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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNDR BUILDER DI'LCARATION
<br />I h.rcbt aftnn und.r Ii.nrlry of pcrjrry rhat I a ercmfl fmmrhc Conkrb^ Li..n\c Ltr! r.r rh. rollosirS rca$n rscc 70ll5
<br />L,usircss . Prolc$ion Codc): Any Cily or Counly whi.h rcquircs a pcnlll lo $n{rur1. ahq. i,npom. Jcnx,lth or qxn rnl
<br />ndcrr,c. rlttr ro irs i$urcc. rh. rcquirs rhclpplicunr nlr \!chlrcmir h fi]. d \i8 .d (,r.mcnr rhar h.or \hc is liccnscd Nrx l
<br />lo rhc pruvhio.s or rhc Conlr.crols l-iccfsed t w (Chr,rrcr 9. connncrcir8 !irh Scdion ?fi)o ofl)ivision -1orrh. Brsincs an.r
<br />Irofc$ionsCodo orlhalheorshc ircrc"ipr lhcrclionrmd lhc hasi\ tor lhe rllc-scd.r.n{rion Anyvn rrio.orscdionTtrll.5byiny
<br />arplicor rora pcrmir \lhjNl\ rhc +rrlicrnrt, acivilpcnalryoltror Bxc rhM fiv. hundrcd dolldrr (S5fii)
<br />l..s wncr olrhc tr.pcny. or mycmployccs sirh qa8.s.s rh.n soh conr|]cnsnrion. *illd. thc *ork ud rhc derm n frn
<br />inrd,xLd or oflcrcd f(tr $lc(S( 7Ot4. Bu\inc$ and Pr csshns Cdo l hc G).ktrr(r\ Liccn{ tj* dNs not eply ro i. owmr oi
<br />dr. rDrrny wio hoildror irrrDvcs rtrr@n. a.d who d.s \rch sork hnn\clior hcrklfor lhmush his or hfi.{n .ntl.yccs.
<br />p.ov ided rhlr such nlm)vcnroF de nor inrcndcJ or Dr.rcd rrtr x c. Il t(,w.vci, ih. huiklinE or nryrowmnr is sld *ilhi t itr ycu'
<br />ofcoqrhlion. ttE ONtrn Buillcr qill tnw rhc idrd.tr of rroving tllf h. .r sh. dri nor truild or nnpn'vc lh. 0mlt!1y fo. rhc I'urtn$ oa
<br />l. rr.$tr$orrh. |'oI(n)_. anrcr.hBivcly.otrtx.rn]8 q(h l:.cn$d .otu d.r.6 tu ..nnrud l,E tr(+.l1Sc. ?OilJ. Ru{nr*
<br />rnd thrli*i.. Codc lhcCo rucroi\ l.iccr\c lr* docs nnlJpnlrr. rtrowrqoipropcn!*ho hoil{kor in,Fov.r rhcrcotr.
<br />rtrd who .o rr.rsr(nsuchprctcr\wirIncoftrclr(sr1'ccisc ru'surilbrhc(ir rrcrofsl,i.ctr\clns)
<br />I nmcxr rt! u cr S.dio
<br />Orn€.
<br />ty(rBL!&rrauPrNstlta!
<br />IICLABAIIaN
<br />I h.rcby rfiirr undcr Forlrl oflr{rlurron. ofihc finb$ing dcclrrlrbn\:
<br />Ih vcand{illnii' riirCr ilicat.fCoiscnrt,Scltlislrclllrso Gr.o r|En\dn .,\ trovidcdtorhySccli,)nll7(xloirl[
<br />Iltxtr Axlc.n)r rhc rcrforroncc ofrhc qo ftrwhichrhcplnnirt iskd
<br />rh. $ork for whichrhis p.ra,ir i\ issu..t Nl, workur comIcnsrrion in\lraicc uri.r rnd F)li.y nxn$cr dc
<br />![rLJ cn'fy rhd
<br />'n
<br />rhc rsrnrnrilc.rrh. sorr r.r shrh ihi\ p.nnir is i\\ucd. I shrll nol crntlo] trny pcmn ir rny mlnn.r
<br />s, .sio t onr subl..r ro rhc mrlcr' conrpcndbn laws orc.liroiIi,, .n<l lercc rhd ifI sholld bc{om rubjcd k' rrr
<br />*orkcn conln.n$rion pmlnionsofScclinn 3?00 oirh. titD. C.dc.I rhlll. ionhwirh comply $irh rhoy pmvtion\.
<br />NAllNlN(; Frilurc n, {.utu qorkrs'
<br />.rLl fin.\ trjr n,.n. hund'r rh{\rrd
<br />S(dn!j r{)76.f nr I rt\tr (itrlc. ri.,r!
<br />'\ , nlstlil rn nlLll \rl'jc.r cnlt,loycr r,, si'nirrl pmlri.s 3Dd
<br />con oicomDlnsorion. drmaEcs ss pr,lidcd lar rhc
<br />/,,,.L ^t t ^r (i
<br />I hcrcby.lurm undcr lcnrlr! df rrrury rhd L{rd N.rl undcr pmvhion ol( huDlcr 9(commmin8 *irh Smrio. TmO) orDivisim l
<br />of rhc Bt\incs\ md Pr'tus\ion\Codr. trid tritli.. { n i',lullnncc Jkl crfl.r
<br />x,*^".,€& t-9zt-L
<br />f,,," /, -(h^l?-
<br />I hcEby 0liirm undcr pcnalryofIsilrr rhar rh6e h r conntucrion kndi.s aC.Ny for rhc p.rfoflrtrmc oI lhc sork for whkh rhis pcmi n
<br />hsucd (Scc. 1097. Civ C.).
<br />AIIUCANLDECI.AAA.IIIJN
<br />I hcE{ry.ltim undq pctrohy olrerjury one of lhc follo*inr dsharions:
<br />Dcnn ir ir P.r.rirsA\b. os Nori6.al ion tudcr{l RcSuld n ns (Tillc 40. P{n6l
<br />Rcquircdt crofNorifcoliotr
<br />s*,rirtur rhr i.dcrrlrcsuhrnn'\ ogdli',C tr6b.i$rcmyatnre n.t lFtlic0blc ro
<br />'hn
<br />pmj(t.
<br />thir thcltnrc innxnErion iscotr(l I "8N ro comply wirh trll Cily and Coutrly
<br />n,n. arn herchy iurhorizc r.prc*lkrnts oirhis Cnyand coutrly to enls up.n lhc
<br />Pemirmn.me lorinu!- |\t ti lz.tLu*/<b'rt ^t r
<br />Set Backs ,/\
<br />Form s/SteeUH o ldown s p4@ E-tt4rl Y,V6A )UP,-).t- Wrr>Y ^}fi<D&Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Rool Sheathing
<br />Shear Wall
<br />Framing
<br />lnsu lation/Enerqy
<br />Drywall
<br />Exl./lnt. Lath
<br />Brown Coal
<br />lVlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Beport
<br />Engineer Final Report
<br />Flood Zone Cenif
<br />J'YorLh6g h/edtj Y-2J4e 9,V)U
<br />FINAL 4-l -t4 tw.Atitd&/
<br />Certif icate of Occupancy Cfl
<br />Notes, Remarks , Etc.
<br />I
<br />LciJr''.^JJcs
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