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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS (,WNER BUII-D8R DEI-CARA'UON
<br />I hcrcby .fiirn und$ t'cmxy of pertury rhar I am cxc'npr rmrn rhc (i,nndos Licctr$ rjN n)r rhc lollowins fu{,n (scc ?0-l {
<br />Br\i'rc$ und Prolc$sion Cdc): An, Ciry or Counry which rlquircs ! rErmil h conntucr, rlrcr, i'nprovc. dc.mlkh or RF r riy
<br />{fl.turc, pritrb ir. i\\utuc. aho rdqun s rhc +plrdr lor such Frnxr k' fiha siln.d sdcmd rhd l[or shc is liccnscd Nnuonr
<br />Io lhc t'ovtions oi rhc Cotuactois l-iccnred L.w (Ch0plcr 9. Connnc.cin-q *ilh Secrn,n ?00o ol Divnbn I or rhc Bunncs rnd
<br />Pn,fcssion\ Codc) or lhor hcorshc l\cicmpl lhcrcfroflnnd llEbrsn iar lM aucscd ciemtrnrn Any viohrn,n ol sNri({ r0r I 5 brtr.y
<br />appl(a fffatrdirsrhjftBrhclpplicrnrrorcililpcnrlrrofft,rnxcrhanfivchundrcddolld\(1500)
<br />-l.
<br />rs owncrollhcnmpcny. (trmycn[lorrcs wnhwoScs!s r[cn soh conDconrlion. willdo llE sorl aelrlaitulurn nor
<br />inrendcn or oltircd for slc (Scc 1}l4. Businc\s Dnd t'rotcrsions Codc -l'hc C6nrd.is t-i.cn* tlw dm. mr ,pply ro m ou'mr ol
<br />thc tmpcdy *ho buikls oi inprowsrhcmn. a whod.cssu.hso*hi'nscllorhcnclforrhmulhhisorhcrowncnrployces.
<br />,mvid.d rhnt such i,npmvctunk m mr inrc.dcJ or ofts.t aff slc tl howclcr. rh. buildinr or iml,ov.nrnr is sU wirlrir o.c ]eo
<br />orcoll{,Lrio rhc O*ncr AliEcr willhnw rlt hlrd.n ol pmeiag rh.r la or slr dil ft, buiu or nrrdvc rhc rmFty ror rlr Drtsc or
<br />LarowN.olrhcpmFcny.ancrclu\nrl!conrr!.rirgsiriIi..n\cd.ontrch^k).o n rud ik tn.]l-.r (Scc 7l!,t.lrusnc$
<br />rfrl Brlc$rirCodc:rhcConrrlolsLi.cnscl.rwdocrn.ti|l,lyrornowrcrol|[rpc ywho huild\or inipr,lc\ rh.rcoi.
<br />and who co mcr\ aor such lrojcch sirh r Conrnctrt \ ) li.cnscd pu^u k) rltc Qn rd.(tr'r Licctr* hw )
<br />I r crcNfl trndrr Srcrion
<br />Dnre: Oen.r:
<br />noBxESstrouflr sarar
<br />DTiCIABTIION
<br />I h[rhy rfll,n trnJc. ncu]ry., n rlury oi. o, rhc f,,ll('q i'r! dehrrriotr\
<br />-l
<br />hrvc d will mlinrain a Ccn ificarc of Con\cnt ro Scla lnslE lor {orlcr' sfrp.nsdn,n. a Fovid.d r(, by Scd nnr l7L\) ol thc
<br />Lohor Codc. nrrhc pcrlonMNc oflhc work I which thc trnrl isnsucd.
<br />p.'mil i\ i$drJ ltlyNorkcF c{nnn tr\rr or i',\urrn...rn'cr rNlS!l'.t nunrhn c
<br />a \".\.\4
<br />I ccnifyrhdr i'rrh. pcifonMftcofrhc $ork ror whi.h rhtr pr nir is isrucd.l shrllnor cnrployrny pcs. inrny trrtrncr
<br />$ r\ k, bc(nx suhrcr to rhc workcrs cotrDcn\ rhn las\ olCrliltrnir. rnd tgrc. rh{ ifl drruld tndnc subr. o Ih*
<br />workcr conrli.nn(iotrlrovisi{)n\oiSccrion:lTrloolrhcL!h,G'dc.l\hxll,ldrhwirh.o rrly wtrh rhr nornions.
<br />WARNINC Frilor. k' $.urc so cr\ .omp.i\ari.i .ov.rngc i\ xnhqful. rtul Orll sublccr rn cnU,loye. lo mninJl F.rlrt\ r d
<br />.ivil firs up k, o.c hundnd rhoustrd dollrl lsl(x).{X ). i,r ddirmn ro ihc cosl ofconrlcnslion. dx'uge\ r\ pmvidcd fd rhu
<br />):'"fruu'o'r'20"1 8d
<br />dbi'rrs fccs
<br />I hcEhyrfiirmu.dn t'ctrollyofncrjurylhtrlI rnr liccncd undcrlmvnionolChapr(9(u,n'n.n.ing wilhS.di 7filj)olDivnn'n3
<br />of rh. Bu\i'rcssand Ptulcs\iorrCodc. xl mt ltctrsc is n lull ture .nJ clfccl.
<br />o.\..efofr
<br />*,.15g_03_20 4t rt,r .,
<br />A.PILICANIIEII/&UIa!
<br />I H', lltim undcr pcnahy of pcrjury onc of rhc tollowins &clarori{,n\:
<br />D.nn[iotr Pcfln sAsbcslos Nolificoliotr Fcdcral Rc3ul0lions ('lillc40. Pan6)
<br />R.quircd l.n.r of Norificario.
<br />-l
<br />ccnifyrhalthcfcdcralrquhrions Egardio8 lstEdo\ rcmval c nor]|)Plic$lc ro rhnrtuF_l
<br />r*liu:lllit I hrk '.xd r[n pfl'.xr rtrr drl(nrc rlr rr d\rr tr]nn il r[tconccr I osrcc ro conrpl, wirn rll Cny .nd counry
<br />rcnrcsnlarivcs ollth City and Cou.ryro cnrd ulxnrh.rrc Ir,*a Ehrnl! b btr ildinB co'\rd.rnnr. x] hcrrlrynu
<br />abovc nrnrn,ncd nm|Fny tbr inrnccrion
<br />/lplli(.nl or 8enl Si[nnlre
<br />a)
<br />rITlt
<br />Set Backs
<br />Fo rm s/Stee l/ H o ldown s
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathi ng
<br />Shear Wall
<br />Framing 6/24/t'b 5s61
<br />lnsu lation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL I/t4/(s 5\ 11(
<br />Certif icate oI Occupancy
<br />Notes, Remarks , EtC.
<br />T-Bar
<br />SONEIAIJSIIONI.INDIIIj.ACEN.CI
<br />I hcrb, lfft undcrlcn.lryoipcrruryrhdrlErci\rcon(ructhnlcndinEr8cn.,ntrihct.rturmn..ofrhcrorthrshichthi\pcrnili\
<br />isrudlS.. 1097. Civ C )
<br />l'ernrild n.rr (prirl):
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