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BUILDING. INSPECTOR RECORD
<br />DATE ,I EIG.COMMENTS OWN[RAUILDER DELCARA'TION
<br />I hcrchy rinm uNlcr pcnllry of lcrjury rhar I anr cicmDl iio,n lhc Contrttra Lkcn\c Lw rd lhc follo*ins rc!\otr (s.c 70-1115
<br />UusiDcs lnd ltafc$ion Codc): Ary Ciry or Cou.ry qhi.h toqrirc |innir t) cof(rxcl, alrcr. ihpro\c. dcmol$h.r rcNn tr t
<br />{rucrurc. prnrb iB ksdancc. rho rcquncs rhc rppli.ahr f.r \u.h F.nil ro lilcn siSrcd (llemnr rhd ltot sh. is liccn\cd lu^urnr
<br />ro rnc lovnioN ol rhc Conrractr\ Licc.*d liw (Chrprcr 9. Cdnrnr,rii! wirh S.crion ?(xl, oi Divtion I orrhc Btrsirr$ atrd
<br />Pmf.stN Co&) or rhd h. or \h. ( cxcmpr lhcrcfroorard lhc hrsn ro,lhc allcscd dcnprn,n Any vn artnrofsNr6nT0Sl5 hylny
<br />.pt'l'u rd d l).rnrir subiccB thc rypli.ant !o acivilFnalryoinor mrclhan filc hunddldollds ls5m)
<br />-1,
<br />.s owmr of rhc nnrEny. o, my er,9!orte\ wnh was.s a\ rh.n {,h .unfctrqlion. will do llr worl ad rhc (dm s mr
<br />inrcrlcd or oficEd a* sk lsd.70.l,1, auslrcss ad ftofcsions Codc: fhc o)nlnckn \ l,i.cnsc Irw docs nor atPly to an otrncrol
<br />tic pmpcdy who huilds or inlpn'rs rhcdn. and who dftr !u.h so* hi'nsclf.r hclsltot rhou8h hh or hcr own.frPlorccs.
<br />nnvid.d rh ruch inlnmvdEna E mr idcDd.i or oatcr.t ,or eh li ho*drd, rh. hoiklin3 or iRqnNmnl is solll wirhin .nd ,td
<br />of complcrbn. rhc Owmr Buihcr will h0rc ll* budcn ol tmvirs rh.r tE or shc dil dn hoill or i'll,n,\t IE ,mP.ny for rhc IttF{ of
<br />Ldsow.rofrlrrolxny-rmcrclusivclyconrrlcrire$irhlicctr\rd.otact^n,.on\ru.rrhcpojccl(S(.7l}l.l.Buiicss
<br />and lr.fssirn Clnl.: 'l h. Codkrcroas Lic.trsc Lrw do.s tror inlly h atr osncr olnropcny *h(, builds or irprircs rh.r.on.
<br />!d who..ntrachlorsuchpro]ccls*nhrftnrrrtn(rli.cn\cdprNrnrrh'rh.CotrkrtriLicctrsL,*r'
<br />I oNcxcnrfl u cr Sccl
<br />II]BtrE&1:CI}IUENIAIION
<br />I hcrcbydfln utrdq ,cn'hy ol r",jr,y "n" ur,r'" rnrr,,*lgffi,-*Mlu
<br />-l
<br />hovc ond qill ruinrdn a Ccni,icarc or C.nknr h S.lf lisur rr worktra conrEnsarion- as prolided lor hy s(rio. lTur ol rhc
<br />Lrh, G'd.. ntr rh Frtuirnrxc oirhc trorl rd whEh llrc t{rn r i. i.\uc.l
<br />i!& n,"" unu *r,u,,'no'n *orkcr' (ornFnssrion insuruncc. rs rcqlncd hrsc.L.n lTmorrhc rjh.rcode, ro. rh.ldrumn.c oa
<br />rlE work lbl wnich this pcmit is icsrd. My sorlcB snu.nsario. insrfuRr .trfti.r drl Flicy n!'nhcr ec:
<br />' fl)E C'.n42.,D,
<br />/2" lt<1D(vrc- 8o\A34 /,<)rr
<br />-l.cnitrrhnr
<br />in rhc !.rllndnccofrhc work lor qhEhrhis Dcflnir is hsucd.l shrll norc fh,y.ny,)csotr in strymrnmr
<br />s s r, lj(.nN uhJcrr ro rhc wolken coar.nsrrion h$\ orCrlinmir.oid.Sr.c rhd ill \h)u&l hlmm sbjcd ro rl'rc
<br />*orkcn'conrcn\dbnpmvGn,nsofS..tion:l?00ufrhcLahrC.dc.lshill.lonh*irh.omnllNnhrNJ\.Pmvsions.
<br />WAiNING rrilurc io *rurc Norkcr'conllensli,)n covcrugc i\ oiltr*tu|, ind sh.ll nrhid an cn{'lorr io dinrinaltrtulrics aM
<br />.i!il llncs ut b onc hundrcd rhouslnd dolhr (Xl(x).lxx)1. ir rddirnni io rhc.on u, conlc.s0rion. danugrs rs Pioridcd for rhc
<br />::r-i##?::
<br />D!!I.!Itll!^
<br />I lINhy (lltnruMcr pcrulry.tFrjury rh,r I m li..ned udcr pnrvisn olChirrcrI(c.nnncncirswirhsc.rir70m)olDirisi,nr:l
<br />u, rh. Brsircss rM Prolt$ions Codc, uM my liccnsc k ir tullnrccMdcfl..r
<br />B
<br />,",., &741/ Y
<br />cQNfIBLlgUANrEN0lNti-&{illLI
<br />I h.R.bt affirn undcr |fMhyofNrjuryrhar thcre is o con{rudb. L i',9xgri.yn)irh.l[rLnmnccolrhcrorkIrshi.hrhisP.riniris
<br />isucd (Scc lUrT.Cir C )
<br />,k,vc nrtrrn d fn,pcnyror in\pcciion!!,toss
<br /> DDlirtrnt trr AutrtSiAMlure
<br />U"."r." ,-," , r"u, t, K I
<br />tlxlc: 1 "/+{
<br />Set Backs J
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Cenif.
<br />FINAL
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc
<br />--+
<br />SITE.WORK
<br />?Z ZZC-O
<br />L.nd.arN.m:-
<br />t ndcic AddFsr
<br />-
<br />AITLICANI.OLELI3AIII!
<br />I l$rb, Mlnn uidrr l,.n.hyol pcrjury onc ofthc followins dccl.nlions:
<br />Dcmlibn Pcrmih Asbc(os Norifi.arn,n Fcdcrtrl R.8ul.ri.ns (Tirlc40. Pun6)
<br />-Rcquncd
<br />Lcrrer of Noriarcnrion
<br />-l
<br />ccniryrh,r rh. rcdc ol .c8n lal ion! EBsrdinS NtEstos rc ovolaru norltplictrhlc t,rhhtmj..r
<br />(rALIccnriyrhdlhotrcaLllhi\drnlrcrnnrrl{,rcrh rherh,v. inr(rnBrion kconccl ,eErelommplytirhrllCiryondCounty
<br />;rdinrnccs arn StBrc hwsrclurinC rob!ildingconefl.rhn. d hci.hyrurlnrizf, rcprcsenrorivcs ollhn Cny and c.uhryro€nrcr u!.nlhc
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