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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.+coMMENTS OWNER BU!LDER DAI,(ARATION
<br />I hcrcby 0flnn under rcnall, {)f pcriury rhd I n etcnDr rb'n rhc Ci rr.ktrr Liccn\c L.w in rhc t,llosinE rcN (S.c?oll5
<br />Itusinc$ atrd Pmic$n,n c(dc) Any cit, ur coutrr) whi.h rcqurcs r Firnit lo consrto.r. alrcr. i'nfr.vc. d.trDlhh or qran any
<br />ntudurc. prntr k, irs is\urncc, rl$ rcquiresihc 0pplicrtrr lbr such pcirnilro,ih r sigtud !r c trr ihrl hcor shc i\ licrtr\cd nu ulnr
<br />lo lhc pmvi\ion! olrtr Conrr.tr'\ l,i.cns.d tjw (Chrlrcr 9. ComnEnclns sirh Sccrion 7llx) or Divieon ] .f rhc llusin.\s $d
<br />Pn,lcs\nn\ Codc)orthrr h.orshc ncrcmlr rhcrclr.m Md rhc hlst for rhc nllc8.d cxctrPrn'n Atryvt,l{lionolS.cri, 70ll.5by.ny
<br />{Dlicotrr ttr ! pcrnrir subj(a rhc applicanr ro a.ivilr.trdhy.rnor.rorc rlrtr livc hundrednollu (S5m)
<br />L o{n r orrh. potrdy, or myctrdo)es wil[ Fqc\ ur rhcn s,h .oil,tcisrrun. willdo rhc sork and rhc iturm n 'di'nuto t .ronc,ll tur srlc (Sr.-'7(14,1. Br'\inc$ and ttonsrtn,r CoJc Thc c.trki(tr\ Liccnsc li,w doc\ ior lPply h rn osNt.i
<br />rhcpmF-ny *ho huild\or i rn,vcsrhdNl rnl who del ruch uoir hi'nscll'orhcr{llorrhtuulh h!\ orhcra*nc Pl,,t.cs
<br />r)viicd lhar such inrrorrmnh rc rt, i cidcd or olTctul ntr et. It ho*cur. Ih( I[ilding or i l()vc rnr r Bld $irhin onc ,t
<br />orcorlI)hti,n. rh.O*mr Buikl.r $illlulc lhc budcn ol ntr,vi,B ihn hc or \h. dxl tr.r buik or in{'nit rhc poFlly for r,[ nuqne ol
<br />-l.rsowrcrolrhcpn,rcny.a
<br />cx.hsivclycotrir0.rtrrB wiI liccnsql c. rmktr\ h .onito.t ilt pro]ccl (Scc 7{}'l'r Bu\inc$
<br />rd'l hifAsirn Codc lhcConnlrtofs l-icen{ l,nw do.s nor npplyt, m owncr ol ProD.ny *ho htrildsor nnprovcs rhcrcon.
<br />(trd $ho conrrucrrforslchproFc( wirhacotu.k){\) lmnscdpurruunr t'lhcG,nttktr s Li.cn\c tjw)
<br />-l
<br />mexcmfl u cr Sccrio Caa-/s- b- tT
<br />I hcrchy rrfinn u $ pcMlry .r Nrjury .nc .i rhc hllos in8 d(lmrbnr:
<br />-lharud,illroi.riin,ccnifi.
<br />.olconentroSclllrNurel'or*or*.ri.otrrpctrs.oon.nslmvidcdio,bysccrionlT00.rGc
<br />Lnbor Codc. for rhe pcdortukc of rhc work ror whi.h rhc ltnnit is issucd.
<br />-l lrv. lnd will nrinrai'r *orkcra.o rFtrsilion irruruNe. as rcquircd hlSr.rnr lTU)olrhc t-rh., Code. nnllf rurfonn.n.c of
<br />rhdwo*turwhi.hrhi\mrnririsiflLn.My*orkcr'conDcnsarionin\u!r..c.rnicr d gni.y nunrhct rrc:
<br />l.cniiylhilirrhcpcrli'rroncc,)frhcworkforwhr.hlhrslcrmirhnslcd.I\hrllnorc Pby rrry pcron ir trny n ni$
<br />vr xs b h... r sul,jNr lo rhc qtrkcs' c.nrFnsar ion la+. or Cxlli)rnir, nnd ,sE. rhd il I fi)ukl rrconi \ubi.r ro rh.
<br />qorkcrl .o'npctrsrr i,n pro*i.ns oI SNr ion .1700 of rhc lixtr C{xi.. I drll. Ld hwilh conlPl, *irh rh.* [ovisio s
<br />WARNINC: lirilurc ro wurc Borkcn'coml'cnsirion corcn8c is unlawlll. and dhll subjccr arr cnrpbycr t, dtri't firlrt\ d
<br />cilil fincs u! h onc hxndicd rhouMnd dolh$ (Slu).(xx)). in rddiln,n t, rhc .o{ of.omPctrsrtion.daouscc ds F)vdcd f.r rhc(dSccrnnr :1076 ol rhc utxtr codc. ir ftc{ ifld 0trorrcy r fe\
<br />1.,"b4-r* ^
<br />I hcreby alfirn urdcr I,cnllryofFrjuty rh,r l.o ti.cnkrl undct pmvision orChrprd 9l..mnrncir8 *irh Scc'ion 7fiD) ofDiuision l
<br />or rhc ausincs md Pmfcssions Ordc, {d h, liccnk t in full rore d cllccr.
<br />Y"
<br />G'b18
<br />(1)NSl Rt:(',uON Lt,tNI)tN(;,\1;t,i\Cl'
<br />I hcEby{firnrundcrlenahyofpcrjuryrh.r th.rc is a .on(dcl6o hndins4cicy lo rh. FrfornBncc oflhc work ft ehi.h rhis,.rnil is
<br />issu.d (S(. 1097. Civ. C )
<br />APPI l(:AN'I ITF(]I dRA IoN
<br />llmby Imund.r Ntrrhy oiprrjury onc olthc ioln,wi',8 .ltu lurdnnN.
<br />llctrhlirn,n Pdrn,ir\ A\h.sos Notili.!tion l:cderul Rcsullrion! (lirle J0. P rO
<br />_R.qutcrl I r(crol Nor rllc.ri.
<br />\h.*tr,cnn^rlx'r trorrt)J,liL hlL (, !h \ pfi..r
<br />rh.r rhc oh.'c inlbrurion ircor(t.I n8m lo.omply*irh rll ciryond Counry
<br />crion. o hcrubyrurktri2r rcprc{nt.rivcs otrhn Ciy rnd Coutrr, k, cnrs upon rhc
<br />I'rmrilee MnF lprinll:
<br />(ad^- t4 -t(
<br />Set Backs ?//4//t ,tt ta.rLe /'L
<br />Forms/Steel/Holdowns clihh- -t 'tYY t'vltl-t r-?
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Rool Sheathino t//r/rl-A4/rrfl
<br />Shear Wall
<br />Framing lolrfi,r i %or*10_
<br />lnsu lation/Eneroy
<br />Drywall
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Cefiif .
<br />FINAL /0/qlt Auq'/n-b)
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc
<br />T-Bar
<br />I rndfl ( Nam
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<br />tt
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