|
BUILD ING- INSPECTOR RECORD
<br />to tG.SITE-WORK DATE COMMENTS ()!rNER lltrlLDER tlEl-( ARA nON
<br />I li.rchy nlllrtrr unds l^-nilry ,, Jtrrrry rhd I mr cxctrrPr lioo, rhc Co kr.!,ra Liccn\c l]r nt rh. follo*ing rca$n 1S..7011 5
<br />llusin.sl Url l".i.\\i, Codc) Any Cny or C.unry $l,ich rcqutc\ i t^-nni k, ro {nr.r. rlrcr. irPi{xc dtnt)li(h or t|]rn rnv
<br />bihcF)vi\iinxofrl[Conrraclq\l-icc\cdLrq(Chr.rA.(!nrcn.i'r!qirhSc.ton7(Ixroil)ivniotr:lolrhcUi\hcs\ird
<br />|pll.xnrturpnnir \rbjc.Fthc lpplic nrbrcivilpc rllyolf rrrrc0 i livc huftrci (lollrr (19500)
<br />l.a{ownc!.lrhclrr)p.ny,.tnrycn{'k'yccs*nhwaacs rh.ir $h (nnNrslrion. sitl do rhc sort oxl lh. qMUr' i( nor
<br />inrendcd o! offcrcd fi, qk (Sa.?O1,1. Btsituss dnd Pmr.ssn,ns Oxlc: l hc Conhtrof s Liccnsc bw dods nor .Pt'lr lo !n oarcr of
<br />thc pmJrny s,x, huirCs or iq)r.vLs rhcND. !d who dfts ruch mrl hinsclf or hcrrll or rln,r8h hi{ r hcr o*n d.DI{I}ccl.
<br />rolid.d rhir \u.h intn.vemnh m Rn idctrdhl d oficrcd ln! eh lf. hoscvc. rhc l^rildin8 .! iq,nr. Ed h sld $irhin ' ft !r0r
<br />oiconDlcrion. rhc o{ncr Buikld sill hrvc lhc burdcn orrmlinr rrxr h..r dE did nor hild or in{,nN thc nmF v for lhc ou{x's or
<br />t. N o*trcr ol thc !tupcny. rmcrchrntly.onta.tirlg wilh li.crscd cotuacr,s k .otr$rucr rhc PR!.cr 1SN.7044- llci'r\\
<br />md ft)nssimCodc'l'hcConlr..rorsLiccn\el-awdoeshorrpllykiM.sncrorPr,r.dy*hohuild\orimrdv.slhcr.on.
<br />lnd who .ontrcrs l'or such pmr.cc wirhaConrm.ro(n licen\cd Pu^urnr rorh.Cotrlrucrois t.ircn* tjw)
<br />I r crrnfl uMcr S(lion-. B & PC li,r rhi\ rcJstr
<br />l).le ()*n.r:
<br />IvoRKFRS- C(lNiI',r'NSATX)N
<br />DDIIAIAXO!
<br />Ihcrcby llrnrumlcr Ntrrlry.lrcrjurru.olrhclnll(,sin8dc.lar nnN
<br />-lhrrcs
<br />lNill rn niDrCcnilicrrcof(in,{nrt,S.lf-ltrsurclirrB{.krs.o.Pcns.rion.is poYidcd r{, brScclion:17(Xlnfrhc
<br />Lnbor Cqlc- tor rhc r.rf.flMmc ofth. sork fff lhich rhc P.rmir il is\ucd
<br />I hrvc riil wrllDridain *orkcrr conltrn{lur insmncc. r\ rcqunrd htScdi.n:l7lx}oarhc t,'bor (-odc.lirr rh! Prrrnirrf,'ol
<br />rhc work ntr $hi.hrhi\ pcflnir is n\!cd Mysorkcn conrP.nslri,,n in(ur.r.ccmicr and F,licy nunlhcrrc
<br />Ic.nilirhdinlh.pcrror.Dn.rnfrM\trktorBhi.hrhi\rnirtri(srcd.I\h!llnor.iDlu,rrvp.noninxdvnDnncr
<br />$ as ft, trmm luhjccr k, rhc q'orkcrs .omNnsdrior laws ol Ctlilonria. lnd rgN rhrr if I should n(onr ublcd ro rhc
<br />*orkq\ cn rp.n\oon pmvGions ol Sccri,nr l7U) of rhc litn Codc. l \hrll. fonhwirh conrlny s irh rh.$ nmvisions
<br />WARNTNC Flilurc t, ...urc trortcrs (nlpctr\dt cor.'r!c i\ lastul. a \hrll suhjc(r an coDhr{r ro si'ni'r{l F_'!'!ris snrl
<br />\1i. nnc. nt L, '{tr' \u' J'.J ,h, trdr. J,,1tr.'(lrxrrvvr,, ,rl,l i,
<br />\c!r.{'t,'7r',i rl'r Lh{ rh,l. ut"r', ",-r-"t."-n '* /Z /I)srer ttp,|ti,anl: f
<br />r ro rh. co{ of.ontnr{ri(r,.dumC.s os provid.d for ih.
<br />DDIIAEAIION
<br />I hcrcby affirm uDdcr Fmlly ol pc.jky rh lrnli.ctrdu crPr.visi,'nofchrprs9lcon lEtrcitr!sirhScdhnTIIX))nrDivi(n 1
<br />oi llE auriEs a.d Pdisions Codc- ud 'n, li.cn\. i\ in tull li,rcc r cllirr
<br />6 (ru
<br />/./
<br />23?./3
<br />s,/-?l 1tt /...-
<br />!.:IJNEIAUI:IIONII:II2INGJIGEICI
<br />IhcEbyrnn xi{rcr pcnalry oiF-rjdry rh rh.rcnn.o.$rudion lcnJinsaa.trc} forlhcn tli,rnrmc or (hc solt irx *hich rhi\ ltinir is
<br />i\{,.d rsm 11,97 Civ C )
<br /> PPI ICANT I)F(]LAiAII{ }N
<br />I h.dylmnnu cr IENlry or Frjury . c of rhc tullowinB dNlard i('ns
<br />DcnEliri(,n PdNh-Asbcsos Norifi.r'ion Fcdcrul RcgulalioN ( lirlc.10. PnO
<br />RcquiNd lxlrcr oi Norifi carnr
<br />-I
<br />ccnilyihar tlrc ladcrn I rc-qu lxl ions rrA,rdnrg $h.slos rcnDv0larc nor +pli.ihlc lo lhi\ ImFi
<br />lcdilyrhdlhavcreadrhildDplicnridl4ndshlcrhlrlh.l(x,vcinnnEti.nhcotr.crlagNroconDlvwirhrllCiryrrdCounry
<br />ord'n.urct nJ Sr. cLnws rcLxn!l. hurldrn8cnnilrucrnn. nlhcrchy rkrrizc rcIte{nhriv.s r)l this Cnv and Cornry k' cnrs uIxn rh'
<br />Jhxc mtrrtrrf,J Dr.nrny l itr\n ori",l.,rrt(,{}....;/2,t.4 -/-,/,._
<br />A ppri(rnr or Asenr si*n.ru ;7 y'z,c /2 -f- Dl" ,13a / /t/'
<br />P€miree nnm. , prr n,,: - ZtZJz-
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Beq.
<br />Deputv Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif.
<br />/n\
<br />FINAL 2-11-17 k"vJ-1t)
<br />Certilicate ot Occupancy ./
<br />Notes, Remarks, Etc
<br />Forms/Steel/Holdowns
|