|
BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE tDistG.
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathing
<br />Shear Wall
<br />Framino
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />N/aso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />I
<br />FINAL )
<br />Certificate of Occupancy I ' t <:.,/ '\-/
<br />Notes, Remarks, Etc
<br />4
<br />I)WNER BU!I,DER D['I,CARATION
<br />I h.r.ry nilinn udd.r l.nrlry ol l.rjury rhd I dm cxctrrfr tu,m Ihc c{n rrcriN l.iccn{ ltrs r.r ihc r{,lldYr8 rcrbn (Se 7031 5
<br />Bu\nrs! ard P(,lt\non Codc): Atry (ity or (iDnly which rcquircs r t^-n ir b coNru.l. rlrcr. nnPrort. dcnrolhh or rcl)an any
<br />(n'crrc,,rhrro irr hsu.,Ec, rko rcqrncsrhdrpnli.ad ,nr su.hJrnnir ro filr r stnLi shlcnEnl lhlr hcor\hc i\ lic"i'rr n**"o'
<br />lo rhc pmvisio l of r)f, (otrt.crols Licctrscd Lns (Ch!!ler 9. Commcncin8 siih S..ti()n 7000 ol Divisi(,n I ol lh. $u\i',c$ lnd:
<br />ProltsionsCodc) orrhar hcor\h. hckmpr rhcrtliommd rhc hr\is lorIhc rllq.d cic'nprion Anyli.hriotrofScdionTOll5hyany
<br />rrfli.nnr turatltnn suhjdrsrhc applicrtrr ro tr.ivilncnflllyolmr nDtuihr fivc hu drcd dollir r$50(r).
<br />-l-r!.{ncrotrhcpn,I.dy.rtr.rtctrlployccssilhs.sc\asrhcirsokcompcn\rlion.*illdorh.worktnlrrrNulurti.tr.rn cnr[d oror.r.d f$ qlc (S(.7(]U, Busincss and PDltssi{nF Celc 'fhc Gnnr&rir-s Li.ctrsc lnw d€\ tro! sIPly n, ri 'strcr f
<br />rhc lDpcdy who huilds or iqn)ld rkd)n. rnl who 'iB such $ork hi'nscll.r hcBclfo hreulh hk or h$ own cmlk,tc.\.
<br />tr,v cd rh.t \u.h inl|novcnEnrs m nor inictolcd or oltcdl rar qlc II. ]$stvcr. rhe huilding or imlrorcnt n krB wirhin .m }tnt
<br />.f.oDtlcri,[ rhr ostur Bniklcr wi]llultt rh. bndcn oi poving lhal h( or shc dil mr build or nnpn,vc thc ln,|rny for rhc pnrFsot
<br />l. r.*Dcrofrhc pn|xny. rmuclu\ivclycontrrclin8 wirh liccns.Jcofur.ktr\bc.n(rucrrhc nnU..riSLt 70.14, Btr\i'tr\s
<br />aM Pnfcshtr Codc: l hc Conta.kr'\ Licdnsc L wdodsnor pplyrorno$ncroipoF-ny*h(,hrilds.rn{rcvc\rhcr.oi.
<br />and who.oDrEcknrsu.hfblccrssilhtrCotrkrdor(\rlicctrscdNrsurnrr,drG ri.rx'\ l-iccns ljl r
<br />I rn crcnDr und$ S(r ior
<br />lrca(l:&[l.:auuiNlaJl()NDlll,la lloN
<br />I lrrcht rl fttrr r dcr ItMliy of tutury on. oi r hc li,lt,s ing Jffllrrl!(n,\
<br />I hr\ c Md rill nrlirrin r (tn ii.arc ol'Conscnt ro Scll lnrrc 6r sorkoi ..nrNfsrr ion a\ P ovidcd in hy Sc.rion r7m ol rlrc
<br />Itrfior C{yI.. ftrihe lcrnmtuncc olrh. $r* lnr wni.h rtu prrmit i\ n{rd
<br />I hrvc rnJ willn[i'nriri $orkua c.nU{ns ri,]n iNurrncc- r\ rcqun.d hrSc.rdr rr(X)ol rhc t-ihot (]nlc. t rhclErr.nnrkcuf
<br />rho {ork fd whi(h rhn Fnnir is hnEn. Nly*orkeri c,,FnstNunm..dif
<br />"rlnricynunrhcr
<br />o,c
<br />(."''"' rv
<br />"t ss I r-' sz|u o-ra 0\I . cfrNcqaq rt- o Irfn \ -L
<br />tl .cn iiy rhrt in lhc prrlnrmrnc. of rhc work ntr *hich rhis lcmir is is\ucd.I \hrllnorc'nnl{,y rny |[rn nrrtrym{ncr
<br />v, asn,bccn'n !uh.{rr. rh.$ortcn conrlcnsdion hwsolC0lilonrir rtrdn! d rhd irI dk,uld tE onE\uhjodturtr
<br />\or[.'a dnn|Xrnxri(itrIn r!An[! ol s.r rr ]7(x).1 rlt l.'h! (intu. I \hxll. r,nrhsirh (nrt)lr *nh rlrv t]'r\ i\il,N
<br />WAINING: I'lil!rc n, suE w.rkcs ..rnJEnsrrion.ovcriSc rs unlistl Md shrll srhl..r cDdoycr ('.ri'nin l p(nxlrt\ rnJ
<br />rrfl. dr! g.r r\ pxriJcJ tur rhccivil ,incs up nr on. hundrrd rhou\rfld d.lli^ (Sll)0.(Xx)). in
<br />Sccri,,n :1076 ol rhc lf,htrCrdc. nroc{ {.d orrcy s lic{
<br />/2A It(
<br />I hcrcby rlltn utrdcr pctrdryolp.rjurr rhd I an liccnwl uidci ttuvi\nr ofChiPlcr 9(con,ntnciU aih Sccriotr 70(t)) ofDivirn,n:l
<br />ol rh. Busn.ssn.d Phics\ions (odc, md nryli.cn{ n iD fulllor.c a'il dlfc.i
<br />]ffi3b lt3 ttp?,-!^"tJ,a-2 19tqo
<br />/ Y ,,,,,,.,,.,,,.x
<br />I hcrchy rififln undcr pcnrllyoiperj!ry rhr lhcrc is r..nsru.rn'n tnJinB tr8emy t{n rhc Pcrrannan.c ofrhc wotk lor which rhi\ Pcnnit s
<br />issucdlSc. 1097. Civ. C )
<br />ATIIICANI.DIgTAATIIION
<br />I )rnhy llnnu ct l{tr.lryolprrjury onc olrhc f()llosnr! d.clrhri.tr\:
<br />Dcnnniion Pcnnns Adf,(os Norilicrrion Fcdc lRcguhrioor lTirlc10. Pa,16)
<br />Rcquncd lrnrr of No!fi .ili(nl
<br />Ij,lrrv ir. rl'. hJcr,lrcptr {Fn. rBualilF r.tr.L\ '"m, Lal.trr ri
<br />2:I..ni'y'r, t r,'.,";'r''. Jntrlrrrtr'n Jt {. crhr rhc Jh{c inlh,n'J mcr I ngre kroDlPly with rllCiryr d ('otrDty
<br />orlrtrr,..\ rn,LSrxr.l x$\ 'clrling n) huildirg tn.\oiri\.\ ol rln\ C i! rr.l
<br />,,lnrr n'. iitnLLil l)'otJ.'1t li,r r.J,r.itr
<br />\ppli$nl or ,\Bunl Sixnslurr
<br />I'cnnir.r n nc(Drhl): ,(-a--/QrA
<br />;),,)?
<br />zltillrit UZ:IZ
<br />COMMENTS
<br />o"" '1
<br />lrtr(lcr\ Nrnr
<br />rra
<br />SubllooriVent/l nsulalion
|