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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulalion
<br />Roof Sheathin
<br />Frami
<br />lnsulation/Ene
<br />allD
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlason
<br />Pool Fence
<br />T-Bar
<br />Handica Re
<br />De Final Re ortu
<br />En ineer Final Re rt
<br />Flood Zone Certif
<br />FINAL
<br />Certilicate of Occu anc
<br />Notes Remarks Etc
<br />or\ NI.:tt IrtIIt,Dtr{ Ilt:t.( ANAl t()NIh*cb, lltm und* J*nrlly oi Nrjury rhd I rm.x.i]pr trotrr lhc C.drrcrim l_i.cnsc r.rw rnr rhc folknvirs rcN)n (Sc. ir):lt 5lrtrsirrrs ud ltoics\i, C(xlc) Anl Ciry or Coudy wlri.h rclunc\ r p.rnril rr,.on{ru.r_ rti.r. inDrovc. dc r,ri\h or rqrr rtrv
<br />\lrucfurc. pritr t] ir\ is\u*.._ rh. rcqurcs rhc ,Ppti.. for \uch F,nn tu fikr \igncd {aicmni rhri hcor rhc s Itrnrcd tu6ui.rb r,r nmli\idrs of rhc Conrracrots t-i.ctr\.d t q tchrptq 9. (innflc,king uirh Sccri.n 7tn) ol Divttr{ :l .l ih. Bu\ircr\ rM
<br />aptlic nr lnr r Nfin uhjc.rs rhc ,mtion o 0 crvit Ftrrlry or oi,no,crhJn fivc hutrdrcddolrs($5Lx))
<br />-1.!sosncrollh.ln'lf,dy.ormycmptoy.csqithwi8csa\rteire,tccorryc\rrion.tri[dortdworkaDdrhcNmrucsnorinrcndd or .lTcrcd for elc ( Se.7OJ4. ,lu{inc$ Md pldt$ionl C{xl. 'I.hc Conu &tr.s Liccnr t_0* d€s troi trplty n) an ownci ofrhctmFny wkl builds or in!,rcves rh.Nn..hd ah. do.s su.h w(,rl hnn\clfor hc^ctfor rhrough rrt* n. t. "*" ".,pt"y""r_proriilcd rhrrsu.h irn!(rvcnf,nh aBrn inkndcd orofland ror sstc l. hrsckr, rhc troiklins or inDtuk,tunr hnrtd wirhinonc rruor.oq)bri.tr. rlr owm, Buildci wilJ hrlr rhc bur&n ot proving rhnr rf, or \tc dil ftn hu*l o; nnpmr rhc tmrn, r{n ihc ruqr{or
<br />-l.r\o*ncroiIhcl)(,p.ny.!rcx.luriv.lrconrrr.ring*irhticctrscd.orrkrkrcotrntudrhcpojccr(Scc7(I,r.r.Susincsn'd tLnssi Cr)dc, ThcConrrackn s L,iccnsc Lawdo$ mrnppt,io atrowncrorpiopcnywho auitds ori,npovs rhctustr.nnd $ho conlfu.* ror such pmjc.ll sirh I Conracr,(\) liccnscJ punudr brh.ConrNktr.s r,i.cnse L.w)
<br />I n rcr.nrJ, lndfi Srdi(r
<br />D.i€: (r*nerl
<br />w(TIKFRS, c()luPF\SATr(tN
<br />DECLASAIION
<br />I hcrcby amlnund.i p.nanyoaFcrJuryoft .f the rolo*iis d(ht.rr,s:
<br />r{-l hrvc(dwillroi rin,Cenificnrcorc.nE ro sctr r8urc rar work.rs conrco{rion. is pfuvid.dtorbyS.crn,nt7(x)otthc
<br />kbor cinc- for rhc !.rrormnce of lh. work tor whhh rbc pcrmir is i$ucd
<br />.l hi\crnd Nillmriflr sf'k.re .. t)rfsrrio iIntrn
<br />rhc s.rk,nr *[i.h rhi\ [nnir is G\ucd Nivso'[crr.,rr
<br />trc.. r\ r.rttrircd hy Sccri{r.l7lX) oirhc lr$or (i'dc. i,tr rhc |trfonmn.. ol
<br />rt,c \arim imurrn.ccrricrx Fnicy tru ihcr e
<br />-l.cnilirh.r
<br />I rhcr.rformamcofi]E work lor{hich rhist nDir i\ i\rucd. t shrl nor rnDtoyrnypcnon ir dny nhrcrv, 6 ro li(o f, \uhjc.r h rh. mrtsi coma.nsar ion hw\ or Cntirorn[ rnn o!rcc rt if t\h;l(lirrn*.,t".rr"rt.tr '1.'. c,dF.n\a n.nnn,vN.,i. tSAriontnO trhctjhrC,dc.t\lI't.ronhtrtrh,,.,rtylrrt,t *pn,ii.,,..WAkNIN(:: Itilurc rJ $cdrc wortcn .ornpcneri,r .oycrgc h nnbsrut, rnd shJl rrbd rn cnDkrrr lo .rinirrtr.nrtri\ rnd.ivil nnc\ uJr to onc hutrdr.d rhoustrd dottus (gl(x).(xD). i,r idtirnnj l. rhc.on oi conp.hstrrn,n. d;nascs rr piovid.d tirr rhc
<br />Sccrion 1076 oirhc hhn Cdlc, inrcrcar sd l[rcystccs
<br />"",.' . 7-L|:lt apDrcsn,:* 6li'va>4/offuy-e 5
<br />LICITNSFD (:( INTR ACT(TR
<br />DI'(]LARNT(}N
<br />I hctohrrlllrnu fp.nllryolp.rjurtrlur I rm ti.c {.1 undcr t}ovisi(n oi Chorl$ 9 (.onnftdcnrs *nh S{rotr 7fitD ot Divisnr lot rhc Businc{\,nd Pturc$ion(Codr. and nyli.cnr is in tu rrtr.c ul cilccr
<br />t5 -c l-iccnsc Nrnhs j 7ov/ lL
<br />*", +?-r1L c.l*o* ;4
<br />c()Ns]RUCU()N I l'NUIN(: A(itrNcy
<br />I h.!.by ullirm urd.r p.nrltyoipcrjury rh, rhcrc is I con{ruclion hMihA,s..y tu, ih; t "rla",,rmc oirhc qork ti,r *hich rtri\ ncnnir i\
<br />is\ucd (Sc. 1097. Civ C r
<br />l.nd.r's A(rdr(s
<br />APPI I( ]AN1' DE(]LA RATION
<br />I hcr.6y rliin undn Firlry o, Frjury om otrhc lotr.s ins d$lallun\:
<br />D.ndirion P..nns Asl,cnos Nolfi.dnnr ltdcrdt RcAut ions (Tirtc4(1, pan6)
<br />Rcquircrl lllrr of Norifi cdion
<br />_l.caifyrllal rhe fcd$rlrrAUhrion\ rc8udir! a{r{o\rcnovatrm mr {,th.jhk h rhi\ [o]c.r
<br />lrn wrr acotrccr t r8rc.hconrJnywirhr[ Ciryr d C.urry
<br />y rurhorizc Rll'c\ctrrd rcs.frhi\ Ciry!d Counry k, cnrrr uFrn rhcoi,linuD..srnJSrare Lrwr rliiDB k,6uitdiU con{ructiotr. h.,.bfitrr rnrnnL.d pn,p.n, tur inspcction pqhscs.
<br />\ttliu !tr lsurlSi[ rr x tJuf'ta-<
<br />",4-21-lt
<br />TDFITil
<br />Shear Wall
<br />-r,rpncs:
<br />' ll '3 o* (7
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