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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDDR DTJLCAR TION <br />I h.rcl,y xflirh und* |).nslly of tcrjury rhd I inr cxcmlr frunr (hc cinlrucb^ Liccnsc li* tn rhc lollowiDr rcr*']n {s'c 70'11i5 <br />Busincss $rl Pmlc$ioi Codc): Any Cn, or county (hich requncs n FJnril lo onddd altcr. inrPRrvc dcmolhh or renrii anv <br />sruciurc. prhrio irs issurrcc. lho rqxircs I hc opdi.anr ir sNh Nnnil lo nb tr rign.d slilcmnr rhnr h. o. shc i liccn\ed Nsurtrl <br />h rhc rornions of lht Contrcrtr s Liccnscd ljw tchnPtcr 9- Conrtn.irS wilh Sccti T(xI oi Divnion I ol rhc Bulinc\s rd <br />Pmlcsions Corlc).r rhrt hcorshc hcxcmpr rh.rcfremnnd lhchasr nrrhc rllcscd cx.nrnrion Anvvi'hri'nofScctiiDT0'll5bvrnv <br />rprlica nr a pcmil subjccrs rhc af'tli.0nr lo acililpoalrrornot mrclhtrn ulc hundrcddoll,^ ls5m) <br />t.,s osRrollhc pmFdy.or nrlcnulorEr wirh wrScsrsrhcir q)lt .otrrpctrs0rion. silldorttPork drhc{Mrumknol <br />inh.n.n oron hd rm $[ raa.?o!r,t, Brsincs end Pmfcsion\ Cudc Thc Conlrlcror's Li.cn$ Lnw docs not applv b nn osncr ol <br />rhc pmtrny who hrikls or nreotls llEon. snd *ho dc such *t* hin\clfoi hc6clfor rhouBh hn or h'r dwn enrPlotcc\' <br />[o;i.kd rhsr s!.h nnpn'rcnBrs m n.r ir clx|d or olleR] for qlc. lt hnrcvcr' rlr huiLlit8 or idrpru\srctrr h s'ld snhii nnc Fr <br />;r conpkrior lhc owmr Buildd will h!rc rhc hhtun ol pmvins lhi h. .r \h. di:l mr huitd Dr iqrcrc lhc PDncnv ror lhc PU'FE or <br />l. r\ owncr .f rhc l()pcny. tr'n cr.lusivcly conrrrcling wirh li.ctr{d conlrrco^ ru con{m.r ilf, Pr(,j({ ( Scc 701'l Bunm$ <br />r Pturc*m Codcr'rhc Conrth-s Liccnsc l-rw do.\ norllPlyxt ad.wnd ollropcrrvwho huildsor ifrliovcs rhcrcon' <br />and *ho conrmc* rd su.h Pmjccls wirh, Cofticlo(s) liccnscd Puru! rlrn.ContNtoit Li.en\' ljw)' <br />I i cx.rrtrundcr S&rnnr-.11. & PC nnrhN rctn)n <br />Dnl. (r*D$: <br />wolrKFksai)vPENSArroN <br />D[sl/&l:IlaN <br />I hcrcby xtfinnu cr lrcn!ltyolpdriury.Nol rlE ltLk,si',! delrn ions: <br />Ihltcandwiutuinr0r0(iailQrc.fCotrsctrrlosclllnsur.foworlcFCorFnsarion.osrrtrvidcdforhvSccrionlT(x)ofrhc <br />ttrhor Conc.Ior rhc fdrronturcc ollhc *ork ror which thc n rmir i\ k{cd <br />-lhatrnd <br />willmtn aitr workcis .otrll{rsnrnrn insurancc ns rcqunc(lhvst.ri.nl7(Dofrhc l-dbor C\dc- i'n rhc P'n'nnimc or <br />rh. work ror Nhich rhis rmir i\ ised. Myworkss lannPcnerion insumncc orici,nd P.licv nun'bcr arc: <br />Policy Numl'.r <br />- <br />I.cflifrrhrrirrlNr.rntrirtr.collhc$orknn\hichrhilr--nnir i\i\{utd l rhall nor .nt|]bt inv lu(r ii drv nN rr <br />k) d1n, hrc.nrc suht.r r, rhc worlcr' ..nr.n\drn hwc.lCxlitunni atrd rE'ct rhd ill \h.uld hc(nrt $Ihj(r rorhc <br />\o*.rs.onDcnsrriin,provNlon\ofSccii,,n:17(X).lrhcLrhtr(itrlcl\hrll.itrrh*irhofit'lv*ilh!'xr{nrorhnrn\ <br />WARNINC Frilurc b sorc workts'c.n'Fns!..vcrrgc is utrlrqltl r d nrll sunjcct i .nrflo)s h cri'nmrl |tn3 <br />civil nk\ u|r k' onc hundi.d rh.uslDd dol! r\ (in rtl(liri,nr n, rhc co{ ol ro rfctr{rnr. drirlcs r\ nrovnirn f(t rhc <br />shrtr lr176 -l'rhc Lhtr Codc. <br />*-,fu/zt /tti <br />DEglnAuoN <br />Ihcrcbyomnnundcr pcndryollcrjurylhrr I x'n l,.ctrrnu c!Drovisktol(hlprq9(.onnrEncing$irlrSc'rion7OI))6rDivti'nl <br />oi rh. Bu\ircss otrd Pdtsi(,h\ Codc. .nd myliccnsc is in lull foe oRl dffc.r. <br />",,",G/tt \e;alJ <br />I hcnh!.llirm trndcr lctrrlry.l Friury rh cotr!rr.ri,)i lcidiryn!en.y tur rhcftni)nnrncc orrhe sori lnrshihrhi\ P.rnrir i\ <br />hucd (Sc.. 1097. Ci!. C ). <br />L.ad.i\ Nr'm <br />- <br />t n,lc, . AJ'lf - <br />APPI ICAN]' DF(I ARA1'IoN <br />I hla$y Jllnr unlcr ruDrlry.fpcrjuyotrc.frlt folk'wi|3 dc.larxri{tr1\ <br />l)cuilnidr Pcnnils Ashc{o\ Nor'li. i,in lcdc.rlRrFuldi,,nrllnt d0. Prn6) <br />RL\quirc krrcr of Nurifi carion <br />I ecniiyrhr rhc l.dcnI r.sullr i{,ns rtgnlirE ish.d.rrc rrrlnrc nulnmlic$lcr. rhi\Px'jccr <br />i!.'in..r lrgrN t).otr{ly wirlt tllCllyrnd (\ttrrl' <br />rcpr.\.nrdn.\.l rhh ciry r d ( onrry ro cnlcr rNn rlt <br />c1.rlr <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Sublloor/VenVlnsulation <br />Rool Sheathinq <br />Shear Wall <br />Framinq <br />lnsulation/Energy <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 />Enoineer Final Report <br />Flood Zone Certil. <br />FINAL Sltfrlbl D'w^rt,,z? <br />Certilicate of Occupancy T UI <br />Notes, Remarks, Etc