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BUILDING. INSPECTOR RECORD
<br />COMMENTSSITE.WORK DATE
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />L1,/Rool Sheathi I z3
<br />Shear Wall
<br />Fram i
<br />lnsulation/Ene
<br />wallD
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />l\,4aso n
<br />T-Bar
<br />Handic R
<br />De Final Re rtt
<br />En ineer Final Re ort
<br />Flood Zone Certif.
<br />FINAL
<br />Certif icate ot Occu n
<br />Notes Remarks, Etc
<br />otvNFx BUll,lrt]R DF.l,('ARAIION
<br />I hcrcby dll,rm undcr p.tulry ol pcriury rhar I d cr.mPr litnr rhc Cdnta.k's l-i{nrc Lrw t'! rhc nllnrwilS rcasoris'c 70rl 5 r
<br />Busincs lnd Pruic$nr cotlc) Ary Ciry oi Outrly lhith (qrncs a Pcmrir h .on(rucr, !lrc!. inPovc, dcmohh or rPnu 'nv(ruclurc. prtrx kr iG rssDtrcc. al$ tquncsilE rtplrrnr r'or ruch |Emil b lik d SSEJ nircmd rh hcot sh' i\ li'!n$d Pu(umr
<br />brhcpr.vi\ion\ofrhcConta.nrsl-'c.ns.dtjw(ChrPrerg,CommncinS*hSelionTUnolDivNionl'frhcBulincssrnd
<br />Ps,fe$r,nsCode)orlhallEor:h.ircxcmprrherclionatulrhchlnslorrhcau.sqlc\cmflion.Anvvi{rbrnmofScuiionT0ll5by'nvr
<br />rtplrMr lor i p.mil s!l,j&s rhc aprliunr ro r civ il Nnrlry ol nor morc r[an ivc hutu]rcJ Jollas (3500)'
<br />I. is own.r ofth. lft)lEny. or my cmlhyes wnh *trgcs rs rhcr $lc.ohl)cnsari)n. will Jo rlf, w'lk arrl rt' {ruxE is nor
<br />intuLrl or orhren fo; sic 15(.?044. Busircss ,n,i P(ni$ions Codo Th. G).rrlcttr i Ltcns I i* Jk3 not tarlv b an
<br />'wncr
<br />ol
<br />rhcp!'l].ny who btrirls or inDnlvcs rh.6,n, ! wh, &ts i!.h w!* him{lf or h.^cll or rhrou8h hn or hct own
<br />'BPbvccs'
<br />lrn)uild rlur sch inrF,vcmnh mnor inrcndcJ uollir.J nl!$h ll, lnwercr. rhc buiuin! .r iolll(,k'ftnr $ $h *irhin "n' rr
<br />;f.oqrHnE rh.owrcr Bu[&r aillharc thc td cn olF,viry {h2r hcorshcdd norbu J or imlrovc lnc pnrrcny
<br />'nr
<br />tl. pu{bs ol
<br />-1,
<br />asoqncroflhc pn)p:dy..mcxclu$klrcontdcrnr! *ilI li!.f,\.d !dnl!&bF t, .onstrucl rhc P'orccr (Sc' 7O{4 Busutcs
<br />;il Pn)tsrnnc.,lcrthcconrracroaxl,,ccnscLn*J(t\norlpllvr,3nowncr I ptuPcnv wlr, hur l'ls u inpn'v's lhcrcon'
<br />rnJ wl$ c.nrr.k l,n $ch pr)jc.l\ wirh a conrtlq(1) liccnti pnNBnr nr rhc cdnkacru s l-ictrsc La9
<br />I rn.\cnDr utrJ.r S(r
<br />WORl<EITS' CO]IIPIiNSAT!ONpEclaxauo!
<br />t h.rct'y !ltmrutulo lcnrlryof Fjoryonc ollh. l;llowmg dcclMrlons:
<br />l hlvc alrl will h,int.h ! ccdincxt. ol conscd b s.It]Insurc lnl workdr conrPcnsaln]n. as tlDvidc.l trhys..tio! ]700oflhc
<br />ld$r Cdc. for rhc Frfoame of rhc work ror *hich rhe lxmit $ issucd.
<br />! h!v. and wrll.rintrin *orkc^'.onl,'cnsatbn inauhN. !s tcqui'c'l bvserion.l?0o drtlE tjtrt C''rt tultu l.rfol1M'c of
<br />lhc ktrk for whf,h rht p.mir i. L$cd. My *o (.n @mllcnslli.n insutre c.Ficr arl Pltv nunl'€, el
<br />lucnilyrh,hrhcl].rblnancdofrhcwotkli'r{hichrhr!.rnrirtkso.tl,ldRllnor.nPk,vinvpcronidanv'nlnnd
<br />vJ ark,bc. mc subjc.i k) rhc workcri confcnsdn hwsolcrLlnmo alNllrr irI sh'uld bccotu srhlclrtrrh'
<br />workcs' comFnsatn'n B)visions ol Scc(n)n t7O0 ol lhc Lrhtr Cul.. I slrll lnn hwirh comPl, wirh lhoe Imvirions
<br />IVARNINC: Failur. 1,, {0uE work r' conl,.lsaron .rvcngc r1 nnla*ltl. Mn shlll \rbid in cmphvd h qmiorl IrMhics Md
<br />urvil lincs utr k' o c hundEl rhoxsmd dolls ($l(x).u)0). in ,l'liri(D ni rlr.o( of con{'(ns,t!)n. JanESrs rs p'oviri'd tur rh'
<br />Sc(ton 10?6 ofrhe Luhtr Cc{.. ,rlciesr anl atomy'( lccs
<br />ucENllpsall} craB
<br />DECI.ABAIIQ!
<br />I heNby alrtnxnJcr pcnalry of !.rjut, rhll I an li@nd;nJs Pv$trn orchafla 9(commncr3 vilh Sftr'n 7uD) orDivist" l
<br />of rhc Busircrs and Potcssiotrs cl)d., ,rxt my licensc t i. tull lor.! dld cltccr.
<br />aELl!ANLll[1L48{r&{
<br />I hm{y nllim uNlcr Ntrrlry oi lcrjury onc ol rhc hll,rwin8 nN h rlnnr:
<br />D.nruhl.n Pcrm $ sbcnos Nolrliu(r)n F.JcrllR.3uhroo\ (T(lc 40. Pan6)
<br />_RcqurcJ Le(crol Notrlt.lk'n
<br />I ccnilyrharrhc ltdcta I cgul.l ions Eas'liDg a\h.nos EnDvrlarc frn,mlMblc u rhir proFul'
<br />-I
<br />ed y ihal I havc EaJ rhis !,,pli..ri)n ni slarc rhlr rhc d,v. inromrion n cotr..r I asE homPlv *irt lllCilv Md Couorv
<br />oilimnccsailSl!r.llwsrcl,li416buillingcon(ru.rion,anllf,rcbylurhortur.,,cenlarilcsofrhsCilvandCounlvloenrsuF,rtt
<br />at[vc ftnrioncn poteny tor insn crion lurFscl
<br />Appti.snl Dr Asen( Sisuruc, Da
<br />P.mltcDm.(pnr0:
<br />Set Backs
<br />Pool Fence
<br />CONSTRUCTION I,ENDING AGENCY
<br />I h.rhy iflirm und.r Fnrlry oi pcrjury rhar rhcrc s . .onntu rion k.Jin3 atcmy fd rhc Jrrl'omuc' 'i lhe e tu whEh lhir Fm C
<br />issrd tScr. .109?, Civ. C )
<br />L.r.h,'\ Ndmc
<br />I
<br />fY,KV]
<br />ID/SIG.
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