|
BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ()l*Nt':R nl,lLDI.:R DEI-(rAnATl()N
<br />I hurcby rlltm unrlcr p.nilry ()l pcrjur] rhor l 0n crcmpt fh'n rhc Conrrrtn Li.cnr bw ft, rh. follnsin3 rcoson (S(?0-11.5
<br />Eusinc$ and P..t$ion Cdlc): Any Ciiy or Counry *hich r.quircs a Fnnil ro cotr(rucr. allcr. i$provc. dcmli\h rr rcrrn rny
<br />nfl.rur.. pri(r r. irs hru,ncc, sko rcqun s th. q'!li.a for su.h lEnnn lo fi!.a sisncd iaremnr rhrr h.or sh. is lientd putsonl
<br />lo rhc rmvhions of thc Conrrncrofs l.icencd liw (Chaprcr 9, Co'nnrcif,int wirl Scclion ?m0 o{ Division I of rhd Burin.$ and
<br />Pmfc*ionsCo'lc)orrhrihcor.hciscxcmprrhcrcfrom.ndrh.hsisldrh.rllqcdcxcnrption.AnyviohrnniofSdrbnT0ll5byony
<br />ap,,li.,nr nr r p.r.ir subjc.B rn atplicant ro acivilpcn.hyoinor rtrc lhu fivc hundrcd.lnlL^ (550(0.
<br />-1.
<br />as o*rcr ol lhc In0ncnr. {tr .ry .mployrs w h wtrCc\ !\ rhci q,lc ohPctrsorion. will do lhc w.rt aftl lhc nMrod i\ nor
<br />inrctulcd or olfetu{l Lr sk (Sd.7(x-4. Busircss and Prolarsirns Codc: lhc Conrracroir Liccisc Iiw doca n.r am,y lo !tr osrcrof
<br />rhc pmtcny sho huil{h or inlpro*s rhcmn. dd who does srch wo& him$llor hcrcltor Ihough hh or hcr own cnlllorccs.
<br />pmlid.d th0r su.lr iDJrmvcm* N nor irlrodcd or oltarcd litr selc lt hokvd. rhc brildirg or inDror.mnl h sld sirhin om }cxr
<br />of.onDbrbn. th. Own.i Auikcr willhavc Itr bud.n ofpovinS rhd hc or snc dil mr huill or ihrn,!. dE pmptdy ror lhc rur|nsof
<br />I..sowtrcrolrhctmpcnr- anruclusivclyconlrrlins wnh liccnscd conrrct,E
<br />'o
<br />con{tucr rlrrn,jc.r (scc 7(r44. Btr\int\\
<br />aRl Pmll:chn Codc: Thc Contacrois Liccnr. Law docs nor llprly h rn owncr oitioperlywho huildr or inr,'n,vrs rhcrc..,
<br />and who.onrnd\lilrsu.hpmj.crsrithrconlrddnis)|i..tr{dnusunnrrorhcconhcrnsLiccn{h*).
<br />Irhcxrtr,Fru {ldSc.rn . a & P C lnr rhls r.xvnr
<br />Osnerl
<br />lvaatrE8,5l;0Nlf[Nl rloN
<br />I)ECTANAION
<br />I hcrcby al',tnurdq rcnahy olpsjuly ore ofrhc follo*iq dcclan(n,ns
<br />\ I harcrn,l,rllrMinrrr.rCcnifrarcotConsnl to scll lnsur titr $brkd* c.nyc.s[ion, $ Dmvidcdlorhysccrio.]7morrh.tf;,, c.,,r. r.',* 6,rn,,,n.c.l rhc wn'l rd sh.h rhc |clrl i. r,u.dlr'
<br />!i r,*"
<br />"na " '
<br />r -,1n.- o "rr cr\' .onFn\ari, 'n 'n\dru.ce.
<br />as rcquir.d by sccl iotr 3?00 of lhe L{hor Codc. fn rhc lrrronuncc of
<br />rRw, lrq(hichrhhrr"n r\n\u{i M,w.'rc .omrn.Jrtr'nrn\uromccatrinJndr.ltynu'nhc'sc
<br />8
<br />I..nir! rhnt in rhc l)crrnrnuncc ol lhc work ior whichrhi{ F rnil i\ i\sn.d.l shrll n.r cnrployanylrcnon in !nynunmr
<br />s sIo lrroflE suh]ccl lo lhc $l)rlc conrFnssri{'n laM or Cdlilninr, .M n8rcc rhd ilI should hcq,m suhjc.r i.rt
<br />workcs conrcnsrlion provhions Df Scctioi 3?m of rhc utltr C(x1., I rholl. lon h*irh omPly wili rlnc Pnli\n N.
<br />WARNIN(i: Fiiluru ro *.urc workcG com!.nsarion covcng. il unhwlnl ,Rl \hall sxbjsr dn.n{rbr_cr h ainriBlreuthiG and
<br />.ivil rmr up ro orE hutrdrcd lhou\and dolhs ($loo.llx)). ir lddirion t, rhc.od or .ompensrli()n. drnuscs as Pi{,vidcd Id rhc
<br />':,,:":,.^*;/)\ri;"
<br />DECI.ABAIIQN
<br />I hcrcby alfirm undcr pctulryofn rjury rhd I am lic.nkd xndcr pmvhion olChnprq 9(commncing silhsccriun 70OJ) ofDivisi.n l
<br />of thc Ausim$ flnd Pmacssion\ Codc- lnd D, licei\c is in li,ll tu@ aild cffccr.
<br />c3?/oz//Z-7Pr//" .,,",,,,.,,,. 7<.-
<br />CONSIA]JCIIONIIINDING.ACENI.I
<br />Ihcrchyiliirrundcrpcnohy.lFrjuryrhlrrhercisaconnrucrbnLodin!ascncyrorrhcpc'onrnrccorrhcsorknnwhrhrhrFnniln
<br />i\st.d (S...:1097, Civ C.)
<br />APILIISNI.IIDIIAAAIIO!
<br />I ffiy lnimundc. pctralry oiFrJlry.nc.f rhd Lllo*ing dc.ldrarion\r
<br />D.nrlirion Pcnnirl sE{os Norificarion F{derll ltqlllrions (TirlL 40. Pad6)
<br />Rcqutd lJrt.rof Norifierion
<br />_l c..rilrrhd rhc tcdcrrlrc!trh1n,n\(grdnr8 r(ti{orr.'Rrrlrrc tror,rpdicrn[ lo rht pm]ccr
<br />I.cnilyrhrr t hrvcrc lhh i0fllc(lion3xl{rrcrhal lhcd!,vc lnrbrnnri{n, i\coftd.I nFe t) ..nrfly wnh lll C irt tCoonry
<br />oili'l .c\ rn Srnrc lrw\nhrirS lo huildin[ cotrsrru.lion. {x] hcrchynulhtric r.nrctfxrivcs ofrhis ('ilyrrd (oun
<br />nhovc nEtrrirnrLl r)rcny lir ir \rL{J!!.rE!P
<br />,\pplicnnt or A!.nl SiInnh'E*r _s
<br />*;*"*':-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Ereclion Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsu lation
<br />Roof Sheathinq dalr ??rndr-l ;)
<br />Shear Wall \_:_
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\4ason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />I
<br />FINAL n/b/t/-,2*7a.l-
<br />Certilicate ol Occupancy
<br />Noles, Remarks, Etc
<br />ID/SIG.COMMENTS
|