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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNEI{ BTIILDER DNLCANATX)N
<br />I h-r.h! iltrnru cr p.nali! ofncriury rhai I an c{crnpr tmnr rlt (i)nta.h^ Li..n\chwliJrrhcfollo$ingrrvrn(Sc.70ll1
<br />Ilu\iDe( rnt Polcrsion Codc) Ai, Ciit or County shkh rcqun \ d ll(nnit h cotr n,cr. rlrcr, inl|yo\.. dcnFlish .r rcI]n rny
<br />sm.r[c. plntrro ir\ iqsunn.c, aho rcquncs llE lplltutrl li)r suchFnnir t,l]1.. \i8tcd (nrcmnl lhrrhcor shc h liccn*d pur\urnr
<br />x) rhc povi\n,n\ of rhc C. tacttr'( Liccn\cd lj* (Chqrtcr 9. (onnncncin8 $irh S.crion 7ffXJ of Divi\ion I ol ric Atrsirrcs .nn
<br />Phfc\sn[rCodc)orrh0rtEorshc n cxenrpt lhcrcfronrrnd rhc hi\i\ torihcallcgcd cxcmfridr. Atry vnn i(rolSccrin, Tlr]l 5 htr t
<br />smliclnrtbr rpcnnir nrbjcch rhc rppli.ur ir rcililFnalry.riorff,to rhdn fivc lrundrcd dolhn(35([)
<br />l.a\oqnrofrhcp$p.yormycmpk,ycclsirhwsScsa\lhcn$b$Dctr$ri{ni.{illdortrwork{nillh.{MrMi(tun
<br />n cRLd or ofcrcd for $lc (Sa 70.1.1, Busi'rc$ a.d Pr.fc(\i,nr Codc Thc c.nk..ktr s Liccnsc Lls docs nor lPllyb atr owdcr oi
<br />rh. pmpcdy *k, tdikls o. in!,owr rhcrc.. rxl wli) d.Es \uch w.* hi,n\cllor h.r{lfor rhmtrgh hii or h$ own cnlLyccs
<br />nNvidql ihrr snch inlrolc.rnh arc nor inlctuct or oficrcd n, sh. lll horvcvc!. lh{ t ikli.g or i'rllriormrnr is sH wirhin onc )tr
<br />.l..npltrtnr ll€Owncr guilds *illh!rc thc h'dcn ofpmvins rhal hc or \hc did ior htrikl or in{,row rfic ln)Idy for rtu ptr4-c of
<br />1..s.{rcrol'rh. pmp.ny, hr.rclusiv.ly..trtr.rtr8 wilh lrccnscd conlracbF ro con{flcr rhc Pn,F.r (scc.7($r. Bu\ir'c\\
<br />rnd lbftsi C.d. ThcConrruclofsl-icc.rcl,awd.c\norrpnlyt,nno*krofPn,t-_dywhol'xildso.imProv.srhcrcon.
<br />(nd who onrnch for srch pm,.c( wirh a conracror( s) li.cnscd Nrsu.trt lo lhc o)ntactx r l-i.cn{ bw ).
<br />I rN.rcn,!r tn cr Sc.rnn
<br />]tQatr}:8s:l0[tfrrNsAlllJN
<br />DIICI.AtsTIJ1Id
<br />I h.rc$y rfttnuklr |fn.lry or |xrjrr onc .a rhc rhlloq'ins dcchflri.o\:
<br />Ihnrtrndwilltrtririrn.Ccnilicntc.lCon\cnrk'Scllrlnwclir$ork.r{.onrN \xri.tr.r( t,.o!tl.dIrhySccri,r:17(Xlofrhc
<br />an,[. 1,tr 1h. 0.'tunnxn.r f l rlr \o'k l(r trhi(h rh. tu rir ! i.{trrL
<br />)rnd will nirinrril q.rkcs com|rtrsllifl inuJrec, rs rcqoi'cd hySc.rn l?(XroIllE Intxn6d.. rnrhc lafornmnccoi
<br />l n{cnsariin nr\!'n ...lntrnn(l Fni., nnnrhcr m
<br />C^/0 LalDl)r\
<br />l..nilyrhrr in rhc l.rf.innnccofrhc work f(tr shichrhn F nir ( i\\x.d.I sh!ll nor enDloy .ny ncnon i'rrtrynrnncr
<br />so Nlohc.on*n,b,cnlolhew( ss.\,nFn\arnnr lrstol crlir(,n,,. and a8rcc rhrlil'I dxrld hcconr subjcd lorhc
<br />rnrkcm'coa]pcnsrrionnr)lisioisofSr.rion.lTfil.frh.t]htrCdl..ldrll.fonhsirIsnnnlrNirhrh.sfmrisiors
<br />IVARNING: Frilur. to surc workcr' .onu.nsarion corcrr8c i\ unltsr'ul. trnd \hrll suhiccr rrr cmnloyrr t, ci'ni'nl ltNlric\ JDd
<br />civil fircs un lo otrc hnndrcd liousund doll,^ lSlm.(XX), h rddiri,)i tu th. co( oi comFn\ tun. dtrnDg.\ rs Prornlcd for rhe
<br />Sccriotr 3076ofrh. Lntrr Codc. nncrc{,nd atormy \ r.cs
<br />Dil?r {pplldnl:
<br />, rcrmen iouii,rcro*
<br />I}ECAMIION
<br />I ndcby {tlirm unds r.nllry orpcrjury lhrl I am li.cNn undcr provtior olChapr&'r (connN.cifl8 with S(rion 7fix)) orDiviiiotr l
<br />.i rh. Blsin6s &l Pr,fcsions Codc, 0 nry liccnB is i,r tull Lreondcfccr
<br />v b g8-t
<br />5 il11
<br />ilyrhar ttu ndcmlrcsuhbns rcEardins nsIrdo\ r.nt)vdl trrd ior rlplicnhlc Io rih pr+cr
<br />rharIhlvcrc rhh dpdi.arhn dt (irc lh thc slnvc inrb.mtrinn t.or..r ItlrelocomPlywilhallCiltnodCounry
<br />liw\rldingroburldnEco,nndion. dhcrcl'yaurhoriTcmprc\ctrrdne.lrhhciy,ndCounly
<br />\^rL,l\((4 fl ,",.5j \\\\8
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsu lation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif.
<br />FINAL
<br />Certificate ot Occupancy
<br />Notes, Remarks, Etc.
<br />J
<br />IAISIBTJCIIONIINDIIIjJCINII
<br />I lwcby 0mrfl trndcr pcnrlryol'p.ljuyrnd rh.rc h s.a,nrxxc(iri bndn'g lCcncy fot lhc p.rrornuncc orrh. work ro! +hth rhn Iltmir is
<br />ksucd rsc. :rtD7. Civ C.).
<br />Lcndcr's N,rnc
<br />-
<br />I crd.''.
<br />^JJrr..
<br />-
<br />AITLI(ANLII&:LAB&IION
<br />I lrrchrnfirnrnDdrr ncMlr!.l rcrju'yoncorrh. nnhqi'iErlc.hr rn,i\:
<br />Dcnx,liri{rn rrmir\ Ashf,no\ Norilicarnr I'cdcrrl Rcruhriors (l irl.10. I'nn6)
<br />Rcquncd t crrqof N.rificdr*rr
<br />Ext./lnt. Lath
<br />l ro .
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