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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE COMMENTS OWNDR BUILDER DELCARATIoN
<br />I lttciy dfllnn unde, p..ahy ot pcrjlrr rnar I on cxcinpr lmm rhc corr.do^ Lkcns hw,orrhc lollosng rc$on (Se?0.r15
<br />Ru\inc$ nnd ProLsiotr Culc) iy cny or Coulry which rcauncs I pcflnil ro $tr(ruct. altcr. improvc. dcnmhh or rcpan ,ny
<br />irucrxr.. riq t, ih hsrarcc. aho rcquircs lhc onpli.anl for \kh Jtrfrn b lilc, ii8n.d darcmnr rhd hcor \hc n liccnscd runuonr
<br />ro rh. pmvniotrs ofltE Conlmclols Li$n\cd ljw (Chaprcr 9- Connncnciis wilh Sccri.n ?rlOO ol'Divnion I olrhc Businc$ {trC
<br />Pmfcsn,n( Cdc I or lhal ne or ihc ncxcnrtr lhcrcfrom ond rh. bfis Lr rh. alLg.d .rcmprio. Anyviolalii,nofS(rhn 70-ll5 hr,ny
<br />lnplicrnt lorr p.m'it subjcck rhc appli.,nr ro r.ivilFnahyofno! nnrc rhm fivc nundrcd doltdr($500)
<br />fl\. * , '",". "r,r,. p-1"ny. n n) cn'llnyes tr h * rlcs ,s rhrn sb .o p.nsd,.n. sill d. rh. so* ld rh. srturm G d,
<br />i 6rlcd ororcmd for slc lsd 7044. Aulnc$rnd Prort$ioN Codcr ThcCofta.rols Liccnk tjr d.cs nor +ply r. .D owftr .f
<br />rhcpmllc y who huilds or in[mvcs lhLmr. nd wtk) dftr \r.h w,rl nimser or ncr{ll or thnush his or nq oun cnrdoy.cs-
<br />pr)vidcd rhdr \uch impdk'ftnkmnor inrctucdororcnd rd\ah lf. hoqcv.i rh. huikliiS or nrqroecmnr issH Birhinonc rs
<br />oiconDlcri)n. rhc Owtur Buildcr *iU htvc thc budcn.f l'olin8 rhar hc or shc did mi hild or iqmh l'lc nFli.ny lor rhc purlbc of
<br />ffi;owncrolrhc |nltxdy M]ci.luq!.ly.o furnrg $ [ li.ctr\cll nmx.i8i'qffh'( llr folt{r (S.c 7lIl1. h'\i'r\s
<br />ntr o(ncr oftrotd'ry trho hoikls.r i'rI(,v.\ rh.rcon,ni\\inrCodc: Ihc Conrrucroi\ l-icctr\c l-nw docs tror t,tl)'ard uho .otrkr.lstu.uchtnqc.r\wnhrGhBcnni!)|lrnr brhconnrico \ Li.cnrc lf,nv).
<br />I hcrchy rafirnunncr |En0lly ofF-rjury onc ofrhc lnll,,wd! ddchrrri{'n\:
<br />lhrv.mdwillruinr n!C.nifiqrcolCoDr[n,Sclll'i\orcfttrworko^rotr1p.iurnnr. \ pmvidcd tur$ySc.rion:]7lx)orrhc
<br />If, txn Cfl lc, lor rh. lcrfoirntrmc i th. sork for which rhc p. ir i\ is\rcd
<br />_lhrv.rndsillnuinrri.Norkc^cohpcnsriionnNurrNc,.srcqutNlhySccrionlr0oolrh.LrhorG)dc.f(,rh.|l.rlnnmncof
<br />rhc *ork lorwhi.h rht l,cmrir i\ nsucd Myqorkcrs conrN.slriofl ilsurun.ccnricr{ policynumbcr rtrc
<br />FrDir\
<br />Ic. ift ihrr in rhc p.rfornmEc ol rhc sork lu whi.h rhn l.nnir i\ 6$.d.I \hnll nor cnlllo, rny pcrson in rny nrtr'*r
<br />$ $ki b.corr rubj.cr io rh. workcr' compcn\ar ior hwsofcnlituari( Md r8rc. rn{ illshoulJ tE.om hjcdtorhc
<br />Nr*cr( c.nro.n\rrion pn,vni.ns .l Srcrifl l7(I)ol rlr ltrlhr Codc.l nq'irh onplt wirhrho{ nn,rhidr
<br />WARNINC I, htrc ro acurr s.rkch .oD,Fn\ir()n Eris. i\and shlll suhFcl !n cmploycr ro laiNirll Eullhs and
<br />civil litrcs uD b onc huidr&l rhor\ri dolhr\ (S1(x).0{xr). in
<br />%::-__.:":)";#f;i
<br />I lrrch! llntrrrn&' pctrrlryol l,crEr) 1]Hr I rn i..n\.d trfdcr
<br />.l rh. Ru\irrs and Proltsion\(nlc, lrd my li.c sc ir in tullr(,(.a loflrcr
<br />i.iaNslBuqlQNrlluN aliN.(:l
<br />I hcrchy !fljrnr undcr ncmlryoft'crDry rhd rhorc is r coiito.ri(nr kidi'rg a!.ncy for rfic p.rfonmrcc olihc sork nn (hich rhi\ pcnnir is
<br />i\nri rS.c. 1097, Civ C.)
<br />AIPIIgANIDECLA.ETIIAN
<br />ItErcl'yntfia,u .rlrmly.rFquryo.cof th.fdl.wingdc.luarions:
<br />Dc.nliriotr Pcnnih Asbcsro! No!iri.rrnr FcdcralRcsuhtnnr ('lillc,l(r. Pln6)
<br />-Rcquired
<br />blrcrof No l.orkn
<br />I cenilyrhar rnc icdenlrc8ul ions rcE&lirunrb.nosrc hvrl c tror rlldrahlc to
<br />'hi\ !tu)c.r
<br />-l
<br />ccnnirhar I h.rc rcad rhn,ppli.rr
<br />odimnas dM Srarc bws El.ri6e r. bui
<br />{rrc rhrrrh.rhn. inlnrnrridr i\..'r..i lrar.c ['con,p]vsirh llClryxndCo!fry
<br />innru.ri,r a hcrchyrurhoriz. rcprcscnrrrivcs.lrhn( ilyrndCoutrryr,. ter$onrhc
<br />rh)lo rctrriinrJ pmF-.n! tu ir\l
<br />,\Dplicrnr.r '\!.Dr si(nrltrrc
<br />Pcmircc mnrc (D.inr ): X-F$ci\(
<br />+1,/s
<br />Set Backs
<br />Forms/Steel/Holdowns ,-LL -t8 J/.5+{*)
<br />Erection Pads
<br />Subf loor/Vent/lnsulation :\11.&&))tAr6l '4-,',
<br />Shear Wall I
<br />Framing J
<br />lnsulation/Ene rgy
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handica Re
<br />De u Final Re ort
<br />En ineer Final Fle n
<br />Flood Zone Certif .
<br />FINAL 9-2?-/9.JJcf,tl=(ri)
<br />Certificate of Occupancy
<br />Notes Remarks Etc.
<br />--)
<br />ID/SIG.
<br />UFER Ground
<br />SLAB Floor
<br />Rool Sheathinq I
<br />Drywall
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