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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE IDiSIG.COMMENTS OWNER BUII,DER DI:I,CARATION
<br />I h.r.b, trrlinn o cr pcoally {)t !.rjury lhol I !m crcnDr lion rhc Cotrkr.iorf l-iccnk ljw lnr rhc iolloqins rcns li((70115
<br />Busnrss rnd Pn,f.*nnr (-dlc) i, Ciry or Counry *hich rcqut.\ a ncnnir r,, con(n'cl. ollcr, inDrolc. dcm,lkh r (.nJn rn)
<br />druclurc. priorro ns nsurn.c. !ls. rcqur$ rhc appli.Mr lbr su.h rlnnirxr il.a \igncd nar.nEni rhir heor sl[ i{ li.. sdt huxnr
<br />lo lhc Dtr'vi\nrn\ ol rh Conki.rofr l-i.cnsrd lrw ichlplcr 9. ComnEDcin8 silh Sculion 7tX)Lr ol Divkio. .l oi rhc Bu\incs rtrd
<br />Pnnc$i,n\ Codc)orthrr hcor\hc iscxcnu rlEcliofla*l rhc brsis f{rrhcnllcgcd cxcmprion. An, vnnxrioootScction 71rll5 hyuny
<br />.f!li.,fr l(tr a F-rrnir suhjcc.rhc rppli.nnr b r.ivilpcnilryolnot nn'rcrhm fivc hurnlr.d d.llfs ls5m)
<br />I.r\owncrolrhcpropcny.ornrycmployccswirlrwiScsrqrh.irv'ltcortositrni.willdorh.*ortnn.lrhcdnf,rufti\nor
<br />i,c kn.rofic(dfor\rlc(SN?Ol.{.Busimsrndftir$si.niC.dc rhc Conrdtr's t.iccn\c tjq docs nor ipply h m owmr of
<br />rh.nmlcdl sk, huild\ or inllr,vcl rlEmn. nt qtF dtus \uch tr1)* hin\clfor hcn.lfor rlkrtrgh hk or hcr oNn cq)iry.c\-
<br />Prorid.rlrh r nrh impm\c'n nrc nol inlcftlcd doltcEd ntr eh ll hoscrrr, rh. hnildi'r8 or impnM,Enr i\ \.ld *irh n$c .trr
<br />of.onlpkriu,. rhc Or'.cr ltuillcr *illhrvcrh.hurdcnolnmvirallut hcorshcdil trorlNildor irnpmLc s ptutdy ror rhc purro\c of
<br />l. r\ownrolrhcp!'pcny. a'.cxclt\iv.lyconrrlclins sirh li.cnsc contrrcrorsromtr{nrctrtrl)ricl(sc.701-1.3ustrcss
<br />rl l\llif,si Corlcr Th.Conra.r* \ L'..n\. trw doc\ nor nrplyro o!nsotnroncdy $ho builds.r imnrovcr rhcrcon.
<br />rnd $ho contu.k ior such prr$ll * i(h ! Conri.trr( r ) li(n{d nrAu r b rhc Conrrckr'\ Li(n{ l-r*)
<br />IrD c\c rt, utrd$ Sccr -.8 & I'C lnr rhtr rcxw,l
<br />NAA(EBSI;AMPINIAIqN
<br />DECI"T&UIAN
<br />I hcEhy r,lirm!ndcr pcmhy ol Frjury om ol rhe hlhwin8 dN[r0riotr\
<br />I hav. mlwill nBinrai'r aC.nilrrrcofCon\cnr toScll:lnsurc lin qorkcN- conDcnsrlion. ns pmvidcd lor bySLrri(rlT0Oufrhc
<br />ljt rCod..lorrhc pcriomEnccoilhc rork lor whichlhcrcnnn i\NU.d.
<br />rltq.rllnrshi.hrlri!NnnIirnsucdlrl]\orkcrr$nrntr\iriotrn\urrn.c.rricrxfrilxni.yfu'n6crrc:
<br />t'oli.r" Ntr[hcr Ii\ftrc\
<br />-l
<br />ccnilyrh ir rhc p.rh nrnccotrhc work lnr ehi.h rhl\ fcrn,ir i\ i*ucd.I \h Llnor cnrtn{,tany ncr{r inr y nrtrdcr
<br />\' st, tf,(nm {htd k, rhc sorkcn soDcn\ariu li*s or Cilirnflrir. rnd lPrcdhat iil \hould hcconr subrcd rorhc
<br />$orkc*.onr!.n\dnrnrRrvi\ion\orsecrio.:l7lr)olrhcl-rtFrCidc.lslllll.tunhqlrhcnnrdywirhrhorp.ovisn,ns
<br />WARNIN(;: l,rilurc h ccurc sorkcr' conrpcnsnriotr .,trtragc i\ xih$ful. a.d drll {rb]Icr , .hplqu L) c'nnirrl t$[n! and
<br />ci!il finr\ Dp b orc huDlrcd lhousud dollirs (Sl(X).UX)). i'r jddirkr r, rhc coj .i ronrIknsrrn,n. drirgd\ r\ pnrvidcd ntr rhc
<br />Sc, n.r nl.t,r'\. |, rs, C,,lc.'fl c.c.r onLl Jnrr{J \ 1...
<br />Dal.r Applnonl:
<br />LrcF{sipa(iiirti^aToR
<br />DI(IAAAIION
<br />I l[rchyr,lnru cr |xnalr! of Frjury th lamliLci*CrndcrpmvtionofChxprr9lc.,nrncingNirhSccriorTl]($)oIl)ivtt,nl
<br />of rhc Au\i,rcsnnd Pn,rcsion\ (inlc. r.j 'nyliccns. is h tulllorcc a clGcl
<br />laXSrAllqrIONrEll)tNG-31i!:Ntr
<br />r\{ul (Scc 1(r)7. ( ir C I
<br />lf,ndcri N!mc:
<br />-
<br />lf,ndcis Aildrcss:
<br />-
<br />APPLICANT DI'(]I ARATIoN
<br />I lmhy !,linnuDdcr Fmhy ol rcrjury onc ollh. ftrkrsirs dc.hrrrn,ns:
<br />l)cnDlii.n Pcflni&Asb.eor N.rifiornnr FcdcnlRoguhrn,ns l-l irlc J(,. ,'rno
<br />-Rcquircd
<br />t rrcrof Nolifc.rrn
<br />I ccrllirhrr rhc lc(lcrnLrcgullri(,n\ r!:rdi'rS rnrnos 'anx,vilrr. nor rfp i.rhl. b rhn Imtd
<br />I.cdiryrh lhalcrcldrhisrprlicoriotrudshrerh rhcrtnritrlonuionhconccrloBreroconrywirhdllCryndC.u y
<br />ordinrtu.lnJsrarcLr$\ahrinsrohuildin8.onsrrucrnnr.dtrdhcr.hyrDltuu.rcFruscnr,rivcsorrhiscityrndCouflyro.mdruronihc
<br />ltnvc nE ioncd I'(,Fny n, irsF.riotr purF){i
<br />Aplli.anl ur A,Snl Sixnnh,fr
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing /-3a-to J)elol-r{o
<br />lnsu lation/Energy
<br />D all f- re-t9 UJr/z -a
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It4aso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Ceftif
<br />FINAL 6-8'B -hta#('e)
<br />Certilicate of Occupanc v
<br />Notes, Remarks, Etc-
<br />UFER Ground
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