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BUILDING. INSPECTOR RECORD
<br />DATE tD/stG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsu lation
<br />Boof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsu lation/Energy
<br />Drywall
<br />Exl./lnt. Lath
<br />Brown Coal
<br />It4asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Beport
<br />Flood Zone Certif .
<br />7FINAL/0-t-/4 ,.'-2{dz-
<br />Cerlif icate ol Occupancy
<br />Notes, Remarks, Etc.
<br />OWNIR AUILDEII DEI,CAR TX)N
<br />I hcrc$y afln u cr |xn0lly of pcrJury rhar I m crcnpr lionrht CotrtJct(tr{ Liccns Lnw lnr rhc foll.wilE,c.son (Sc.7oll5
<br />Busir.s rftl Prolc$ion Colc) Any Ciry or Coutrr, $h(h rcquncs r Fnnir k, coN d, dhcr, nnprovc. dcnxni\h ,tr rclJn rny
<br />nr.rurc. priorlo ils hsurmc, also r.quircs rhc amli.d n such |Eflnirr{) lilca \igtrcd nrl. tni rhnr heorshc i\ licer\cd pnNunr
<br />ro lhc provi\n,ns or rh. cotrtrcrois Li.cn$d ljq (ChJPrcr 9. co nrRtutrrg lirh Scdion 7(xn .r Divi\trn I oi rhc Busin.ss nnd
<br />Pturrs\nr\Codc)orlharlEorshchcxcnrpllhcrutronrrJrltb.sislotrhc.llcscdcrcnDrion AnrvilhrionolsfcliotrT0-ll5hy ny
<br />rDDli..trt (r rr.nnilsuhiech rh. rptli.rtrt tu rcirilpcn.lryofnolnucrhrn fiv. hundrcd dollus(:r5u,)
<br />-1.a\owrcrolrhclnlxny.ormy.nproyccswilhs.8N$rhctr)kcorp.n\irio,ailldorlr*6rkmdrlEdturuetturinre cd or onarcd fr ek (SE 71X4. Busire$ 0n lhlcssins C(xlc Th. (nnrNror'\ l,iccnsc ljw d.Er nor rPDl) lo !n owncr ol
<br />thc |x),Eny sho truilds or irryrnts rlttu[ ard wh. dms su.h ro himscliorhcndltorrhox8hhisothcrosnc'nll,)\tc{
<br />proviJ.J rhir \uch i'npmvcmnh m Rn inrcnd.n or ollcrcd lor sL ll h,*crcr. rh. bdiDirs or imPmxnrnr is v)B q irhm .m !c!r
<br />ofcon crhn. rhcO*rcr B uildcr will hrlc rtr bu rdcn . t lrovirrS rhd lEor\hc di{l to boitlorirPr.vclhcpDP.nyf(trrh.luqhscof
<br />-1.!souncrolrh.pmprdy.rnlcxclusivelyco.tactins$ithliccnrd.oitr.ro^roconndclrlErtojmr(sc.7tx4,Bunrc\satul Ar,l6sbn Cod.r Thc Conlrucktr s Liccn\c tis do* nor rytly ro $n o$ncr ottrcPcn! $hL buildi or improrc\ rll.r.on.
<br />and *ho conrds ror {ch Ikids wilh a Conlruclon s) liccnEd pt^um h rhc contrloi s LiccNc lf,w)
<br />lxN.r.r,l, u .r Scrrnn
<br />Deie: - Ovn€r
<br />woRKEuslctttttpprtsltttttt
<br />Decl.dnAlra!
<br />I hcrb, arfinn xndcr pcn ry or lrrury one of lhc n,lhwing dccl* i(,ns
<br />-t
<br />h!!c aodwill tui'lriraC. illcdcofConscnrroSclflnsrrcfor$ork&r.otrPcnn(ion.r\ Pr.vid.dlirbySeclionlT(xrolrh.
<br />tilxtr Cod.- lbr lhc pcrfonun.c.frhc work lor *hich rhc pcnnir i\ n\ucd
<br />I hrvc 0trd will mlinrrin *.rkoa .omtt.sdl i,,n ir\ufuncc. rs rcqtrircdhySeri({l7(DolrhclihorCodc ttrrhc|E dnltrrccol
<br />rhc so.k l',)r whichrnhr.rmir is is{cd. Myq.lkcs comncnerion insurm(.ricr rrl P.licy numh.r uc:
<br />Policy Numtx.r-E&iEs
<br />-l.cnily
<br />Ihol in Ihc pcrfi,rnr cc olrhc work nt which this l}cirtril k i\.u.d. I \hrll nol cn{]],y any pc*o. irr drv minncr
<br />w, n\ t,l$.'ft subjd fu rhc wo*cr\, conrrcnsrri,,n h$s otCihfornir Md i3te rlEr ifl \k,ukt b..om suhiur ri rh.
<br />soik.rJ c.mNtrsrlion F)vh i,, x ol S..! o rTix)or lh. l-rlx,, C,!lr. I \ll l. 1n,rhuirl,.f trl
<br />i utrl.rtrJul. rnd \hrll $bier m cmployc . sinii'd Fulrics rnd
<br />lrrrlllttuo!
<br />I lErcb, affinn x.d$ p.MxyolFrjury lhll , am liensn lndcr pmvhio. otChl|lq 9lconnxmi'lg wnh scclion ?Od)) orDivi\i,n -l
<br />of lhc Busirc$ ond Pmlcsions Codc. {nr nry licnsc is n! 6nl tue 3fr1 cffd.r'
<br />ry 614t4(
<br />I hcrch, arrnrntulcr FnnhroitErjlry I
<br />issucd(Scc 1097. Ci!. C )
<br />trn rud i(n, ktrrLir! dlcNy n, rh. |t lonutuc ! if rhc rwk lar $ hi.[ ih,\ PLnrir '\
<br />A.ITLICANLI]ECIABAIIO!
<br />IlErctyrfilmundcrpcMlryorpcrrury.ncolrhcrolloqin8Llcclr i,ins:
<br />Dcnxniiiotr Pc nirs Ash.{os Norifi. i(,n Fcdclal RcEUhionrl'lirlc 40, Pd6)
<br />Re{unc(l lxnrr of Nor'fi ..rof
<br />hh.(os rcnDv0lffc trollpIlic hl. roi)$!rcJccr
<br />{dc rhlrrh. xbve intur.rridr i\ conc.l I
<br />nrudi,)n. r' lsrchyrurhorizcrcprcscnr3r
<br />sr4
<br />asrccr,com y sith nllCiry,nd C.unry
<br />rrc\or rhnc ydld co/try,?cdsupflrE
<br />..,. qt/ ,t
<br />SITE.WORK
<br />of.o rNn$rror, dann8c\ r\ Itr.v rd for rhc
<br />L.n,lcir Ad.!c*
<br />-
<br />I lurc rcrd rhh llFlli..rion
<br />\d4 /\j
<br />I
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