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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG,COMMENTS OWNER DUILDI:R DELCARA'I]ON
<br />I hcr.hy rffinn rnder pcnahy (,r ll.rjury rhrr I nn.rchp! fn,:n rhc G)nh.n)* l-i.unsc bs lir Ihu lirllowiD8 rcrqr (Scc7l)ll5
<br />susnBs r Pofc$ion Cdc): Any Ciry or Coutrty whi.h rcquircs a poDi ro consrrucr, nllcr, nnpovc. dctrmlish .r Bplt an,
<br />srnKturc. rn{ro irs issum.c. dso rcquircs rhc ll)rlicant lor s!.h lEnn't ro filc!si3ne! nalcmnr rhd hco.shc i\ li.cnscd lu*Urd
<br />ro rhc pnJvi{ions or rh. Coit,.nn s Li.cn\cd uw (Chapr.r L conm.Ring wirh S.ction 7u)0 ol Divhbn 3 olthc Bu\iness and
<br />Pmlcssiotrs C.dc)ornlal tuarshc hcxcmfl rhcrcfro'nand rhchasis ior rhc ollc8cd cxcmrriotr. Any vi.llrt,nofsccrionT0-ll5 byany
<br />applic! nn a !.rmil suhj6.-ls rhc lpplicanr n, a civil pcnalry of ml m,c rhu fivc hridmd dollrs ($5fi))
<br />l. N owncrorlhcpn)l[ny. ornrycDlno$cs wnhwaScs N rlrir nrc co l.nsrlbn. will do lhe q,rl onl lhc srBtit il trdr
<br />inlc Ld oroficrcd for$lc(Se,Ort- Busirc$ ond Prolcsiotrs C.dc lhcConta.ttrs|-icctrrlrwdksnot,pllyr. o*ncr.f
<br />rhc lm)t dy uho boilds or i'ryro\6 rhcNn. ari who des skh e.rk hnnscli or hcrclf or rhmu8h ht or hcr o*n cnphy.cs,
<br />providcn rhrr ch irymrcrnk m , inrcnlcd or oA.Ed for slc ll ho**6. rtr huiuing or inpmEnrnt is $ld wnhin om )rE
<br />ofconplcriur, rhc Owrcr Buiklcr wil h e th. bunlcn ol poving rharlEor sn di.l mr huili o, inlpolc lhc pn,Pdly for rh. NrlxE ol
<br />-l-
<br />sowrErollhcprol. y.! cx.lurivclyconrrucri'rgwirh licctr\cdcontf,cbnbconirucr rlr frh.,..r lscc.7044. nulncs
<br />rkl tn,lc$in Codc: Th. Conk0cln\ Licctrsc Law docs trot rpfly b tr. owmr oaplopcn, wno $uilds or inpr.!.l rhcr.ui.
<br />and who..nr6clsaffsuchll.ojccllwithrConrrndonrliccnn-dpurMntr.rh.C.nr(ttrsLi.rn{Laq)
<br />llQBXEtrSt.qOTtf[XS IIANl2ltrla&[rax
<br />I hcrcby nfltrd undci F nalry of pcriury Dnc olrhc (nhNin8 dc.hnrion\
<br />I hrvc will maini0ir {Ccnificrcofco.sc lo Scli-Insurc l'or sorkcr' onDcnsarioi. I phvidcd tur by Scctnr 17(Doathc
<br />htxtr Cudc, lor rhc p.rrornhmc of nr work for which r lr dml is h cd.
<br />I hrR rnd will Drn rin workcrr conDc.s(l ion insurarcc. !s lcquir.t 6y S(r ion .l7ll) oa rhr libor Cod.. lor rtu Nni)nnmc of
<br />lhc $orl,n shich rh( r,cirnil is i$ucJ. My uorkc^ omptNrrinr i,Nuranc. crnicr xt B)lny iumhcr dc:
<br />qth
<br />_l ccnity rhd inrh. pcrlornrft. of rhc *ork for whkh rhi\ p.rmir h Gsucd.I sl[llnot cmploylny pcron hany rnncr
<br />$ !s ro tEcom subj..l lo thc workcn.onrcnuion laws olCrlilooir r 4r.c rhrr i{ I \hould t n,x srbr{r to rn.
<br />*orkcN.onlFnsarionF,vhionsolSdiotr:17(DolrhcLlbrC.dc.l\hnll.t,nhriih..mllywirhrho*provisions
<br />'IYARNIN(;: FnihE b sc.urc eorkcK otrlFcnsdbn .ovcfulc is unhwful. rnd dFll \ubicr an cnyl,,]tr ro dininil ,).trrlr$ aM
<br />.i\il fdc\ nt b o c hui [d lhousrDd do]hrs 1$100.00()). ir, diri.tr b rh. (o nssrnn,. dniugcs r\ pnvidcd lor thc
<br />Sc.riinr 1076 orrhc Lrhr C'(xlc, trrcrc{ rnd rrlonrv s lccr
<br />D!rr: - g-Z- 19 ,rppri".r,Y.
<br />I h.rchyr innundspcuhyoincrjrryrl lrnr liccn\cJ undcr!r,vii, ofch fl*I(.rnn cn.in8 wirhScclion 7(X[) oll)iri\n,i.]
<br />ol thc BusncssnDd Pmlc$iorFCodc. ard m] liccNc n in tulllom ud cr(l
<br />tot {q,{6
<br />b^,. '8 - 2.'lg coi'rucrm:!4r-to llgooElAr(aLl -r\C-
<br />ratsralquatitEtDAlncENtr
<br />I hcEby a!finn uadcr penlhy o( lcrjlry lhd thcrc n a consldcrira lc.dins ,g.ky ror rh. IEnbrmrc of rlE work for shth rhk IEmir L{
<br />issucd lse.1097, civ. c.)
<br />afftttaNfD[cLd.BAllaN
<br />Ilan$y nn undcrpcnrlryoipcrjuryoncolrhctulowinEdcchrJlion\
<br />D.molin,n Pcnrih Aslf,sros Norificar i f.d$al Rcguldidis (Tirlc.l0. PlnO
<br />-Rc{luncd
<br />Lcrrer of Norifiorion
<br />I.cnrfyrh.rth. Ldcral
<br />^oflE.cn'lv rhd I hJ\c rcnd rhi
<br />;I;.m.*:,rr \,.nc r trw. r.r.
<br />rhorc Nnrtrnrcd lopcny lo. i
<br />ApDli.lnl o. Agenl SieMIuE
<br />lemile nnmetp;nrt:j(
<br />rcEulolions Eeoi(ltr8 $bc{os cnnnl lrc nor lppli.nhl. i' rhh tmA_r
<br />\ rttl'rn(tr, xnJ nrrr rl,n rhd rhrr i'rl(trnr1.tr trror'(r lnr'.ci).,trn|b*irh 'll(''rr_r (inn t
<br />.3 Z-t?
<br />\-.1e=PEsi.ea
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Rool Sheathing \l /
<br />Shear Wall )
<br />Framing
<br />lnsu lation/Enerqy I
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Itilasonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL I V.b'l?-l"t€561 2(Y/)
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc.
<br />-+
<br />-l
<br />!mcx.q,l und$ Setion-. B & P C. for lhis Ea$i.
<br />Drlcr Own.r
<br />,c0,c\.frrrtr$.1rIi\ ( ily i (i)unry k] cnrrr trpon rh.
<br />Pool Fence
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