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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Ereclion Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Venti I nsu lation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq J ./t,?)
<br />lnsulation/Enerqy
<br />-Qtywall
<br />,,/4.1OD17'Ext./lnt. Lath C Iz"tB
<br />Brown Coat IIO 4rlt*c\, t,.<o ).zg.r6 ,L24Masonry fS$ S-".t
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL ,(2-P),0(.4mt]
<br />Certificate ol Occupancy
<br />Notes, Remarks, Etc.
<br />o \__-z
<br />OWNER BUII,T}DR DELCARA'IIoN
<br />I hc!.hy rfirn undcr F.,lrt or pcrjury rh l m .x.nu fm lhc Conlmdos Licensc l-q* tor rh r.llownS d,etr (S(.r0:t1.5
<br />Busircr\ d Pnna{sion Codc): An! Ciry or Coutrly which rcquircs a Itrdir ro condtucr. alt.r. inPtovc. ilcnnlnh ot rcPrn sn}
<br />siruch,c, !rn, to irs issuancc. als rc{luncs rhc rrrpli.lnl forsuci p.lmir ro liLa siBn.d {.rcmd rhot hcor shc n liccDsed I,usuanr
<br />ro rh. pnrvisi.ns ofrhc Conkocrols Liccnsd Llw lcn{ cr 9. Comncncing *irh Sc.ri(,n 70{n of Divhiotr I oflhc Businc\! and
<br />Proltsio.sCodc)orth0lh.orshcncxedplrhc.efron!.drhcbu\istdrh.J!.ScdcxcNttion.AnyviolalionolSccii,n.lo.rl5byrny
<br />.!'plica foraFnnit suhj(ls rhe rttlica.r ro acililpcnaxyofnor nic rhd livc hutrdre{idolhN (S5t[))
<br />l. N o{ncr .f th. pn,Fdr. or ry cmplo}es wilh woscs .s rhcir $lc (,mpctr\ari.i, will do rhc work dlhcslnriuE is ml
<br />iNcnncd or oltlrcd r'or elc (Sa 7Or-{, Brsinc$ end Pnncsi().\ Codd: Ihc cbnlrlctols Liccnc tiv doc\ nor apply b an u$icrur
<br />rttrj toJfdy who hrildsor nl{rmvs rhcNn. ud who des such $* himscltor hcrclfor rhhuSh hh.r hcr own cmpk,ycer.
<br />pn,vidcd rh \uch inpR,wmn( m tur iln.nddl orolt rcd lor qlc ll hotrcvcr.lhcbuildir8orir{,rovc'Enris$kl whhin.k itJr
<br />ofconptrion. rrr O{ner Auikr will h.vc lhc hudc. olprulins rhrr hc or rhc dil mr hrild.r irlwrc rhc pmFiy fttr irt PU4is.r
<br />$h'
<br />-l-aso$nerofrh.pn,,f,ny,nnr.xclu\ivcly.ont&ri'rgwirhli.ctrscdc.nrr0cro6ro.onrrdcrlrtpR,iccr(s..7ol4.Buim\\aM Plorc$irtr Codc ThcContmcroisl-iccnscli$doesnor{plrhnnowncr.ff(ip. ywhobulldsorimprovcsrh$.on.
<br />and eh. ontNh fq h prul..rs wth a Cbnlru.rods) li.cn{d Nnunl lo rhc G)ntDrkn\ l-i.cn\c LB).
<br />_l amcxenfl lnder secrbn-, B. & P.C. for thh rca$.
<br />D.r.: Oqr.r
<br />trl)B[E8li:lauflillalt9N
<br />UII(IABAIIAN
<br />Ihcrchyrffi u drr |tMlryorpcrjLtrt,otrc ollhc r'olhwirs dccl.riri(N:
<br />-l
<br />hlvc rtwillnuinr0inuCcniliqrrofCon\cnriosclfln\urclaiqorkcs'comDcnsarion,as !tuvid.df.rbyscctionlT0oolrhc
<br />tihor C.dc. for lhc pcrlormrcc oflhc wort lor Nhich rhc pern,ir t issxcd
<br />Ihrvcrnd*illnrinrain*orkds'.otrIrnraronnrsurdtrcc.as.cqntcdhySc.rim.lTfi)ofrl[lih.rc(dc,lhrrh€|Ertornx,rccoI
<br />rlr work f whi.h rhklfnnir is ksucd MyworkcG conlEn\irion insuruncccr cr u Fli.y nunrb(rm
<br />lcdniry ihd i'rrrf, p.rro.Mmc or il[ w.rk r.r *hicn rhk pcirnir is nsued,, shallior entloy a.r tcs.n ir rny aurnc,
<br />s s h bccorN suhjd Io lhc *orkcr odpen\lrion lavs oiclliromia, mrl l8rcc rhit ifl slmuld h.To.E sobjer ro rhc
<br />Borkcn conpcnstion[ovnionsofScclion:1700orrhctrhorcodc.lshall.fonh-nhconrlywilhrhr{p !nnn's.
<br />WARNING: Frihrc b surc Rork n (o,nn nsrn,r .ovcaSc is unlNrul- und shnll suhi.cr an cnrdortr lo niminll t€nrlrics lnd
<br />citil lincs up b onc h!nd!.d thou$nd dollar ($10O.000r. iD addirion ro rlE co{ of.o ll.nsarion, daflEgcs as pn,lidcd for rbe
<br />Sc ion 1076 ofrhc litltr O,Llr mrcrc{an,lsdrncv'\lcc'
<br />,",",02q'.tD V*", t4 5.yv6.,.>
<br />/ n u(ENSED-!-rrNra (Ilxv \ DEqaEAIlo!
<br />I hcEb'.'fllrnr unJ.r l.ndlry.fncrjury thd I NEnEI undq povi\n,n orCh,,,tcr 9 (conrnrcncios $ilh Sccrnrn 7000) orDivishn 1
<br />. rhc Buvnc* rn,t P^'l.strrsCod.. and mr l,lcnsc r m tullLrm !'d.nMa /a79a41
<br />"*", &2o,.@ zra,y'- Fo<kttt:'
<br />I ncrcby !ffirmundcr pcndlryofFrjury rhd rh.rc isa on{flcrion tnditr8 0sencr aor rhc Frro.mr. ofrhc work for *hich rhir Fnth h
<br />tsucd (Scc.lo9r, Civ C.).
<br />APILICANLDECI BAIIQ!
<br />I lB!5y nrmundcr ncnalry olncriury oN ofrhc foll{,win! ddltrrrrn'nsl
<br />Dcnblirion P.rnirs Arb.\ros No(ifiration li.dcrill{c8uhrion\ (l'irlc 40. Pd6)
<br />Rrquncd Iincr ol Norifi cdion
<br />_l.cdilyrhrr rhcrcdcralrcsuhtons rgardr!,shc(o\ rcrmv.lirc nor lPplicrtJle k, rhh ptuiccr.
<br />I I brvc rcad rhi( ipflic iondndsr.lcrharrhc.t{vcinfitrft ion i\.onc.r.I rgrero.omflysnhallCiryJnd C.u.tt
<br />srarctiesrclarirslohuildiosconslrucrion-lndhcrchyaurtutrnrrqr.\chrivcsolrhnCilyrn{lCoutrrynrcnlcruFnrhc
<br />md pr'lcnt f(tr nry..rnnr
<br />d Sizz--;^,". E-zq:19
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<br />ktrd.r. Addrcs
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