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BUILDING- INSPECTOR RECORD
<br />SITE.WORK ID/SIG.COMMENTS OWNER BtII LDER DI]LCA RATION
<br />I hcrch, rflinr uMcr |Enrhy ol pcrjuy rhal I m cxcntfl nnrn lic Conlruct)F Licci{ Ilw rd thc h,llowirs rcrer lsrc 70.11 t
<br />Busincs !0d Prcl$\ion Codc) iy Ciry or counry whi.h rcqunc{ r lEnnir h cotr{r!.i. rlrc.. impnv.. dc'nolhh 01 q)at ttry
<br />{rucruc- priut' ih t\urtuc, nl$ rcquircs rhc aplrli.anr ld $.h Fr trrir io ljlc a \igncl {ar.nEnr rhd lf, ot sk\ h liccnscd l)u6u3lrr
<br />ro lhc ptuvnnnrs ol'rhe Conlla.ttr 1 l-i.lnscd La* (Chaprcr 9. Cdnnn.kirS q n Sccriotr 7uf) ol l)ivirii,n :l orrh. Businc$ rnd
<br />Itoltssin\ Codc) or rhrr tf, orshc i{crc'npr rhrr.lion M rhc hNs turrhc.llcScd cxcmtlion. Anyvn,Lrn,nofScctiorT0-ll 5hyrny
<br />rrnh.Jn,h"rn.'trr\uhjNr.rh..'n!.'(rtrrro.!trrlFrrlryi'ln.rtr1,.rh'rrtr.hund'cJ't^llr'\r1iar
<br />AA
<br />/ !L!l *,,"n-, rh"n.nd!.,trnrlc'nFl,,ycc\$ h \,'cr\a( rhcn $ L' .onr pctr\rr ion- *illd,) rhcso'kurtrh.nMiuEi( n.l
<br />i'nc,kl\l or ofi.r.d r(, elc ( SLr r(}lil, Busirc$ rnd Ptufc$n,ns Coic 'rhc Cofkr.ttr r l-ic.tr{ tr* des nol annly b an oN cr or
<br />rhctr,p.ny who huilds or inDn,vs rhcrmn. md *ho d(f,s such No hi't\clfor hcscllorlhmu8hhisorhcro*ncnPk,ycc\.
<br />Dhvidcd rhd such mpnk.rtrh (rc mr inlcndcn o, oficrcd l s,lc Ia lxr*$cr, rtr bu iUing or i'npruv.nrtri is $U s irhin on. ltr
<br />ol conrphrioi, rh. O*i.r Bui&r will hn\r rh( hrd$ ol pr.vin8 rhnr hc or \hc dil tror hrikl or inlpn,lc rhc nnJtdy n rlEpurF)Eol
<br />I. a\ o*turolrtu Pr()txny. nc\.hrncly.rtrtr.rin!Nirhlic.nscd.onrrcknsi,con{rucrrltImlc.rlSLt.7(!!.Busncss
<br />rod Pnics (lnic:,hc(innn'ctnsl-ic.\cl-trwd(rsf,orrnnlybrno*ncrofDrcNnysh{)iuildsorirpmlc(rh$ctr.
<br />rkl qhu $trtr.rs ror \uch preJcch $ilh tr Conkucro(\ ) liccrscd l,urslnnr t, rht co rkkr's Li.cnsc tlv )
<br />,1 )i. i,;;,-i;^' * - tw' Y -
<br />tl o (t El{\' coIt l,tNsA'l hrN
<br />) -C'7- / r>t,--+
<br />IzE!lA.8iIII0!
<br />I hcrchy rflnm trnJrr pcinlrrorp.qury.Dc olrhc hlhsire dc.hnliqN
<br />l-xlr,(ixlc.lnrrhc ncnirnrN..lrhc $ork nn ehit,rrh.trlntn i\ '\{rcd
<br />rhc w.rl nn $hich rhn pcir ir i\ rs{urd. Mysnrkcd.o rt'ctrrt(ror Nuran.c.rrirr Jnd |x,li.yrtrtrrh.r irc'
<br />I\,licy Nu ,bcr-Erfnc\:
<br />-
<br />-
<br />/4rtcnifyrharirrncpca"nr!rccofrheslrkfff*hthrhi\pcrnrirni\\u.d.I\hrlltror.mpl,'yanypcr(nnr]y
<br />ntrrcr
<br />{, ns ro hcconE \ubjcd nr thc $lrkcrJ..nfcis ti,n h*\ olClrlilanrin. r0i {grc lhrr il I \ht,okt hc.o t \uhlccr to rlr
<br />workcn.ompcnqiionlrn)lision\ufSc.rnr:lT0OorrhctihnCulc.l\h.ll.tunhwir[.ontdy{rrhrho{fiovhnnF
<br />WARNIN(;: Iblurc ri) s.um sork.r\ coill.n{nn (hfuBc i\ unhwtul. rtrd shlll suh]r.i ri rtrrtl.y.r ro dimiml Pcnalrics rnd
<br />civil lincs up ro otrc hundrc{lrhousrid doll rs (S100.(XX)). h rddiior lo lhc .o{ ol conl|rLnsnrnn. dr rlcs 0s Provi,lcd i(n lhc
<br />sNrirr.li)76 0frl[ I rtxtr ci r.
<br />^*.' .,\ -q; 1 /'"":J:;;/,,1 lr zi t/ry'
<br />DECIdBAIIIIN I
<br />I hcrby lfinn undd !.n,hroipcrjury rhar Irr lic.trrn und$ lnoviliqr orClrPrcr 9 (.o'nrftncire wilh SLtrio! ?(xx)) or Dirisi(,' l
<br />ol rhd Uu\incs\ rd Pdfc\\iunc C.dc. o nry trcns is in lirll lorcc aBlcfle(r
<br />I-i(i{ Clr\(I i.cn\c Nun r.
<br />CQiiIIIBUqIIaNIENDINCTIjjIIII
<br />l\\u.d rscc 1097. ( iv (l r
<br />l-cndcfs Ninrcl
<br />AIIUEINfD}:ELABAIIIIN
<br />I hcrL{ry rmmr u tul.r rrndry.rtcrjry onc ol rhc tu1lo$irr8 dcclnrnri.n\:
<br />DcnFlirion Prrmirs Ash{o\ Norillcrrion Icd.ralRcSuldrn r{lritlc n0. Pnn6)
<br />-Rcquirl{
<br />I!lrcr ol Norifi crri(ni
<br />l.cnilirhd rhc fcdchlrclul.rion\ rcglnlirE r\ii({os rcnn'vrl r'. nor lnflrnhlc b rhr pn're.r.
<br />4L t-nr, 'r,,' rr..'.*,,1,r'\,'prl'LJrtrrrrld i crl'. rlrah,v. ir,hxuti,)n is cor..r Itrrrsr'd,n!lys h!llCiirtrndCntrnry
<br />ortli'un.csrnd Srrrc l- {srrhri gio huildin! conslrudlo[ and hcrcby ruihorizc rcprcscnrdirt\ r)flhnCityMdCou yhcnrcrul).irh(
<br />,; ;:, ,,...;:, ,. l" )'y',., ,")v",)t
<br />P,an,,sn h.,pri ,:X A6,,)-/;tt- //fi6ry J
<br />.,9 z'l
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsu lation
<br />Roof Shealhinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lVlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL 't ^t0-lK \-,w1t)
<br />Certiticate of Occupancy aul
<br />Notes, Remarks, Etc
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<br />DATE
<br />lf,nnc_. .ld'c.\
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