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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Rool Sheathin s 7 tllrl l4tt*w ln.,
<br />Shear Wall L {
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lt4asonry
<br />Pool Fence
<br />T-Bar
<br />H andicap Req.
<br />Depuly Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL v ;b<'t
<br />Certifica te ol Occupancy
<br />OWNER IIUILDEI{ UELCAIL{TION
<br />I hcrchy dlrlrm und.r Fnrlr, r,r p.rjury rhnr I m cicnDr rFm rhc Onrnctm l,iccn\c l.rw lor rhc follo*ins rcN)n (scc 70.11 5
<br />Btsinc$ tr'{l ltolt$ion Conc): Any Cily o, Coutrry *hi.h rcqtrncs . Fnnn k, coinru.r, .lrcr. iDpror.. dcnnlish or rcpar rtry
<br />(rucxtrc. nrid rr ils issurtrcc. iho rclun \ rhc uldi.rnr ftrsuch ncrnrir i, filc r \i! .d darcnrnr rhd h.or shc i\ li.ctrrcd N^uiir
<br />b rh. lr'vnions of rfu Conrrrckr's I icenscd ljw lchiplcr 9. Conmcmin8 *irh Scclion ?urO ol Divhion :l ol rhc llu\iner\ rnd
<br />Pn,fcsioni Cudc)ur rhar hcorsh. n.xcfrpr rhcrciromlnd rhcblsh ior rhr rllcgcd cicnDrion nyviolnrionotS(ri)n70.l15hyrn,
<br />rppliqtrl lor r ,t.rnrir suhr.rs rhc {plicanr to r civil Fnnhy of nor frtrc thm fivd hundrcd dollds l$50O)
<br />l-rsoscr frhcpmp.nr.or rycnDloycd uirh wrgc\ rs rhcn{n.comr.n\ari{'n. willdorlr*ork rlrh.{ru.tni\mr
<br />inrcndcrl or.llbrcd r'or srlc (S( 7l}4,l- Busircs 0nd ftot$nns Codc: Ihc Conrnchls l-icctre hw des ml rpply r. rn owrcr ol
<br />rhc pDpcny who hoildr or iDpr)v(:s lhdsn- akl whu d(rs skh wo hi'n\.lforhfsclro.rhn,ulhhirorhcruwrctr oyccs.
<br />nrovidcd rhrr \u.h impmrcnrnrs nc n.r irr.ftlL{.r oficr.d fff sL.li lb$.\aJ, rhchuil]inAor i'npn)rn.[ i1$hwnhm..c ]e!r
<br />.f.unDlcrion, rhc Own.r Bnild.r will hnk rh€ hrrdcn ol povill3 rtur lE or shc dit mr buiu or i.qnc rh. IDFny f{, rhc puqn{ of
<br />l. r\o{ncrolrhc prclcny. rncrctusnrlyconrrdin8 \rirh liccf\cn contr,(r(rs n,.of(rucr rhc 0F].crlScc 7(}1.1.lll\nrs
<br />! ltnlirsi)trCodc rhcCoftfuctr'\Li.cn(.I-Ndo.sr.rnppLyro ,o*icrofpnrcnyshohuildsornnptuvcsrhcrc.tr.
<br />atrd sho (,iricr\lnr\!ch t)oFcr\ *irhrconnr.rrtrl\rliccrrscd Du'!urrl,)rhcorntx.ntr ! l-urc l]s)
<br />I an'.x.n'rr lndcr Sccrn,n_. B &PC lhrrhi\E{son
<br />D.l. t)tr..r
<br />tvolx ctrs' colt tlls,rrrtx
<br />I2X(LA.BIII!]!
<br />I hcrcl,ytrllinnu drrlcn ktol|c'irr)'otuollltlnlk,si'rgdcclrrxri{nrs:
<br />I hrvc trdw,lllMi ainaCcdifi.ar.ofCoiscrt,Scltlnsuclj,.*o!k.ncon,I(nuri{,n,a\tnlidcdf{nbtScrri({l?U}.frhc
<br />tit r coJc. ntr rhc pcrfonMNc of rhc {ork fir ,h ich rhc p.rmn h is{rd
<br />_lhnlc(ftttr1llmiirtr.insorkcG.onuctrsari( mntrn cc.11 rcquncdhyS..rn:17(X)ofrhrLaborCodc.liirrhcNrlomrmcol
<br />rhc *ork l'{)r whi.h thh pcrnril i\ i$uci M, workcri .onD.nsdtnn i'rsurnrc .Mid md FJlicy nu Dhcr .nc
<br />Arnn-r\( 1'^v''l {-t tttcY-->
<br />/)JC Cl-Z''t-aZl-A\-3 i
<br />I .c'rili rhrr n,1hc |rrfoi,unc. {rrhc *o* tur $hi.h rht tcmil n i\e,c,l. I shrll nor cmnk,y ry pcnon in rny 'nrnDcr$ rski tr.onr srhic.i lorltc w ikcs .onrfcr\rri( hw: of Crlilnriir. J l3r.rhrril I \hould hc.o c \ul,E.rt,rhc
<br />sorkd\ (omNtr\di i,r! Frvr\ii,ns .r SL\rtr :1700 or rhe l.rhr Codc. l shrll tunhwirh $ rt,ly wrlh rho* Jnr isi(rr
<br />WARNING: Irr hrc t, r.curc qorkc^
<br />clvil ,nr\ uf !o otrc h0drcd rhou\trM
<br />s..rir 1076.rrh.Irtr/ (ixr. i' .nr
<br />corcrrgc N unh\lul. rtr,l d,rllsuhEcr rn.rpl{
<br />(X).(Xr)r. ln rdJii{,n ro r1[ ..n ol .o ,Nn\rrl n'r!.\ x\ I',rdld 1,tr rlx
<br />t'^,",(Y/ Uo/ 16
<br />tr r t.\R\tk)\
<br />I hctoh! rrrntr, undrr pcmlryol |xriu'y I m liccn\c(lrndcr povi\nnr .r'Ctu/cr 9 i.i
<br />or rh. Bu\irc$ lnd Pr.ic$ions Cadc. and my li.crsc s m rull rare .nd cllc.t
<br />I . 2-a1 '1
<br />,"," gr17 SifE
<br />I hcrchyrrln rundcrIrtrrlry.l Nrluryih
<br />n\ucd (Sc. 1097. Civ C )
<br />r.oi{tu.ri.n Ln iigr8cn.y n)r rhrprnon r .c ofiht x.rk k,r *hirhrhnlrmir i\
<br />Lndci\Addrcs _
<br />AITLII;ANLDECIAAA.IIIJN
<br />I llrrby dnnn undcr p.tr,lry.l|crjury.nc or lic r.tkwin! dccldart,'\l
<br />Dcnhlirrs l'crmir\ Ashc\ror Norilic!rior FcderrlRcEuhrn,ns l lirlc 40.l'rn6)
<br />R.qtri'cd Lxus.t N.rillori{nr
<br />fcncnlrcluhri, \ tu8el tr! r\lrdo\ rinL rl n' r trrr rt)t)li.nhlc t' rln\ U,i.,r.r
<br />I Lr\c,ord r[n xpt i.rli{nr tl\rrr. rhxr rl[ xh^. ii .orucr I rg'tr n,ronlPly rv hrll(irv1trrl(,!unr!
<br />rr.lf,s\rcldi'rgk,htrildiigro'$rn'cri{nL an(lhcrchyrtr rcfrc\rnrrri\r\ ofrhi\ Cir, rtrJ C.u ryticnrrruAntrh.
<br />y'Y1
<br />aol(06/ tf
<br />Notes, Remarks, Etc.
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