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BUILDING- INSPECTOR RECORD
<br />SITE-WOBK DATE ID/SIG.COMMENTS {)\1Nt,ll M ILt'l:ll t)tir.( '\R,\ I l()N
<br />I hcrcby,r,nm undcr pcnnly r,r Pcrju,y rlur I !m cxctrrpr rmr rhc Cont do^ Liccnse t-iw ror lhc lolbwins rc$ntr r\n-7)rl5
<br />Irmin$s ond Pofcssii Cc{,il Any Ciry or Coutrry which Blrnc\ r ltanil b coninrcr' nnct. impruvc, dcndirh or rcttrtt rnv'
<br />drucrtrrc. prir ro irs issulncc, als rcqutcslhc alrplirMr fd $.h trmirb filc, sigmd \rJleftnr rhli heor rhc G liccnsd pur\uanr
<br />ro rhc pmvni,'ns ofrhc Conimcrorr Li.ciscn ke (Chrplc.9. Connncncing siih Sc.rtr 7t1(X) of Di}ision ] ot rh' Bn(i'r's 'nd
<br />P('fcssionscodc)oriholhcor\heilurcnptlhcrcliomsdrhch$isrhrlhctrllt!.dcrcmlrion Anvviol0rionotSdidlT0ll5 hvdnv
<br />smh..nl fo. r rrmil suhjds rhc apllicinr lo ! civ il p.nalry o f ml mF rhm fivc humlrtd dolhrs ( $5m).
<br />-1.
<br />rs osn r of lhc lol)cny, .i .ry cn[]or€c\ wnh wascs N rl[n a,b cotr1l. \alion. *ill do rh. work $d llE nft1m i\ nor
<br />innrrlrl .rofltrrd ftr eL rss.?044. Busincssdtrd Pm,tsidrs Codc: -ftc Conrracroa\ l-i.cnsc L{v o.sn.r.mlvk'anosi'rof
<br />rhc ptr,Fdy wht lds or iq,n,vc\ rhrNtr. .ni sh() dft. tu.h Eod( himsclr or hc6cli or rlmoBh hit ot hcr own cnDlove's'
<br />p",,a"a rU *.t imrn*$rnh s n inrc icd doltc.ci ntr \ak ll ho$crcr. rh. t{ildir8 or in{'mvctutrr n so[l virhin 'nc )tu
<br />;r$npkti4 rlE Owncr Boildd wrll h0vc rhe hurdcn orNrine lh:r hc or \h- dil nor ttriH or imFnru thc pnlFiv lo' rhc purP{ ot
<br />L ai.sncrolrhc pnDdy. r cx.lusivcly.otrkr.rtrrS *irh licctrs.l roitid.r\ro cotrnrud rhc n.ojc'r (Sc' 701r' llrhio'$
<br />xl ftnssi,nCodc ihc 6naacr.r'\ Licctrsc l,xw tloc\ nor nntlv ro 3n oqicr otno|Ent sho huilds o, inprolcs rhcrcon'
<br />rtrd who conrracrsf(tr:u.htrotc.r\ sirh r Conlficktr(, licc,Ncd puhxrnlrn rh. Coiki.roii Licctr\c La\r)
<br />I rmcxcrnpr undcr serion--
<br />D,*, eEy' s // S:
<br />DLCLA3AUA!
<br />I hcrcbyrllirDundcr p.nxlryolpcrjuryoNof rhc ft,lhlqinr tlc.hrarn t\:
<br />lhrvcvlwillmrinr0inrCcdific0rcolContcn os.lf_lr!trcfor*o'kcra.ompctrsiir.asPmvidcdli'rhySctiion:l?lx)ofrhc
<br />litxtr C{xlc. ror rhc I'.rlonronce orrhc work lor shich ih. |).nnr n nlucd.
<br />I hrvc rnd willtuinrrin workcrr.onlNtrsariotr imuraocc. rs rcqoircd bvSc.ri.n:r7(Xrol rhc LohorCdic. hr lhc r'rr'inHtc "rhc work tur *hich rhis p.rmir is issucd. My workcr I conrPcnslri{'n iNUrrtrcc crtric! aid B)licv numbcr dc
<br />ir)rlENni)'uncdofrhcworklnr*hichrh^ptnnirN\nlcJ.lnrllnor.'nPhyntrvltrr\'nhtrv tnncr
<br />!ubj!.r h rhc $o*c^' .onD.ns,i i(n liN\ olCJliknir, rtrd r!rc. rhJr ill \tu,uld hs(otrr \uhr$rto rhc
<br />tr\rri(,r|m,!Nlotr\of Sc.ri( .17(X)ol rhcLnrtr(itr1.. I
<br />nhtrc 1,) {drc *u'kc^'.. ,frn. ri(nl.o!c't!. r! utr!
<br />nhll. innhsirh coilnv \irh rh.\. !'oviii(f\
<br />\hill $li(l ( In.)_.r h .riniilL lf,nrlri.s xtrJ
<br />o om hundr.J rhou\rnd dollrr\ (SlO0,Ux)). ir id!of co'npcns i r. drmxg$as Provtl.d lnr lhc
<br />s.di.n 1076.fihc litxn Codc. intcrcn and srl
<br />,.,", * v{ / rils *,
<br />l2[r.\B!lar
<br />I hcrcby riir uid.r rnrlr, orIl.rjurr rhdr I rnr lie!\c,undcr |novision olCh]pr$ 9 (..mnErin! snh SNrion 7ffx)) ofDivi\irin.]
<br />.f rhc llurncss rnd I'.olcs\io sti c.rtrd trtylicctr\e h in ltlLl,n( a,xlclll.r
<br />(](INS'IRUC'TION I FNDIN(; ]\CEN(]Y
<br />i(qk{ rsc. lo97 Ci! C.l
<br />APPI I(]AN DFCLAiA'I'(IN
<br />Irlrhyanimxndcr lEtrslly orp.ritrry one oflhc roln,*ine dc.hnrions:
<br />D.nmlilnnr Pr nih AsEsos Norificali.n kdcnrlltcgul(i{n]\ (-lirlc 40. Pan6)
<br />-Rcquncd
<br />l!ricr of NorilEalion
<br />lcc ifyrh[ rhclcdcElr.AUldi(, s rcE di'rgnsh.(.s'cnirilrr. norrlrl]ublc lr) rh'\ ldLtr
<br />I ccnir!r[xr ll,rvo rcrdrlri\ nPnli.]rnn, r d {lrc rl r rhc rh\d 'nl,tr hrttrr i\.oir.rr liErNrocofiplysirlrallCiryrndCounty
<br />r, ivcs olrnt Ciry tnd Counrrro cnrd ul.n rh.
<br />rxrer oglt5//3rrdhrrccs rtrd Srarc trws iclnrir8 ro {flcrior. and hrcbyrurhori- rcpr.sc
<br />rlarc if, ({ul!ropc'ry l(tr i'Nl
<br />\ppliri l or \lrtrl Sitn.l
<br />o EL-
<br />rOr.J
<br />?..1 kt/Q., z-c-<- ,1
<br />tret/t-l ,k **.qTL
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Ve nl/ln s u lat ion
<br />Roof Sheathino
<br />Shear Wall
<br />Framino
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lr/lason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL 7- t6-79 ..tt.16/2 4?)
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />. !, & PC n,rhir rc6on
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