,DER DEI,CARATTON
<br />I hc6hy a,firh lndcr Icnlhy.r p.rjury th8i I m rxc rrr rrom ihc C.ntxdor\'l-i.cnsc Inw lor rhc folloBins rcavin (Scc 70.115
<br />Btrsirlcs\ rM Pturc\siotr Codc) Any Ciry or cornrt whi.h r.quirc\ r lEnnir ro con(rud. .ller. impmu- dcmnth or Er n an,
<br />nrucrurc. Driorro irs hsuatrcc. aln rcqutcsrhc lnplic.trr ri, suchrcn ro nba stncd (a'cnni rhar hor\hc is li..nscd llnrunnr I
<br />h rhc lrovnnJn\ ofrh. Conrd.ttri l-icctrscd ti* (Ch.rr.r 9. Corncmin8 wilh Sccliotr 7000 ol'Division.l ol rh. Bniin.s ind
<br />Pmlcssidr Codc)orrhri hcorshc kcrcnu thcrclromsnd thc hash for thc illcscdcrcmnlion AnyridarionolScdi.nT0.ll.5bylny
<br />uptlicrtrr i(tr J Ennir $rl'jcch rh. apnlicrnr h rcivilpcnlhyolnor nrrrhnn nvc hundr.d doll s(35(XJ)
<br />-1.
<br />rs osncrofrhc propcrlr- itrnryempbyes {irh *r8cs rs lhcir slc.onwnsdhn. willdo rL sork $d rh. {trtrrE is trl
<br />inrcnd.d or offcrd for \rL ( S€. 7Lrll]l. Bu\nrs nnd krfc*n,n\ Codcr Th. (iflru.iitr's l.kcnr L{s dncs rcl aptly ki m o$ cr of
<br />rhc pro,rny wln, huilds or irnpmvcs tlrcrsn. ml who dcs suc[ wrk hnnself or ncrcll or rhn'ush ii\ or h.r owtr c rdoyccs.
<br />tRJliilcd ih su.h i'npn'Rnrnk:ftfr inrcndcd or.lttrd r'or a,lL Il hok'ci rhc tnrikliq .r iqhBnEnr is sld wihitr orE yro
<br />oIo'q'krion. rhc Owncr lruiUcr *ill ho1! rhc hurdcn ofpmviry rhd he or \hc ditl ior huikl or inlpmh thc llfi)tdy ritr rhc purtosc or
<br />I.r\owncrolrhcIr1My,amcx.lusivclrcoiticrinstrnhlic.iscd.otrrr&rnshcotrsrrclrhcpr+cllscc70,14.Bu\ir'r\{
<br />sod ltofssi{,!Codc-lhcConrrmtn{l-iccn\cLawdocsnorrpplrbnnowncrorpiot ywhr' hxildsor inrrovcr rhcrcon.
<br />.nd eho.onrrhforsu.hpbj.rFwirhaCbnhfi)dtli.cn(dNnuonrrorhcConrracroisl-i.cn{tjw)
<br />lrmcrcnpr undcr Sccrion-, B. & P.C forthisrcason
<br />lrste Orncr
<br />noRKr-f$ colriPriNs.{l Ir lN
<br />IECLAAAIPN
<br />I hft.hy nlfinnundft rn,lr, olD(rjury onc ollhc nrbqin8 dcchftri(ins:
<br />I hrvcard willnuinrri.uCcnilicitcolConsctrrro S.lllNnrc hr wortoa conrncn! ioi.!s Drolidcd rffbysc.rtr :lT0oufrhc
<br />Lab.i Cod.. f.r rhc pcrft,mnrn.cofth. work forwhi.h rh. p.rnir is isrucd
<br />-lhar.nd
<br />sillnroinloin *orkcFr compcnsrtion insuruncc. n\ rcquircdbysccri('n.17(x)ofrhct-fiotcodc.lbrlhcpcrl'onume.l
<br />lhc work lbr whi.h IhN pcirnit is hsNd M y *orkc^ Lompcnqln,n i'rur!m. clricr atol Erlry nun$.r dc
<br />I..nifr"rl r n, rhc Frforrnrm. ol rh q ork for shi.h rhis l{nnir I Anrrl. I \hrll tror .rDl.! in\ |f(.tr i', xny m n[
<br />$ ds t) lr(nk \rhlcd ki lh. wor kcr\ ..nrNtr\irtr Irw\ lCililnrnin. r !!'cc rhr i,Ishoul,lhlco t{rh}drirlf,
<br />so*crJ c.nrt'crsrrii{ frovisi.trs olS.cri,r.17(r).lrlt Lih.r Citrlc.l \h]ll.lanhRi(h conUly { iih rho{ IrR*nor\
<br />11ARNINC lJilurc k' {(urc "Ltl(^ Lrn{fn.. irn' .',\c g. i\ utht,ul, ntl \hll (ublc.r nrr cnrln.y.r ri .ri,nirrrl Pcnrlii\ rnd
<br />;.; Al)q iiB ""M", Iaaw\o+lkn
<br />. / \ t"[rN)I:DLl]!-l&lrll)8Y DL(L,\R,II()N
<br />I hctoby rfinnundcr pcn.lryollcrlury lh.l I am liccn*d trnrtcr tmv$iotr olCh.llcr 9 (conrmncing *irh Sdrhn 7ff)0) ofDivttrn l
<br />of rhc Busin.s lnd Prcfcsi,,ns c(d.. Md my lic.n\c i\ in full f(trr dd cffcct.
<br />'Ov tl
<br />I
<br />(rt
<br />I h.rrhy nillrNnnd.' Ntri ly.f Frlurylhd hcrc i{ r..n(ndi.n lcftlirg rgcncy lnr rh. rcrhnru'ncc ofrhc qo* lnr $h(_h rlti\ Fnnir is
<br />nru.d (se, 3097, cir. c. )
<br />Lcndo \ NaR
<br />-
<br />d.ttt.rcaNfDlic1,A3trIllttr
<br />I lf,rby rninn u Mu lrmlry oftcrlury onc ol rh.lall.wirt dc.litrrri(rs
<br />Dcnx'liii{r Pcrnirs Arbc{.\ Norillcari,nr FcJcrrl R.3rhrn,ns iTirlc,l(1, Pan6)
<br />Rcquird lincr of Noiii.dri)n
<br />*k/.r*-. -/,.tt
<br />h. fcdc.ll reslhrions rcssdins ashesros Ennval arc nor,rnlicdblc b rhis rroj..l.
<br />v.rcadrhnaptlkarionaxlsrd.rharrh.abvcinlonrorioohcotrcrIaBreroconrplywirhallCilyrndCouty
<br />Pd,g"
<br />Set Backs
<br />Ereclion Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsu lation
<br />Roof Shealhin s
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lr/lasonry
<br />Pool Fence
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL a tlrr l/O €lvhT0- F.-->-''
<br />Certilicate of Occupancy l---r
<br />Notes, Remarks, Etc
<br />BUILDING- INSPECTOR RECORD
<br />Fo rm s/Slee l/ H o ldown s
<br />T-Bar
<br />t.tr.,,1'. \'t.t'rs
<br />I
<br />t-
|