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BUILDING. INSPECTOR RECORD
<br />SITE-WORK ID/SIG.COMMENTS OWNER B('II-DER DTI-CARAAIoN
<br />I hcrcby alltD undcr lrnally ol pciury th l an' cxcn'fr from rhc Onrlrocror'Li.ctrsc trw lor lhc finL)winr rrv,n (s..7o.rl5
<br />Dr\irc$ ind P !$nrn Codc) Any Cily or Connly lhich rcquircs r p.rnrir l. con\rtucr, alrcr. imti{,!c. d. tolish or rcNiruny
<br />(ru.!u,r. priorr. ir\ i\luancc, ah. r.qrtcsrhc l'nplicanr ttr su.h Ircnnirtr lih r \iB cd (d. rnr rhrr h.or shc is liccn*d nuruirn
<br />h lhc ptr,vhions ol rh. Conrrrcr(tr s l,iccnscd ltrw (Chrnlcr 9. C.mnEn.irg $ih Scclion TlXX) or Diri\n,n I of rh. ar\i'rc\\ nnd
<br />Pmf.\\nri\ Codc)orrhar hcor\hc i\dc {rrhcrcfromrndrhchr\i\forrhcalk!.d.k'nfit,i Anr"viohrn olS.cri,n 7011.5 b} any
<br />.pIIic.trr ld rtxnnir subjLrh rhc rptli..ni ro n.rvrlp.tr!kyDrtro! morc rh.n hvc hunirc,ltlollnF l55U)r
<br />I. as owrorolrhcJroti.dy.or iycl.yarsirhwr!r\n\rhcir$lcconlprisalotr.wrlldorhcsork.trdrhc\lnrrurci\mr
<br />icndd oroficrcn l.r srle iss7()t4. Businc$ {nd Prnfcsiotrs codc Ihc$nnactols l-iccnsc l.flr docs n.rxpplyb own.ror
<br />rhc nmr.nl sho bu iik or in{mvc\ rh.ron. md who J,B such sork hnnscllor hcr{lfor rhR,rgh hi\ or hcr owtr rnrfhtccs.
<br />lbvnbd rh sudh irnl]n*qrnr\m'mr inrcMcd d ollc.cJ fttr!'L ll hosc\rr. rhc h,ildir8 .. ir\rovcm is $kl sirhi" unr )trrdf.o plcri(r1. rlr Owtur Buiklty sdl h$ c rhc burdcn ol lnriig rhrr hc .r shc dil mr burkt .r irqn !c rhc nmlcnr ld rh. purIDE ol'
<br />a Pmfc\k,Cinlc l'lrcCotrrr .ktr \ Liccn\c In* {k,.s norrfplyh rn.!ncr orfr.pc y who huikl\.r iDtovc\ rlrcr.on.
<br />Jn(l *h. .ontrlclslor such pnj.cr\eirhs (i,irr.tri9 liccDr.i nur{' n i'rhc(in[rrkn s l-i.cisc Ii$)
<br />-l
<br />anr.\cn, un,l( S!-ri,'n
<br />Dale Owner
<br />woLklRs c(lNtPI.NsAnIoN
<br />IlEclanrlrlQ!
<br />I hctohyrfllrn,utrdcr pcmlryol Frjuryoncof rhcfolhsi',gd.chrlnnx
<br />lhalc rnd willtruinrrin a Ccn iftrrc or Gnn.nr tr scll ln\urc trqorkcr'co rr.rsrridr. xr |nivdL{fttrhySdioo.!r($olrhc
<br />Ljho!Conc-,brlhcpe ornuncc oflhc work tu whkh lhc t^-rmir is isuud
<br />rtusorkf(n\hlchrhnpcflniri\alrJMvs.rkc^r.nll).f\rriortrxurrorr.rtricrndNl'.yNtrthcrtuc
<br />lhll.yNtrN6.,
<br />lccnify rhrr i'r rhc pcrtuiirrr.c ofrhcwork tu shi.h rhh ltnn i!t$rcd.IdulltrorcU)|.!anytrroninrnyDunner
<br />$ !s rr hccorN ubjccr ro rhc *o.k.r{ conrcn\Jrior h*\ olCalilornir. rnd +rc. rhrr if I dxNld h.on{ ruhlc.r rr rh.
<br />work.n cornlirn\rrn,nImvisi(,n\.fSccrbn17fi)nfrhcLhtrC.dc.l\l ll. tunh{irh$nitly trirhrlF*Ir^i{iqr
<br />WARNING: Ii,lurc ro ecurc \orkc co'npcnsrhotr corcrr8c ,\ unh*lul, xid \hall suhrc.r rrr cnr o}Ir n, cnnriml lf,nrlri.\ md
<br />ciril llncr up t, o.c huidEd rk,!\rid doih (S|{[).(XX)). in ]ddirion k)ihc..n of.onrFn\ rnr. drnnScr rs lro\id ,nrrhr
<br />scclion]0T6ollhc l.rhn G\lc- ir crcn nnd rrt'mcy\ lcc\
<br />Iolc: {ppllotr!:
<br />LICENSFIT-ONTR CTOn
<br />DECId.IAIION
<br />I hceby.niD uflds pctrrllyofrcrjury llrr I ifl licc.s{ uodcr l)mrhion ofCn0prcr 9 (d'nnENins eirh Sccri.n 7un) oiDivistrtr' l
<br />or rhc Busi'r.\said Prof.ssionsCodc, turl ry lkcns. i\ i fxll lor&ddclhcr.
<br />cgxsrtrll:llllNLlNluNli-acENrl
<br />I h.6ht amrn uidf ltMhyofNrJUry rhar thcB is r.. {n.rbn lcndir8 rlctrcy lor rhc p.n'oirBncc.frhc sork lar whi.h rln( Nnnir i\
<br />i\!u.d {Sc. :llr97 Civ C )
<br />AITUCAIiLDLCI.dX{IION
<br />tllEbyrfln rutr crpctuk,ol t{r.)uryo.cof rhcnrk,srEdc.lrrdlion(
<br />Dcnx,liri{r Pcmik A\h.do\ Nor'licrri()n fad.rrl RdErhrn,n\ (T lc,1(r, Pd6)
<br />Rrqrncd Lrr0 of Norilicxrnr
<br />I.crlilr_rlrl lhclalcrdlre3ul(ri(i ( r.t Jirgr\tt!',rrcN\'rlircn,trffli.rh[n'r[nf',!..r
<br />-lccnlfylh
<br />l hilc rcld rhn !!!licort'n!'irllrcrhal rh. itnvc irlonMri,D is corcc' I dlrrt k, dnrlry snh arl Ciry ..d Onrnry
<br />ordin!rccs otrd Sr.tc uws Ehrins ki hrildins con(ru.ri{'n. nnd hcrct,y aurnornc rcprcscir,riv6 orrhn Ciry and Cotrnrylo cnlcr ul.n rlE
<br />ntrv. nrnriimd ptut ny ld i lFrri' nurtDs.s
<br />/\u,licr l or Axdl Sis nl r
<br />PemilE mmc (print):
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsu lation
<br />Roof Shealhinq PAtf 7-za-lV EN
<br />Shear Wall
<br />Framing
<br />lnsu lation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Reporl
<br />/.'.,
<br />FINAL a-70-)r k\a:\a
<br />Certificate ol Occu pancy
<br />Notes, Remarks, Etc2-l tr${-/'41-
<br />L v
<br />DATE
<br />lxicrr \Jtrr
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<br />Flood Zone Certif.
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