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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG COMMENTS OWNER 8T'II,I'I]R I'I]t,CARA'IION
<br />Ihcrchtnfi rtrMcrncnulr,otn rlur, rl l dcxcnpr ln, thc (in n'ctns l-'ccrsc t-uq lirt rhc lblk,sint arqr (SccTlrll5
<br />EusnDs md Pr.lc\sion Codc): ny City .r Coutrly *hich ..quitur n Frnrir Io con{rucr. rlrcr. irnpoc icnnri\h Dr rcl]dtr rnv'
<br />srocrurc. llirk, ih i*uimc. rlsorcqutcsrhc umlicMr for su.h l]crrrilro lllc I sigrcd srdc.rnl rhar k ur shc ir li.cn\cd Pur\mnr
<br />ro lhr Pmrisions olln O,ntn.rofs Liccnscd lis (Chaprcr 9. CornrN s $irh Sccrnnr xxx) of t]ilhion I 'rrh' Bnli'r's 'lnd
<br />Pn,ltssii)ns Cod.) or rhd hcorshc i\gcnrfl ihcrc&nnnnd ihc bNi\ forthc lllcPcd crcnDrion AnyviolalionorsccriotrT0.ll5bvnnv
<br />rppli.itrr ror n lcnnir suhjcisrhc rp0li.rtrrro rcivilrcnillyormr nnrdr'dn fl\c hunitcddollrr\ (S5m).
<br />L a\ ow.ci ol lhc lo|Eny. o ny.nDloyccs wirh wiScs us lncir {rlc co lPcrsrr ior- sill do rhc soA rxl rhc nrudtr ir n
<br />iN.ML{ oroicrcd fitr $lc lsd ?(X4, Susinc$ rtrd ltofcsion\ CGlc:'Ihc C:onrNntr \ l-ic.tr* trtrv docs nor lplly t, rn o}'.cr oi
<br />rhcI'FFny whl huild\ or mpmvcs rhc@n- od sho dd\ \u.h wo* himscll o. h.rsclf or rhbu8h hn o. hcr os ctrUolccs.
<br />nn,eiilcd rhrr such nntoBmnrs m nor imcd.d d oflarud kr sib Il ho$cKi rhc l)uildirg or ilrllrovcmnr is vrld wilhir onc )ur
<br />ol con{lcrion. rhc owndr aurlild qill h{!c rh. butrhn ol povi'rg rhd h..r shc did mr t itl or irlot rh. PDIrry f rh.l,u In*.1
<br />-1.
<br />N o*nf or rh. pm,!oly. ar celuriwly conrad irg virh liccntd co.t,.ron h conrlru.i rhd rtuFd (Scc 7O&. Btr'in'*
<br />d Rdissi,nCodc:1hcCohka.rofsLiccnscLa*doc\nor,Iplttuanowncroll)ror-- y sho ttuilds or imrov$ rhcron.
<br />rnd who.onrm.BlorsuchpDicrs{irhacrnrncrons)liccrscdpunur rorhcco.tracroisl,iccn\cLrw).
<br />_l rnrrr. rfl unds SLrlio
<br />Dele Ohn.r:
<br />woR(Eis' coiil'FNsATxlN
<br />DFCI ARATION
<br />I h.(bl al6rnundq rcHhyorpcjuryorc oflhc follo*inc d(lmrioN
<br />Ih,vcand*illroinrdnaCcnificdr.oiconsnlroSclllnsu..f(,rworkcccomtnsation.a\Pmvidcnforb,S*rion1700ofrhc
<br />Utx, Axic, ror rlr pcrfonumc qfrhc soik ror shich ll[ J,cnnil i\ is\uLal.
<br />I hrvcrfrl will mrinllin workcra conDcnslri( i',\urrmc, r( rciluncd bySccrion lTLrOolrltr blx,(ixtc. Lr rhc tcrlolEncc of';ti: i#-'<
<br />con,Fn\arnr insurane.rri.r rid |Fli., nunrhcr u.
<br />q03i77O t-l-t 7
<br />-l
<br />ccniiy rhrr i. rhc !.rfoflnitrcc oflhc work lnr *hich rhivrclrnil is t\ucd. I drll troi ctrtPl{iv lny p.ikr. in rtrv nranner
<br />n) r\k)l{.o rc {rhlc.rni rtu ro'k$s .rnlrf\rlidr ha\or r'irr rM nsrLr lhrr ii lrh.uld **conE suhjccrk, rh.
<br />nsdi()n pr)!isionsnrSc.tiotr 37(X)of lhc lrhr shall. lonhs'irh $nllly *irh rhoc Irovisi.n\
<br />orkr'\ con'ncn\ 1i!trr (o\c'lrslul. atr nrrll n,blc.r rtr . nbt$ ro cri'ni' 1F-trrki.\ dd
<br />k,. c hu rc,l rhou\rnl ollrr\ l5l(X).(,1[r. ir ntrr. d nn[c\ a\ p(,r'dcd i(tr rhc'::';/;il;i;y'""
<br />,rr.I..t rr
<br />Ih.Ebyafirmundc.rcMkyoipcriurylharIahli.dnsnuidcrpmvisn,nofChrrrd9(conmncing{irhs..rion70U)orDivkii l
<br />of thc ausircss !ft1Pmfc$ions Codc. {r.l my liccn\c i\ in hillfoN atrd cfltcr
<br />Itbz rt-
<br />coNsrRtr(lT(rN t FrtDlN(; (:EN(IY
<br />I hcrcby arfinn und.. Fnrhyofp.rjuryrha, rhcrc h,..n(dcrion !:n!inr ascn.y lnr rhc lqfornunc. orrhc work li'r *hi.h rhis rcanil k
<br />issucd lscc. 3(,7, Civ C )
<br />l.tr,lci . a.l,l'c.'
<br />-
<br />AELICANLDICLIBAIIOX
<br />I h.nby allinn undcr rcnalry orFrjury orc ollhc f.ll,,winr dc.lar0rions:
<br />Dc'Bn ion l,crorils Aib.{os Noiification Ijcdcrul R.sul,rid* (Tirlc 40. Pud6)
<br />_Rcqlircd lxnd of N.tificlrirn
<br />lcenilylhalrhc lcddal (8ulniions resudiis asbcsos rcnrul arc nor spplicnblc ro lhis pnj{r
<br />rl'rr l l \r'i(l rhi\rl,P i.rrnn, rnl lhr rhc rh*. i'no'n ri, ^..r1:.r l r!r.c t) c.tr]lrly \ ir]l rll ('rln trl L,{nry
<br />odininccs rnd Strrc b*s rclari.3 n. orl hcrchyarrh,rc rcprcscnlolivcs orrhis Cny ond Counrrr. cnrct utln lhc
<br />rbvc mlrlioncd F)n.ny n,
<br />/Z*-.(-7 t*.( ,..- L /?-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsu lation
<br />Roof Sheathing u '-<aqlnl
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certil.
<br />FINAL \-1 IlAA6\
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />e a- ,ttlr',v1 M^v *toit.4". TolA t" (we
<br />A'N
<br />slit
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