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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER AUILDER DEI,CA II TION
<br />I hmhy arfifl, utrdcr pcnulry {n pcrFry rhtrr I an crcDpi rmni rhc Conh.h L'mtrr hw ror thc lollowins ,c!sn (Scc.70jl.5
<br />Au!ir.\s rnd I'rofc*ion Codc): Any Ciry or Coutrry whi.h rr\utcs . Frnir ro cotrslrucr- lltcr. impro!.. dcnn ish or EFir y
<br />nructurc. Dr to ir{ hsumcc. also rcquircs rhc lnpliclnr lor such IEnlilro fi|.tr riSncd nat'ftnr rhd h.orshc s liccrscd tunumr
<br />kr rhc pbvilroDs of r C:otrhcnn's Li.c.scd Liw (Ch!prc,I, Connncncins wilh Scrrk,n 7O0O.r Divilion I .l rhc Busirlcs rtrd
<br />Pror'c$iurCodcrorlhlrhco!snchcxcmprrhcrcfronrandlnchari\fi,rhcrllcscdcx.rrrion.Any!iolarionolsecli('n7lr.ll.5hylny'
<br />opplicur n, tr r--rmir slbjsr{ rhc +tli.,nr t, , .ivil Fn,hy or nor fttr rhm liv. hundrcd dolhm ($500)
<br />-l.
<br />r! osncrollhcpn)pcn)..r tr,ycmnbrcs $irhwrgc\ r\rltt (,lr$nlf,n\rrn r, \illd. rh. \ork dthc (k--tr'r h nor
<br />icdcd or.llcr.dfd!c(Sr..701-l,Busircs\rndPr'L\(n sC.i.Th.Ginkr.ttr\l-icctrscttr$tl{{\norrpflyr.nnoBrcr.f
<br />rl[ FIf,ny *ho buikl\ or i'run{ct rh,Eon. i,kl *lru d({s $.h tr.& hmscllor hc'rll.r rhroulh his or hd otrtr cn!n.y.c\.
<br />pro\dcd rhrl such iml,olcrrnts lrc nor itrlcMsl orolttrcd lbr L,le lf. hoNrvorrhr hu,tlin8or imflorcorot is $r] *ilhin.'rc )c.tr
<br />olco'npkrriun. rh Osn.r Briklcr *illhnr. rl{ bxnl ol pmvirg rhrr hc or shc d d mrhuill oriDf(^t ihc lmpoly nrrh. nury,{ ol
<br />l. d uqNr or rhc ln)pdty. incx.tusncllcotrr.rinswnh liccnscd contracroF h .on(rud rnc proj.rr lsc. T0l,l. Bunncsr
<br />a,xl hDf€$irtr Codc lhcA'nlrlcroi\ l-icenr hwd.cs rollmlyIo nn own.r or F,r.ny who huildsor irrrov$rhcrcofl.
<br />rnd who.onrrrsforsuchpbF.*$irhrconra.r.r(9li.cnscdlununfiorheG,ntncroisl-i.cn\ctis).
<br />I a r.x.nrrr undcr Sc.ri
<br />IYOAKE&::(AIITE|NAIAN
<br />DIICLAAAI'IIN
<br />I hcrc$y illiflnnndcr pcmlry oiFrjury orc ollnc,nl&,wi'r! dc.lfirii,rs:
<br />I hrvc ul $ ill 'uinhin n Ccdifi.rc of Consd roSclll.srr. hr s.rkc6' coDpcn\{i('n. !s proviJcd torhySccrion lT00ofrhc
<br />Lrkn Codc. hr lhc pcrfirmrncc ofrhc *orl lar {hi.h lhc psnrir n isu.d
<br />lhavcrnd will'nannain s.rr.r\'..nlrnsarn'n i,su..n.c..s cqutcdhyScction]TO0olrhcltrborG)dc.r{trrhcpcrlonrtrEcol
<br />dr $ork f(tr*hichthi\ pcnnn is isucd Myworktm LnnlPcn\mi nNuxrrc$dcr atulp.licy numh:r dc
<br />P.l'.v Nunfi.r: ErDic\
<br />-l
<br />ccnily rhrr nr lhclcrlonninccolrhc slnl l,n shi.h rhis pcrni i\ n\u.d.l shrll n.r cmtloyrny Frvnr ir atrynrrn.t
<br />$ r\ io lH.mc suhJc.r t, rh. trrtrkr^ .on1Pcn{ridr lrs{ orCdlir{mir. lnd rrrcc rhd ill \h,ult ncon,r \u}jtr t' rtt
<br />*brkcri cohpcis rnn, piovirbN of S&t n,n lTm of rhr Lrhtr C(xlc. I shrll tun h$ith coDDly wnh ttu{ p(,!i\n r
<br />WARNINC F{inrc h *.nrc workcr{.oupcn\nriu, .o\!rugc i! utrlJwful, Md nhll nr\c.r rI cnrlkrycr lo rininrlFnrhic\ rtl
<br />civil fircsupx) nc hundrcd riou\rtrd dollDn itl(n.l[X]). i'r aJdirrnr rorhc.o( oi .orrpcn\!ri,D. drnugcs as Pro(idcd lnr rh.
<br />sc.i iur .1076 oi rfu utln codr. inr.rc{ aid.n.nfy s fc.\
<br />Ll(:[NlEDr()Nr&r(11)tsDIilLIldIa!
<br />I hcrchy linnundcr p.trdryofpcqury thar I rm llcctr*d utrdcr pmvision olChxJrrcr 9lc.dn*n.i'19 wirh Setiotr 7Om) ol Divi\ion:l
<br />ol rhc Br\in.s and Pdasion\Codc. my li.cn* is in full forenklcfcct
<br />SANETAI(.:UQNIINDIN1;ACENII
<br />I hcmhydftn u dd Nnalty ol FrJury lhli rhcrc h a connruclion kNii.s rsctrcy ft{ rhr pcrlnnmm. or rh work ntr *hi:h lhi\ rtmir is
<br />isrictllsr. .1097. cn L-)
<br />AITUIANI.IIECLAAIIQN
<br />I hcKiyullimundcr lcnalry orF.jury o't ofrh. fdk,wi.g dc.l& nrN
<br />Dcoolltiofl Pcnnils Asbcnos Norificarion [t&,al Rc8uhrions fl irlc 4). Pn6)
<br />-Rcquncn
<br />Lcllcr ol' Noriricrrid,
<br />l.cnilyrhdr rhcLdcrrlrcSul0lions rcErdilr8 nshcstos rcmoval rc nor rlplicrblc t, rhi\ pniNr
<br />-1.lrlifyrhar
<br />I harcrcadrhis alplicarn,nrd *!tcrltu rhcah,vc inntri1dtun i.onccr Ia8reroc.mplywilhallCiry3ndCotrnry
<br />o.dinanccs ond Srllc Llws ahrins lo b!ilding condocrion, ud hcrl,y axrhriz. rc0resnrllivcs of$n Cny und Cou.ryro.nrn uPon rr*
<br />tuorc mnrind prcpcnt l'or i,spccriotr pu.poss.
<br />ApplicBnl or Ag€tr! Sianlh're
<br />Pemrile nome ( prlnl ):
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Rool Sheathing 9lultQ rN/w)
<br />Shear Wall t
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />,..71 ,/.4
<br />FINAL frt./,4Js'u'"E
<br />Certiticate ol Occupancy
<br />Notes, Remarks, Etc
<br />Pool Fence
<br />Licc.sc chs:-!,iceose Nun$c.
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<br />D.le Co dd.r
<br />Gtrd.i'Addrc*
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