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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BU!I,DER DELCARATION
<br />I h.rch, rilrm un'l.r Fnslry ,,i pcrjrr, rMI I rm ckcq{ lion rhc c.trta(n( Licnr L.w tar rhc n hw p rcavr (Sc(.?0:11.5
<br />Buin.ss lnd Porcsson Cirlc): Any C y .r Counry vh(h rcqurcs ! ttrtul h conslnEl. altcr. mllrNc. demohh or rcpat any
<br />sdrr rc. trktr k, \ (\orkc, ak. icqxfts rhc {Dli.anr tur so.h Fmir ro til., $8n.d stdt.mnl rh.r tEor shc r liccnrd pusu.nt
<br />n, th. pn)vEons oi tlE o)ntrrlff's Li.cnscJ bv (Chatlcr c. Commn.in3 wilh Scclion ?(xx) or Divilbn .r ol rhc tsu\incs lRl
<br />Pn'ns\n,nsCuJc)orrhar lEorsh€ i\crcm0r rlrrcliomxftl rhc hari\ for rh. alhg.d.x.nDron Anyvd.tronofSccru\7011.5 byNny
<br />anp[.anrl{rpemir\uhjelslhcunplicanrroacrvilpcMllyolnormor.rh,niivchtfrlrcJdoll-s(s5ur)
<br />_L is owxr or rh. pnrpcny, or my cmployccs sirh w,!cs as ihcn nnc omFnsanon, vil do lhc woi( a tlE stmluE is nor
<br />dc,rlcd or o,i.r.d lor srlc (Se 7(N4. Busirc$.nd Pnncssons Cdlc: Thc Contrrdm.s La.ns L{* der n r lpdy ro an o*ncr of
<br />rh. F)I,.dy wh(, boiusor in{r)rr rhcF,n. a,rl *h) des s&h kln himscllDr hc6.lfor rhn)uth hN or hcr owtr cmnl.yccs.
<br />pn,vdc.i rh0r su.h imFovcmnrs m n.r orrcd.n ! oricrcn hr s,c li h,kvcr, rtE bnillina or inl,otmnr E v,l] wirhin , 'tu ,t
<br />dl c.frl,Lrtion, rh. (rnf Bu kr * hM dk bnd.n ol ttn)vrg lhar h. or sh. Jrl rul hlill] or inl[roE thc lmFny tu dr I'uq{E ol
<br />_1, rsow'rrolrhc I,rl,I.ny. rm.rrlusivclyrotrkadine *irh lircnr.d (onh(n)N k, connrud rll tlnJl.d rS(. 7(x4, Bu\0rcss
<br />a,rl B!i:\onC,xlc: Thc C nta(r'r Li(ns. Ldw doci nor rftly b {n owtrcr .t nor{.ry wh{, bu ilds or mprovcs rhcrcon,
<br />anJ who onrarh tur su(h pnrccc * h r Conkrcn(r) hcnscd lu$uanr b rhc Cl,tur(tr's Lircns tir )
<br />_! ahcrchfl rBler S.coo
<br />llaaf,E8a.tautENlar'Ia!
<br />DECITBAruI!
<br />I hcrcby atTrm unJ.r Fnrlryofp.rJxryon ofrhc ftnhwrt d*lddrion{l
<br />_l hrvc r*lw'll Bai'na'n aCcniirar.olCon\cnr t' Scll:lnsurc h, wolkcrs romtlc \r.otr.r! phrklcd br byS.cl,.n lT0Oofrhc
<br />ItrIxtr C,xt., lnr rr p. nrman.colrh. wor[ 1,,*h'ch rhc Arm is lstrc!]
<br />I htrv. rtrJ w,ll man in, workc^ (o rs rcqutr d hy Sccrn ]TLU oIrhc Lrh.! C !c, tu lhc ncrti)rmrn.. oI
<br />n ${riN c (Mrcr .nJ Enq numli.r uc
<br />t G a a
<br />l(.dnyrhr nrh.F-nornHk.,n r[cworl l!tr$h'(hrhNnrnn'r a A{'c']. I shrll nor .n loy ahy lEson itranymMncr
<br />ifl sh,ulJ lxom srbJ.cr rorknr .sr, b.!om sublccr lo thc workc( .onpcnsrror la*s otCaltl]miu. {,1a3rc. r
<br />work.ri comt nsarnD pn,vd)nr oIScrLo lTmot rh.lih, c(rc.I shill. l(
<br />WARNINC: Failui. tu *rurc wdrkcrl conlc.sarkr .owra8c t
<br />ron fincs utl ro om hundNl rhonsrnd d.llds (310O,0O0). in
<br />,,.," ' rlr?12( .,,x
<br />\
<br />I hcrchy allhBUfrlcr pcnihyolFrjury rh3r I an lircn$n !
<br />ol rhc Ilu\i',.s\atrJ Pnn.s('n\CoJ.. aRl nry I'rcn\c s n'lnlll(&c ntr,lclla(r.
<br />1 qrRtk\
<br />\
<br />I h.rchy ulhrm undcr nen.llyolrErjuryrhll rhcrc is a (on{tucr tur rh. ,. omrncc ot rhc hrk hr whf,h thr IEmn $
<br />rlu.tl (scc. r(r97. clr c ).
<br />AfILTCAILIICIA8AIION
<br />I tEEby allim undcr Fnally ol F:rjury onc ol rh. tulh,wins Jcchrari.n\,
<br />D.ntuli()n Pcrmr$Asbci.s NotlMrnr Fcdcrrl Rctnlrrx)trs (Tirlc 40. Pln6)
<br />-R.quncJ
<br />l.n.rol Notli.rri)n
<br />lrrc ndr l'I)tlrihlc I') llrr l)rllFcl
<br />in,omrr('n N rodcrr I agie ro onrply wnh all Ciry rM Counry
<br />ADDli.anl or Eeni SiEn.trrc
<br />hcrcl,y aurhorizc rcprcscnllrivcr,)irhis Cir, anJ Cou
<br />o
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Rool Sheathing ///4?/Ulk'ha atl
<br />Shear Wall //
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif.
<br />It.t .tl .tO ,,
<br />FINAL tllkl4{UfYtllfi K/,rrY
<br />Certiticate of Occu anc
<br />Notes Remarks E+^
<br />n t
<br />-+
<br />Pool Fence
<br />9lcomkin8 qirh Scdkm T0UJ) of O,rsirn l
<br />t--f--
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