BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Sel Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Roof Sheathino
<br />Shear Wall
<br />Framing
<br />lnsu lation/Enerqy
<br />Drywall
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />lVlasonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil.
<br />\t rOr
<br />FINAL v\'tr1\'L\DAS{,rs1
<br />Certifacate of Occupancy
<br />Notes, Remarks, Etc.
<br />OWNER BUILDER DELCAR-ATION
<br />I lEr.hy allno !' d Fmlry r)r Friury rh I am cxcmnr nom rh. Onrlra.hr Liccnsc ljw ntr rhc fdlowhs rcr$n (Scc.70.11 5
<br />Busi'i.\! dnl PtuLsRnr CGlcl: Any City or Connly which lcauncs r Fmir i{' co!{ocr. ,xci. inlrov.. drmlish or t.lr tny
<br />srruururc. !.kr ro irs issurmc, also rcqniEsrhe applicanr li,r such Frnnr ro 6lc. s8.cd stltcmnt lh.l hcor shc i5li.cnr.d p!^uanr
<br />k, rhc Jroltn'n! or rhc conkncttr'r Lt.nscd tr* (Ch,ptcr 9. cdmmtrcr8 rilh Selur ?0(& ol Diviri{,n .l orrh. a$,n$s and
<br />Poi.ssions Cdc).rrhrl lforshc s cicn:rllhcrclioma lhe h.sn lor thc allcr.d cr.nqr'o.. A.yvidrtionofsetkn?031.5bylny
<br />,0tl'e,nr Id, p.in subjeklltr,ml,carirroi.rvilp.nahyolnolmorcrhanlivchuoir,ldollm(.i500)
<br />l. is owner of rhc Fopcdr, or dy cnployes virh sascs as rbcn sdb comr.ns.'ion. w l do Ih. vork $d lh. nBlur n nor
<br />idcdel or oflircd for vlc (S( 7044, Busincs and Prof.s{n,Lr CdLr Th. conkrltr: Lkcns L.w d€. nol amly lo an owrcr ot
<br />rh. llnlrny who hondr o qmrcs ilrDn. snd wtu ,lcs ssh u,rl hinscll or hcrrlt or rhough hn or hc. own.mJioy.$.
<br />p(,vi!cd rhar \uLh imllrokmnk m fln inr.RlcJ or dltbdl tur elc. li lxrwq, rh. tulljnE or nqmwmnt is sol] *iinh one yc{
<br />ol.om*lbn. rh. Owncr Builcr will h.rc rhc l&{cn oi pmving lhar lE or shc did d hrilr or hl'ft)vc [E I,mFn, tu tlE pu{ns ol
<br />_1, a!.wncrolrhc!io!.ny, rm.xclurvclyco mclr8 wxh lr.cn\cd co 1.n'n n) constru.llhc pr'hcr (SN.7X4, Bu\i',cs
<br />xl hulcs\ nC c: Th. Crntrrl'tr's Li.cnsc Law docs not apply b owncrotp!,pcnyoh()hxius.rimflolcsthcrc.o,
<br />rnJ who r.ntrucrs n)r surh p!)rcuh *irh a Co Bcrtrl, liccnscJ Nrsur n) ll[ cotrtr.lrtr s Licctr* Law).
<br />I amcrcnrpr utrdcr Scct!,tJ & I'( litrrl,isrcrnr,
<br />Dire:- Ow
<br />WORKEfS' COIIPENSATION
<br />IECIIISAIIO!
<br />I hc,cby 0r'lrm undc, p.nalryol pc4ury onc oaU. n,fiNirr deldarn,nr]
<br />_l hlvc !n will tuinrain a C.diltarc.rconrd ro Scl nsu( lor mrkdr .omFnsalion. as ,,ruvilc, lor by Sern,n -uU) oa rh.
<br />tilx)r Colc. to. rh. Fraolm.. ot rh. srk ror whih rhc p.mi is nsucd
<br />/havc {i will @,flaii work.rs .omFns.lion insuraNc, .s r.tutr d by sdl!,n J?00 ol thc rlbor Lodc, ior rh. l,crrolmBc or
<br />tne vork ror vhdh fiis lxmil Ll irN.d. My workdi cohFns.lion insuEncc cmi6 .,n Fky nunhq ml
<br />?- .r.t,,)'?- 1 ,
<br />pori.yNlnrbs:.,r1\rd?aao zz o? Er!trcs b',L- L I
<br />_l cn,li rhrl ir! llrc |t,liJ ninrcorrhcworklirwhichlhisFrnririsNricn.Ishrlltr.r.nnk,y.nyr.rnn',r'anymnnncr
<br />$ .sto b.cooE s$ic.r k,lhc*orkcrluompcnsali{nrl,wsot Caulnrnir,, ,!r.c rlrril I sriNlJ hcom lrhjccr lolh.
<br />wo*cn.omlEn\lri,rF,vi\ion\olSc.ri,,n.lT0OolrhdlrtirC,)tlc,lshdl.,i)rlhuirlcomnlywilhrh{xepn,vi\bn\
<br />WARNING: !i 'c b \c.dr w( (n (,mp.trsarnr cov.rdB. ,s tr l.wlnl. .trJ slrlll suhj(t ,', .'.ploy.r nr diminal !.nahisl'ft]
<br />rn'l lnr\ Ii'.trdl, JrJ rhotr\xiJ Joll.n ($llxl,txr0l, r,{l!ln!r r) rh. (.n]n.n\rrnrn, 'imrgcs r\ fnr'JcJ n, rh.
<br />L-ta-L(
<br />!2E!rz!-8!L!.()!
<br />I hcrchy 0li,n u n,ls rcorlrr ol rcritry rhd I 3n li(n$d und.r l,t)vino. ol ch,t'lc! e (..nrmnuinB * h Suii,n 7(xlo) of DivN.n .l
<br />ol rh. lnsix\s an t Pof.$n)ns C( c. dil ny liccnsc is ir full Ltrcc .nd cller
<br />-t ?rr SS-s-5-
<br />CONSTRTICTION t ENDING AGENCY
<br />I h.rcby rinnukl.r lEnuhyo, Frjury rhar lhcrc is a.oldtuction hnilins ascncy tut rhc Idroinun c ollhc qolk lnr *hiuh rhis rrnit it
<br />ilsxcd (S.c lLq?, Civ. C.)
<br />APPLICANT DECLAXATION
<br />I lErl'y alrm rndcr Fnahy or Frjury onc or rhc lollowib! JelaRt ions
<br />Dcmririon PcrnnB-Asbcslo\ Nolrllculn r l;edclal RcE! kl Nrs lTnL .r0, Pd6)
<br />Rcquncd L.rr.r ol Nori,Eari,n
<br />l..n'lirhri rhc l.!l. lrrSu[rtr,n\ r.!rdng r\bc{os rcm,vr I d. n!( inn]rrhlc r) rh'\ pr,tc.r
<br />_I .cnili rld I hnvc rc l thn {dicattun uxl srarc ih.r rhc lbvc intumn tr r cor.cr Llrd Io comtly wilh all Cny rDd Counly
<br />ordinrN.s anl Stur.l-uwsftl&n8 b hulldxr! .onslru.non, .nJ hcrcby rhis Cxy,'d Cou,ty lo.nt6 upo, tlr
<br />o.t,2-19-L\
<br />rhx. nrtrri(,ul pn,pany li,r dsJf,.tro
<br />Aldi.lnr or axot six .h,.r.o,t P t.J 7-t
<br />UFER Ground
<br />T-Bar
<br />Sccton 11116 o, rh. tllrtrGxl., idc'rn nnd iuorncy\
<br />o,r., Z-r 3-z I .."n*^,,\lr 7 t0t-z- (,* ocrttr it ,,'c .
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