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BUILDING- INSPECTOB RECORD
<br />SITE.WORK ID/SIG COMMENTS oWNER BUILDITR DELCARA'I'ION
<br />I hcrchy rfllr uMcr Fn,lry oi pcrjury rhd I .m crcmtr from rh. Contrrckm t-iccnsc liw tur rhc lolb*iot tcNnr (Sc.70Jl 5
<br />Businc\{ rtrd Prolt$ior Codc) Atry Ciry or Coriry *hich r.quire\ r lrrnnr ro .r (ru.I. .lrcr. irnprcvc. tt ,noli\h 'tr ftFn . v
<br />srruduc. priqr. irs hn,rEc, al\o rcqutcsrhc rlplicrnr tur ru.h tf,iinn h [k r si8rcd nnrcnrrr rh i htor shc t li.ctrsd Pursua
<br />t, rh. tnirntr s or Dc Conl,a.loas ,-icctrscd lj* lchrprcr e. ContR'ki F Birh sc.rion 7uD oI Divhnnr I of rhc Bu\in.s and
<br />PnlcssionsColcrorrhrrhcorshcircxc rtr rlkrclron dnd rhc htrsh li,r rhc rllcgcn .xcDprn,n Anrvn,htn tofS.crio!?0ll.5by1ty
<br />amli.itrr ror rltnnir subjLrr lhc rmli.anr ro lcivilp.nrlrrotnor nnn.rhd nvc hutrdtcJdoll(s (S5n0)
<br />-1.
<br />ar osrcr oirfu pmpcny. {rry cnrpkDr.\ *irh $ngc\ tr\ rh.t {,lc c.r.pctr\{ti.n. willao lh. tr.rl r rlf,{Mrrcisnor
<br />inrc cd.rolTcrrllirrvlc(Sr?(}4-l.Businc\\andl']rolcsrionsCodclhcConrrx.ntr\l-i.cns.l]sdocsnor.DPllro0nosnsol
<br />thc pbtrdt sho hoildr .r inwrn$ rlrcGnr. rl wh) d@s {ch snrh [i'nsrll or hc .ll or rhmngh hn .r h.r own tm]rl,,ycc\.
<br />!'ovidcd rhrrstrch i'nF,vcn.trrs ,trc Rn irncidcd or.nitul fttr !'lc ll h.wcrd. rh. lrildirS .r in{)mvcnrnr t{nd silhi',oic tr
<br />ofc.npLrion. rhe Owncr griklcr sill hrvc rh. burdcn of ptulina rhi h\orshc did not btrikld mDtrtrc rhc pri,ld, firrht rF)*of
<br />l. r\o*nrr olrtu ptuIl.nr. rlrrlrsn.lyconta.i'nERnhli.ctrs.d.ontri.l,rskrcon$ru.lrhcpol(rlSc. ?(X,1. Btr\ias
<br />u Pnncssidr Codcr l-hc Conhcl(r's Liccns. Lr* (loc\ for it,dyt, rnoqnfi oll(,Ndy wh. burldsor imtro\cs rhcrcon.
<br />r d $h! .onkd\nr\u.htn'tccGwir[r Cl n ro(9lrctrrcd tnr\urflr. rhc Conta.nn s l-ircn\c bw).
<br />I rrfirn,pi u dcr Sdtrtri
<br />]IASNiBIS}TITIiNIAIIQN
<br />DICL 3 rI0X
<br />I hcrcbt dfinn utrdcr pcnrlryol tErjury otrc olrhc li)11,,$ing nc. 16ri,trN:
<br />-r
<br />hrvcrtrd $illnuinrlin rCcn licarcotC.nscnr t, Sclrlns!'c ror e.rkcra d,nl,cnlirion. as pR,vidcd r(rbyssriotr lTtroolthc
<br />Lah, Cirlc.lor rhc psloinuncc olrhc *ort r{,*hi.hrhr pcmir i\ il\x.d
<br />lhrlc untl silln[nrr3in workcF con,p. \rrion nxuDi.c. r\ r.qtrircd h, Sqlio, ]700 oi rhc lrhor Cod., lor rltr Pcrrinrurcc ol
<br />rhc workIn.shichrhtpcrn,iri\ i\\dcJ N1,so cn co'nfnurn)n rlur .c.riricrd policynun,bcrrc:
<br />,.cniryrMr hrh. r.rfolMtrcc ollhcBork tbr $hich r[nlcrmil i\ i\{'cd.l dklltror rrPlot rny IEr('n inantmMmr
<br />sr s Io bcm r suhJd lo rhc *orkc6 compcn\ io. hw\ of Crlironrin. d.J l38. rhrr i, I \hould tE o r nrhlc.r ro rhc
<br />worken' c.mpcnsalion prolhions of Sc.rbn l7U) ot rhc Llt.r Codc. I slllll. lonh*irh $'ndy virh rhns !r ovhions
<br />WARNIN(; FJhm h suic woricn dnnpctrsarion orcrrAc is unlrwful, ,trd shrll subict atr cmlloy.r t' rinri,rl |Etrrlrics md
<br />.i!il fin.ru!bon hundrcd rhousrnd dollart (Sr0o-(xD)- in ddiri(in k, r)t..t olconrl4n\ulion. d!rus.\,s pt(,vidcd in lhc
<br />Sccrioi 1076ol(hclihtrCodc.inrcrcsrud!lktrrcy llccs
<br />Dore: Appliconrl
<br />t rcrNsen ctrNTnacTon
<br />DIC!|SAuON
<br />Ihcrctyarr.nundcrFnslryorFqxryrharI!mli.cnktuMcrpmvisionolChrprcr9(commn.,n8withsccrio.?(x)0roiDilnio.l
<br />oi rhc Busirc$ r ProfcsioNCodc, u nyliccisc in full fttr.c arl.lfccr
<br />CONEISI]SIII)NTENDING.AGI'NII
<br />I hcrbr rflirm undcr p.mkyorpcrrurylh.l rhcE is ! con!ruL1i.n lcftling i[cncy [.r rhc pdtuirMrcc ofrhe worl iff qhich rhi\ Fnnir ir
<br />h\ucd(Scc .llr97.Civ C )
<br />tadcls Addrcss:
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<br />AIIIII:ANLDI(.LAIUION
<br />ItErcbydliflnu .' pculryol p.rjury.i.of rhcfoll,)snr!dLrlir.tions:
<br />l)cnrlirion Pcn.ils Alhc(o\ Norilicrrio. F.dchl R0Srhri()n\ rl lc 40. Irrn6)
<br />_RcquncJ krrcr of Norilicaridi
<br />I.cnilyrlrxrrhc rc crulrctuhri,,rs r.!{nlirg !\h.{o1 rcnn)ul rr. nor l,)t,l'.rhlc hrhi! lrol.cr
<br />.rdirrftcs ind srdlc ti*s rclding lo 6! ikl ir8 coNnr.r ion. r ltr.hy rurlxtrrc r$rc\rnariEs otr
<br />.'rttr. {trrtr, '.tl InTrdv lLr n.nrli,{,l!|)"$
<br />nrr,-r-n"-, *,"*,,,.r/ il4-
<br />,;,,,":,;J;",. Z Z,o^&"^ A 3 lol,n
<br />:'"':;1!/if;-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lns u lalion/E n ergy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Il4asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Heq
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil
<br />FINAL -1-u q.vJ.1q)
<br />Certificate ol Occu nc
<br />Notes, Remarks, Etc.
<br />DATE
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