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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNDT NUII,T)ER DELCARA'I]ON
<br />I hcrchy rin'n unlcr pcnrlry of Nrjury rhrr I d crc,Dpr ln,D rhc Conrrrn,r Li.ci\c l,r* ior rhc tulk,wnrg rd$tr lscc ?0.11 5
<br />Burincss {nl Profc$ion Codc): Any Cily or Counry qhth rcqunc\ r Frnnr b ..n{ru.r. .1r8. nnptuvc. dc.mlidr or rcprtr niy
<br />itucrurc. prntrlo ih tsu.ncc. aho rcquirc\ rhc {flicanr for $ch lEnnil tu lika rirncd $rtmnr th.t hcor shc n li.cnscd puisu.nr,
<br />lo ihc FJvrs..s ol rlr (intr.d \ Li..n\cd bs (ChJprcr 9. Conrdcncing sirh S.crn,n 7(X)O o, Divisnrn :l or rhc Bunnsr oid
<br />l'rc|'rsriuN Codc)or rhrltu.rshc is.rcnu rhcrcfnnnindrhc br\i\ f(trhc rLltScd rxo.rrrtnr Anyvn)ldnrofSNrio.r0ll5byrty
<br />rmlicaflf(trrtcrnrnsrhle.Brhranp]i.rirr,a.ivilpcnallyotnornDrerha.ivchunnrcddolli^(:ll(x))
<br />L s osDcr oirhc pntcdy. or fiyc'nnhJcc! silh wa8er rs lhcn s.lc conpctrsrlion- willdo rhc *1rk ant rhe slBrurc ir trol
<br />dc'dcd orollcrcd trwl.(S1r70,1-l.Bu\incs\rddllofc\\i,,nsConcl'hc(innBrtrtr\liccnsclr*docrnoixtlirhrnowmrof
<br />lh.pErny sho hild\ur inpfl*r!rlf,*4 md who d,*\nd *o hnn\cllorhcrs.lforrhn)ulhhisorh$ow cnpk,tcc',
<br />F)v idcd rhrr such DpNr.nEtrls !N flor inrcndcd or oll:Bl lar eh Il. h.{d cr rhr huillins or nn rtrcnrnr i\ n,Il wnh' r ] ,tu )t,r
<br />ol.oDl'Llion- rhc ()trncr lluiklc. uillhr\c rlr tddctr ofpmving rhd hc or nE dil nd htrit or nnporc rhc Dn,Fny li,r thj lunx&ol
<br />l. r\owrE olrhc pnrlcny. rflr.xclusivclycanrr&rnrr wilh ll.cn{d .onhdrtr( r,i ..nsrrucr rhc omicr lSe.^.7itl,4, Bu{nc\\
<br />{ hl)lcssi)trCodo lhrCo tr.ttr s Li(cn\c La*,nrc\ mlamlyr. rnownc.olpoperryrho huild\or irnprius thcrron.rid sho co&uF li)r Nch nrcj.cts *irh r (tnircro( n li.cn*d tu6u nr k' rhc G fu.rtr'\ Li.cn\c Laq)
<br />I rm.rcf, unn.r Sc.ri,,o_
<br />llolc: O*n€r
<br />woRKr,rRa-(iiNiPiNai riiN
<br />DECI /lrtrur]!
<br />I h.rcby rlfiiln undcr I.mlry ofr.rjury om otrhc nnL,sife lcclmii.r\:
<br />lhave *illnuirlrinaCcnillcrleorCotrEnrroSclr.ltr\ur.r(trwoikc6'.o.rr!-n\arion.r\ |,olidcd hr br Scclio,r .17(t) ol th.
<br />L{hr O{c.lar rhc l)trfonnm.c ol rhc work for$hrh rh. Itnnir n n$Llt
<br />Ihrvc ntls'llmnnrineorkdrrcon,|xtr\Jrotri'r\uranc..r!rcquncdhyS..ri,)nl7(xrolrhclrhor(inlc.turrhc0rrIon,um.ot
<br />rh. so n)r*hichrhi\ p.nnir i\ i\lud. Mysorkcrs omtlcf\rrion in\urJncc.rricrnndtnicy nuDhcr rc
<br />,,-,", . .t1,4'ie Pun t>t- l- 20/ 4
<br />l.cniryrhrrnr rhc Itrrntr'nrn.c o, rhe $ork ra. $ii.h rhis |rnnlr ir isnrcl lshrllf,{ cndoyrny,tr$r in rny mrnNr
<br />$ .sn)hc.onr suhl..r r) rltr tr.*.ri.o rlrnsriN hf\or(rlira'nir_ trnd rgrc rhnrifl \l.rruld hcco'R {$i.d rorlf,
<br />workcG..nDcn\rri(nrfmvi\n,tr\.lScc!otr:l70O.frhclf,htrC, c.l\h,ll. n)nIsirh.oirnl! {irh rh{^. pniri\i(,n\
<br />wARNIN(; }lrlurc t) {.trrc sorkor onrl[truii(n,.o\crrgc is unlr{lu|. rn \hall \lhicr m rmdo}cr t, M"rrLBnrlric\ nd
<br />sc.ri( lr)76.lrhc ljhrcodc. i' ('.d n rnonry'r r.ds.) u-tt ^rr,,".,, X
<br />IlElliIXtrlIQN
<br />I hcrchydljrn, un.lcr r.nrlryofpcrjurv rhi I rn, li(n\cn trndcr aDvi\ on olChxprcr r) (comnrn.inB *irh Srcrion 7(XX)r.fDirhi{rn.1
<br />ol thc ausin.\(md Pnr.$tunsCodc, rlnrv li.cnsc is nr fulltui( clltcl.
<br />B1^t O-)
<br />S-17-1F c",r*"r*;A
<br />COAIINUqUONIDNIIIA!.AGEN(I
<br />I hcehyrfinnrundd Frrl'y.lpcrjuryrhd rhcrc isr..n{rucrn{ bndingrgctr.y rir rhc tc i)nnrncc olrhcsork lor which rhis pcnnn n
<br />issucd(Sc. :i097.Civ.C ).
<br />A.TfJ.ICANI.D!q"AAAII!]N
<br />I llrhy afilm uM.r Foalry oI p.rjury oi. ofrhr folh,sin! dcclffdioi\:
<br />I)cnnnin'n Pcrnih Arhc$s Noiificrrion lcdcral Rc8ullln'n\ Irnt 40.1'rni)
<br />R.qrncd Irricr of Norifi cdi,n
<br />-l.cnil'_vnlol
<br />rhc rcd.rilrcsukrn,ns rcsrdirs islics.s rcm.vrlirc tror inplicftl o rhis pr'rccr
<br />A4.rdiryrhd I hrvc ruJ rhl\xnrhc ri{ra'xlnarc rhullhcrh r arccroconu]yqihrrrc r trd L.u ry
<br />ordi'iriccs rtrd Srrrc I-rs\ rclrrilg b huildin! c..ntu.rn,n- ud h.rchtrurl.itrizc rrprcscnr nc\ ofrhi\ Ciry dd Ct,udy b c rcrulr,irhr
<br />nh,vc nrrri,trrcd prircny tu ir\rcdionNrrii
<br />r\Dpli(rol or,\!01 Silnnlu
<br />"x-o lZgueto
<br />,^,"c s-l.)-lt
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Boqf Sheathing
<br />Shear Wall A
<br />Framing 9-r{-)V
<br />lnsulation/Energy IJ
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handica p Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />2-n11 N.U .tn
<br />Certilicate of Occu pancy \./ \-z
<br />Notes Remark S, EIC
<br />-+
<br />Qr"\r-dIJ
<br />Flood Zone Certil.
<br />FINAL
<br />I rr n1 . A,ll'r\.
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