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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE IDiSIG.COMMENTS oWNER BTIIt,DER DELCART\TION
<br />I hcrchy rfilrn nndcr !.nrhy of pcrjury rhar I run crenrpr tom rhc (tnrradoF l,icrn\c lrw rbr rhc f(rbhne drv,n (sc( 70:ll 5
<br />Bu\incss aftl Pn,aesion C.dc) An, Ciry or Counry which rqtnc\ a ,unrir t, .on{ru.r. nrh, iDpmrc, d.nDlish or rcprn atry .
<br />{rucrurc. pri{, b \ nsuaf.c, ik. rclurcs rhc.pdtranr lar \u.h pcrnri ro lilc a ri8rcd {rrcnrnr rh, hdor shr is licctrs.d Nrsurtr'
<br />lri lhc p0vhtls oI Ih. Conlrrcr{tr\ I i.cn{d lrs (Chrprcr O. (inn rn.nrg wnh S.crim 7(Xx) ol Divhi.n 3 ofrhc Bu\i'rc$ rnd
<br />Pn,tcssnntr Codc)orrhrrhcorshc is cxcmf hcroU o'n.M rhclx6i\ Id lhcrll{ci cx.nUion AnyviolntionolS..rn T0Sl.56yrtry
<br />qrllicrnl lnr r pcrni subjcclsrhc rpplicrtrr lo acivilpcnnlryoinor morcrhnn fik hundmd oll,r1(stm)
<br />l. N .*nf .r thc lnrtxdy. or nry cnrdryccs wnh wi8cs !\ lh.ir blc compcns{rion. will do rhc wirk ,nd rhc sldurc k mr
<br />i c*L{ orortrcdforslc(Ssron.BuimsandPncs\ion\Codc:'lh.C{nnrscn,rt-h.nsclawdocsnolarplyroanosn.ror
<br />rhcpnrFnt wl{l huitds or inDmvcs rh.fr . and wlk) des su$ so* hnnsclf o. hcrscli ar thDUCh his or h€, o*n cmFloyccs.
<br />providcd rhor such imlmrc'Enh 'nr inrefllcd or ofisd for rk I f. ho*c\ti rhc boildirS or irn[,otmnr G n,kl $irhin onc ,utr
<br />of(rryldioh. rh. olrncr Bu,ltd w,ll hr\r ilE burdcn ofpmvir8 lhnl hc or \h. dkl mr boild.r iftnnrv. rh. Pmlrrly ior lh. PurFt ol
<br />-l.nsowncrolthcB)pcrly,uDcx.lNivcLycontricrirrguirhlicctr\cd.onrricnr\t)coindrltt)n,rd(Sc.7(!t,8usncs\ri lh,lb\\inlCodc Th.c(nrdor's l-iccnsc Lrv docs tror il'tlylo 0n.nncr olfn)pcny*ho huilil! orinrrbvcs lh.rcon.
<br />and $ho .onrr{crsrbrsuchnror.l\wirhrConrrlrro(nliccnsdpunurmk,rh.Cu t,.rn-s Liccn\c Lnw).
<br />I imcrcnrpr und.r Scclio
<br />na.8f,l;&rlauuiNlarloN
<br />OICLANAIIO
<br />I hcr.6yxlitruMcrpcnalry lFrjrryo cof rhc n)Llowingdc.lxr nnr
<br />-lhrvcudwillnuirhh!Ccnillcrrc.tCoianrr,srllltr{tuturuorkcn..nlic.srrnr.r\fmvidcdf(hysccrii:17(x)ofrhc!ntu (l!lc.lirrhctcrldm{n.colrhc work lnr *hich rhc Fnnir i\ n\ucl
<br />l hrvc r d sill hnnr qorkcra .o |ttr{riotr iNurrrcc. ns rclu ircd h! S(rin.l?(Xrotrhc lill, Codc. tur rhc
<br />l
<br />tuvtt
<br />-l
<br />c.nili thol in lhc lenbrnnnc. ofihc sork ntr *hich (hn Frnrir is ir$rd. I ihrll n.r cn{loy rtry lcrvnr i', rny nrn cr
<br />$ n\t, trcon* \rhlr.r k, rh. *olkcd .onfcnsaltu. lnws ofc.lili)nir. rRln8rcu lhal ill \horkl h..o'ft subjcct bth.
<br />wo&cri co'qrnsdn p()virionsoiS.\rion.lT00ofrhctitxtrCodc.l$rll.lodhsirhcunplt,$ihrhxcnrevtions
<br />WARNINC frilurc lo s(urc $ork 6 .onrrcn\ rion $rcruc i\ lilrwtul, and $ill nrhiar rn cmplorr ro.rinitul |inrhi.\ itrd
<br />.iril fincs u,r l() onc hundrcd lhouund Jollr\ lSl(D-(x)O). in ad iri,nl b rhc .o\r ot con[tnsrrion. danEgcs as prt)vidd r.r rlt
<br />Sccli(in 3076o1lhc tjhrr Gtc. irtcr.{ d dkrmy \ lcc\
<br />L]IEN$IITCQNISA!.I9BDl[L l]dltaN
<br />I hctohy rlfinn undd ncMlry.fp.rjuy rhrr I rm lietrslu crpn,vhion.lChaprcr9lco ntui.nr! nirh S.crinr TOtr0) ol'l)ivisi,D:l
<br />oi rhc Bu\incs and Profcsiod\Codc. atrd ryli.cnk n i'r fullturrc ud clltct
<br />broV-aF€ ,""*,- SA
<br />IONSIAUEIIQNIINDINIj.&{iDNII
<br />I h.rhyilfinnuMcr Ftr{llyoipcrjuryrhrr lhcrc haotrslruli(in k insns.i.yrorlhc,rrf.nnnmcoflhcworklor*hichlhn!&nrirG
<br />isucd (S.. l09l.Civ C ).
<br />AITLTAILDIiCLA.EAIION
<br />I lmby iltinn u M.r l)cndky of pcrlury om ol lhc lollowinS d.rlir.rioo\
<br />DcNlirion Feflnirs Ashcsros Norificrri{rn F.dcful Rcaularnnrs (lirlc 4), Ru16)
<br />Rcqriren Lcrr.r of Norili.dio
<br />_lccnilyrhar rhcfcdcralr.sohrions rclrdingasb.no\ r r'rrlrc nor olplicnhlc rorhn pDjccr
<br />,rJnnn..\r srrrc lrN\ rchrii! rohui[htrt c(rion. rll lrrchy.urhorir rcnrcscnrari!$ olrhis Ciry Md countyh ctrrcr ulor rhc
<br />$ovc nEnriindl prop.ny ior inspccr
<br />Anrln nd or \!Pnr Sirnlrur€ -
<br />""-'U*
<br />*.",r.r,,, N \
<br />*,., rp?gltK
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />I\4aso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Ceftil
<br />,l/Lty'6 >\ &
<br />Certif icate ol Occupancy
<br />Notes, Remarks, Etc
<br />I cndfl\ \Jme
<br />tJndrr'1Addr6!
<br />-
<br />Set Backs
<br />UFER Ground
<br />FINAL
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