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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BT]ILT}ER DI]I,CARATION
<br />I h.rcht alfisn xndcr lcnnlly ot pcrju'r- lhar I !m cicmnr r,om rh. Cdnt.ctus Ltn{ Ijs ntr lnc hll.lins rcN- rs,! rorr 5
<br />Busincs aM Pflrfe$ion Cclc): An, Ciry or Coxrry *hi.h r.quircs r fcrnir to.otr(rucr. rhc!. iDprovc. Jcnptal fl rcP{ir rny
<br />ructrrc. prior ro ils hn'ine- al{, rcquncl rh. applicad ror \u.h P.nnn tu filc { sisncd ( cnrcnr ihsr hcor sh. n liccnsea Purluonr
<br />k) rhc pmlisnm\ otrlr Co hd.ror's Liccnscd La$ (Ch{lcr 9. Conrnrcnci,r! {irh Sc.rion TIXX) oI Divnion I ofrhc 3u\nrss rnd
<br />Pi{'rctsionsCodc)o!rhd h(or shc iscxcnu thcrcfonmd lhc hNi\ fitr rhc n llc8cd cxcarPt io. Any viohri{,nofScction?0:ll5 6y rny
<br />rrpli.^trr fd n fcnnrl suhtccklhc al,pliclnr ro acivilFnrlryofnor nFnrhin irc hrndlcddollrr\ (S5m)
<br />-1.
<br />a\ owncr.frhr pn,Fdy. (, nrycnrployecs wirh wrgc\a\rhcir $lcconPci{rin! trrlldolhctrorl u:l rltindurc n {
<br />inrc ci.rolt.rcdlbra'1.(S(TOl,l.Btrsirrs id tlofcsn sCdc lh.Conkrcttrsl-i.cr\cltrN,l.csnorrpllvt,rfowrtrof
<br />rhc nD,uy sholdikhor mrn,rcs rh.rL\n hd who,les nEh *.tk htns.lr or ltr\clrorrlr.uAh hNor hcr owncnDl.v.c\.
<br />pr)v n[d rhrr nkh imprcvcnrnh rc nol inte0dd or .fltrcd rbr {h It hoqcvcr. rlE huilling or i'nFrontd n skl $irhin om ltr
<br />ol.onDlcrion. rhc Owncr Blildcr sillhnvc rlt buntcn ol p'.vnrg ih.r ht.r shc did nor ttuikl or ml("c rhc lmlrny ln rhc purtxM or
<br />l. is owncr .i lhc nroP.ny. u exclu\ntly contrri'U $irh l$n\cd .onrndor\ ro conntu(r rh. ftu,,-cr rscc 7(!1. Bu{ncs
<br />rnd Pn,li\\bnCodc:ThcC.ntrdor'sLi.c0scl-!wdor\mrapflyk)mo$ictolpronc,whoSuikhorimpnrvcslhcrcon.
<br />rnd wlr conrn i\ fttr srch !tulc.r wirh r cDnrd.n \ ) liccn!-d Pur\urtrr h rh. conkr.tn\ l-i.ctr* L!*)
<br />-lxn,drr r|, un,l.r Sc.r
<br />I)8le O$mr'
<br />\!(IR(!l(S CONII'DNSA.I',X)Nl][lj,,rn lo!
<br />I hc'.hr- rlltnuDdrr !.nrlryol l)crury.ft ol rlr tull(ivirA dc.h'rli,Ds:
<br />Ihavc xl will nuirhin r Ccn i&rr. of C.isctrr n) Scll: I trsurc ln ro cn conrp.n\di(nr, J( lolidcd l hySNri(,n:17(X)ofrhc
<br />htxtr Codc.lorrhct rlbnmrcc .l rhc sork for whi.h rhc Nrmir is i\{rd
<br />Ihrvca d s'll rn ritr trorkcra.onrncn\nli,r i,Nlrrn.c. rs rcqr tud hy Scdior l7O0 oilhc lrh(tr Cod.. tbr rhc Nrlomuncc ol
<br />\urm.c.rricr rrl F)ltynumbcr ar.
<br />l.-:
<br />\r1,r.)
<br />tnrshi.hrhi\ Fnnir ir irsuc{. M l, }q(.' r .oDr.n\Jr i,D in
<br />[6y. nil.r < ]f^lblnr^/cotq3g?8 55
<br />I c.nifr_ rh.r ir rMncnnfllrn...l (hc *ork nn qhirhrhi\ I[r n n n$'.n.I !tullnor cnrnl(,yaiy !cn.n ir iny n nncr
<br />$ r\bhcom{hFdrorh.workcn cor|Enqln hss olCuTili)roir, rtrJ !r.c rh.llll shnrld bccorE sutri.c' k)rh.
<br />workcn con,Fn\rrn F,vi\n,isofSc.ri( ]r00ol lhc tih,C{xlc.l \lBll. n h\irhcomnlywirhr}xr{nrolitn \
<br />wARNlNc: Iltlilurc lo {ccnrc work.r\'conrt^-n\lntrr ..v.rasc i( utrliwftl. un \hJll rtrhtcr rrr c lilortr h.riminrltc.{lrics i
<br />sNri.tr rlrT6flrlr lrlu (ixl. iircr.n rn rinrrt \ r('.\
<br />kf,,. (,/rr ld
<br />I hcrrbr" nlrirm tr rr J,.nrlry.l tutn'y thrr I. n L'n Mrl tr r J,rori\ on.la hxfrcr 9 rrotrr,f,n., r! \nh S.eri.r ?lIx)rolIr!'\n ]
<br />of th. Ausiftsand Pmlc\rionrCodc. and my lkcn\c t in tullf(&t n cllst
<br />s, crr Li 11)
<br />b-t3-tt CG cI Co 'sJ'*clru'
<br />coNsraleuoNuiNulcili[M:r
<br />Ihcr.nyrinnnnnd.rp.nxlryorl)crjurylh lhcrc isacon(ru.rion lcn(lins rlcnty l lh Dcri,n rnrcc ol ih- *ork rar which r hn ncmit i\
<br />ir{'.d asm l(I)7 Civ C i
<br />t n,lcir NlnE
<br /> I'I'LICA N-T DF( II AR T(IN
<br />I rrrcb, !0inn u nd.r ][nalry or!.rjury otrc rlrhc nnLr*in8 d(lxrrri(,'\
<br />Dcnd rnnr Pcflnirs A\hc{or Norillc rion Fcdcml Rcsnhri()n! (lirlc.l0. Pnn6)
<br />Rcquircd lxrlcr ol Noriri.rrioi
<br />rr.! dirg!rh.{o1'cnnnrlrr. or tfluhk n)
<br />I a!rL{ ro olnply *irn allCiryrnd county
<br />divcs ofrhh City and Co!.rytu cmd nlbnlhc
<br />*,. 6-tlt{
<br />i,rrnd!xrcrl'rr rlrrhi\.,trDrri,{i..orc.r
<br />ildin! co.{dcttr,n. und ti,r.by irlhoriz. rcrr.\cir
<br />5ac.Lr \),g1.or
<br />Set Backs
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathing q.nhk I vl,rffi /rf--
<br />Shear Wall
<br />Framinq
<br />ln s u lation/E nerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL X--l tt Anqy|lrt,
<br />Certif icate of Occupancy
<br />Notes, Remar tc.
<br />-r*;r,-
<br />'l
<br />Fo rm s/Stee l/H o ldown s
<br />Erection Pads
<br />,,ffi.\ Zz,0t/ztz, /t)l.t.'.,. ltl
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