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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNEf, BUILDER DEI]CAN TION
<br />I ha!t, .rm un& Fdly orFlury lr I m ddF tDn tt co,i,..r6' Lt@ t^ for rlE lolt!*iDg lann (S< 70ll J
<br />Bsind .d Prof6ii! Co&): Any Ciry or Co!m) whxh ,.q!ic . Fnn lo otBrud, .,lrq. idrrce &mlih or rqE ry
<br />rrudur.- Fior lo il! i.u.N. .lso .cqu6 lh. r9pli.mt aor lucn Fnn lo fiL . liSn d n.l6r rht lE o. $. ! li.aa.d F!&r,n
<br />ro lhc provllbN of rh. Conn..tof! Liened Lrw (OEpt6 9, Comdci.B wnh Sclion 7000 of Divnion 3 ofrhc BuiB 4d
<br />Pot*ionr Cod.) or rhd lE or lhc i! d@pl $@from ai $. bels lor rh. dLl.d odFion Any violdion of Sdion r0ll t brq
<br />rptltn{ tor . Fnn lbjcl! lE roAlicDt lo . .ivil Fulty of mt mE lhu lir. hurxiEd dolla! (1500)
<br />-1.
<br />! orc of d'c FoFrt. d n, dpbrg r ih $.C6 - $.n rk on{Esih( $iU & llt *qi in t,t ttuft ir mr
<br />itroi.d,off.rldfGrttsa.rou.&BiBDdPrDlBirBCo<l.]TlEcorrrdd'!Li@l,w&6dTplllodo*c.t
<br />rlE p.rFry srr hl*! d irgot6 th.g^ !d *ho dE *fi srt nirell or lE*l f or lhrouBh hr. or hd om mphlB.
<br />Fnvid.it rhn iuch idFlrqErr G mt iiai.d d ofiftd 6r sl.. l[ ho6s, rlE h! dnB or nnF!!s6, ! eB Mhin orc ]d
<br />of.onplaiotr th. O.r's Buitb vill ha( dr hsdd! ol Eoviis ttur h. or !h. did mr hild or ihpmlr lh. FrFty tor llE F,pos ol
<br />-1.
<br />sorE ofth. FlFrr, m.rclGiy.ly ofurlins *nh lnaB d..dr-o6 ro 6drud llE FtrFl lse 7014. &!nB
<br />!n ADisir co& Th. Codr.dor'r Lic@ Ls &'6 mr .!ply ro e o*n6 orFoFty sho hildr or impbtc th6@r
<br />.nd sho ofitlr tur kh Fnj.tr3 rilll. Codrx.(3) lad.d Fs@ b
<br />'h.
<br />Codn.rd'. liu* l.*)
<br />-l
<br />m .rmpr u,rl6 S.<rion-. B & P C. for rhE r*n
<br />Drr.: ornc:
<br />WONKFRS' COTiPENSATION
<br />DECId8AIIO!
<br />I hdqD.L tft@ u.da Flitt.lFj-r_ on ofrh. folloss! d..Lrdi.G
<br />-l
<br />h.E nd sill qifl.in . Csri6.!. of Co@I lo sdf-lM f *qtaa on{osrior!. Fridcd aor b,Sdion 17((}of 'lEliDs co<E fd rh. pnforffi of tlE *dt fd rtth rh. Fnn i! i$ql
<br />I h,v. and sill mrintlin work.r! comp.esltion icurlncc. s rcq!n<,J hy s<r $n :i 700 of rh. l.nlu ( bdc. for lh. pdfom@. ol
<br />,h. "{k trr shiclllil|mir is is.d
<br />(l?ao lz
<br />Myudldc composari.n iaurM(..rnid dvl policy nunrhf s.
<br />R
<br />I cdiry lh.l in llE Ffolrr!ft. of lh. *orl fd *hii $t Fin ir iqGl I .h.U mt aploy uy Fsn in e, tffi
<br />s a nr b@@ sblxr ro rh. $o 6 6nFdi6n E*i ofc.lifomi( ud !*E lhn if I dNuld b.@m. lobjcl lo llE
<br />work6 comFnsrion pmvi.ioN of Sdio. 1700 of lhc L,tor Code I sh.ll, lonhwilh .orply wilh lhos prcvitioN
<br />I'VARNINC: ltilu. ro Be $o 6 @mpolrnion corBrsc ai ML*tuI. Md nEIl subj.cr u dplors lo oitid Ftrnir &d
<br />cnil fi.6 up to oG hu,r<N rhn@rl d.lld (ll0o.fi)o). i, rddnion h rh..oc of comDce'ioi. d,De6 6 F.id.d lor 'h.S6ron 1076 ofrh. lils ( o<l. ardd ad.n("E_. r fG
<br />(-77 - tg r-
<br />lJcEll[LcaNrEalfllf,oEgiaAIIo!
<br />I hnb,ofimMdd p6,lry of Fjory thd I D licaE d und6 Flvilnrn of (]lafld 9{.omftin! *irh sdion 7(]0O)oaDiv'rnrn l
<br />of rh. RBind tud Pmf66N Cod., arn my lt@ i! in aull lo!.. Erl .ttsl
<br />3 .{vaeso
<br />1-2-z -(?c-,-"*
<br />gl!,t1Bl]cllltNrlilDllliAIiE
<br />I h6.h, lrnn und6 FEhy uf pdjury rhlt tha. ! ! conllrclDn lrdinB .sd., for ih. p6fol1ruc. of
<br />nsu.n(s( J097, civ (.)
<br />*orl fo. *hich
<br />'hir Fmil ir
<br />n'".,. ^n, n".r-1in.,on
<br />lhdd'rotrtrnund6 p6rhy ol psjury onc ofthc follo*ing dcld ioN:
<br />I)cnolihn Pmtu-Albdlo! Nolilictlion F.ddil RqulrioN (Tnb 40. Pd6)
<br />-R.quir.d
<br />1116 of ldrifrrit
<br />I .dif, ih, rh. ftnr.l ..glLrioE rqrdins sldor rmrsl @ mr irl&l,k to rhis pmFr
<br />2QQ-'t,*, t*,*,ns.ppri.drn err n . rh,r rh..t.y. i.roturn ir.ord.I asrE to comrly *irh rll Cnyrnd (i,un!t
<br />r.F6d div6 olrhr ( iryd'l Coory ro dld uB)n llE
<br />-,,. /:p -ry
<br />.rnnr.c6 iDd SIarc l.a*s 'clintr! lo hu'ldins con\r'trrrk,n.
<br />aholc ,norioncd pmp61y tu itrspcrion
<br />.{ppll..nr orAg6lsiin!(!.. E
<br />n.rrrir-. nrmt rprino: 9( \./c.1.t z U)o Lc.iT
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathino
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL 4b//O t 7ilU//A--fA/"
<br />Certificate of Occupancy / // I
<br />Notes, Remarks, Etc
<br />+
<br />Brown Coat
<br />1
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