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BUILDING- INSPECTOR RECORD
<br />SITE.WORK ID/SIG.COMMENTS OWNEI' BUILDEI' DELCARATION
<br />I hcrch, rrrtm hdcr Fnalry or ll.ryry rhdt I m c\cmtl hrm rhc Contra.br' Lic.n\c Uw ta. rhc tblL,*ins Eavt (S..7)ll 5
<br />ll[$nc\\ I Pn)fc\!.tr Cd]c) Atry City or Counry whrch r.qurcs r 0mir b cor{d.t. altq mror. &moli\h !tr rcl)Jn rhy
<br />ntu.r!rc, flrxr, [s nsDn c. aho rcqurcs rhc alplicanr Lr sNh !.m b Ulc, stncd ( cm.! rnd hcor {hr s lNnscd Pusumr
<br />t' rhc porirutr of rlt ct,nkd.rtr \ Lacn\eJ ljw (Clu er 0. C.mncncms w h Sccron ?OOO dl Divjsnn .l ol rh. Bunncs\ tt
<br />Pn'Ls{ons Codc) or lhlr lr or shc is crcnfr rh.rdh xrkl rhcha!\ turrhc {llc-!cd c\.trUrrii{ Anyvn,hrionotSccli,nr?0315hyrny
<br />q'rl'unnrh, rncm subi.chrhc imlr,trrb icrvrlpcnrllyolnornucrhrn riv. htrtdicd dollds($500)
<br />l. rs owncr ol rhc F,pcny. or my cmpktyc.s wirh wr8cr nt rhctr s,lc conrPcnsari,,,, will do rlt 8or k !,rl Ilr sture is nor
<br />inrcnJ.'l or ollcrcJ tu {L (S( 7J4-4. Businc$ and Prr.sn,ns CGlc: 'I h. G,nr.cM s l-i.ensc Iiw Jm\ nor aPply r, M wncr .l
<br />rhenn)Fny wh' hu'lJs or Dp(nt\ rhcdr, r wlo (llf,s suth M)rI h'mrcll or h.r\.lt or rhtn'8h his o. tu. own.n[loyc.s.
<br />I)' oliJ.J rhrr nr.h i ONvc,mnh N sn inrcnlcl or ollcnl tut $b ll. tDw.rtr. rlE l[rutrrS or imlJn,v.m is sr[l sithin onc ,tr
<br />.lcomphri4rhcOwnrBu'ldcrwdlhrvclh.hurJcnofamvm!rlBrhcor\hcd'dmihur or inlrrovc rhc nnrlEly lnrUr Nqb{ ot
<br />-.-1. A.wrrorrh. F)p.dy, drcx.lNivcly conrradi s w(h [..n{d coikr.ntrsr)consn'.rrhcl,I,,j.cr(S.c 70{-4, Bunncs\
<br />st PNI'6srr C-r)d.: I he Cofirrntr'1 l-'ccnr. I -rw do.( *n rt)nly I', an owncr ol lrn)p.n y qhr hurlJs dr imlnvc\ rh.rcon.
<br />.nJ who conrruchn, such ,x)jc.h wirh a Ci! n.bne li.cnsc'l ptr^uxnr brh.conr&rx s Lic.nsc liw)
<br />I Jm.\ch.runJc' s.!tr,n .B &Pc [i{ rhn rcrs.n
<br />lvol{I(ltRs' (lollIPENsa1loN
<br />UECTAIAIXTN
<br />I hcrchy |irmu,rd.! Fn.ty olFrjry oncofrhd Idl,,wtrr! dc.ld.rnnr:
<br />-l
<br />htr1r dilwill hrdrir r Ccrrili.lc ot Consc n'Scll.lnnrdlarwo*c,|.!nlEn\ari,n,.,\pn,viJcJtur$ySeli,)nl?00ollhc
<br />lilxtr CG]., Lrrh. pcrlornuNc ol llre wo* lhr whi.i lhe pcmn is istr J.
<br />I havc rnJ will mrinrrin worl€rs .onlrnsrlion in\unn.c,.\ rcqrirc'lhySc(rtunJ7U)oirhcl-rhorCotlc,l{rrh.p.
<br />s a\d.al Mv*o'ld\'.dmmnktu,rlurhrc rmcr.rnNl(t numhcr (
<br />,",", fu,<rcy) &"hr"a\ I.nsl,(^,r\ccCp. ,
<br />",,,,..",,,,,,-, J6!2()0 tJ129i0\ ..,. ll/otlla - --
<br />-l
<br />rcn'!yrlBr Drhc ltrf.nniNc ol rh. work ntr *h'(hrhFrrn , A t{'rJ I \lull nor cmnLirt"n, *,.,,",,,,n, nto"',",'
<br />s) r\hlr m. sulr.lk,lhc *orkc^ conlltNdtrD Idws olCa|r.mi,, ani 4rcc rhrr ifI \hoxki b.com {,hic(t ro ihe
<br />I \lull.l,ih{iIroirnly e hrho\c l[,vNons
<br />IVARNIN(:: F3ilurc tu {cnrc wrkcr{ comFnsiri,n.ovc sh,ll suhiel an .n'n!'y.r h dmnrrl lf,nin€( atrd
<br />r. hrnll'.,1 rlbtr rl.l.llir\ rSl(rr)lrixr)(D( ol. n$.\ili,xr. ']rnl+r\ r\ l', vnl.d lu rh
<br />rlcr.d rnl fi.nf,yi licr
<br />a q
<br />I hcrchyitlirtrrun,lcrpcn ryotpcrjtry rhlr I dn ltcn{d
<br />ol thc Bum.\sod Pn,lcssions Codc.,r*l hy hc.nt r
<br />r 1rnr\!tri.1(hxtr.re(otrnr. rtr!trrrhS.rrkin7([xrrolI),1trrr,]
<br />L
<br />I <)
<br />CONSIRUCTION I,ENDIN(; A(;ENCY
<br />rnul (S.( :ll)97. (rr C )
<br />hDncic Annrcs:
<br />-
<br />4-rEllljNtlrEsLlAdr!(t!
<br />Ilrrrlt,rllnn,u .r Nnxlrvolttljurv.n. I rhc lnllo*trr! rl.tlxrrri,nr
<br />I\.D!'liilr P.nnirvA\hc(or Noril'r]rnn, f't!t.'!lRc!trl.nrnN al (lc.nr. Pidl,)
<br />kr. trtr.(l l crh i Nii iliton
<br />-lccnriyrhrrrlr.lc{i.rdlrc8uhrionsNg,h,srlh.iorcar)vxlrdnorit'tlic$lchrhilnnrccr
<br />I (flr'ry rlur Ilu\. r. rh'rrpfl'r rhc i,v. rli)rnrri,xr is conc.r I rgk. n) (nnf l! qirh ill (ily lnJ Counry
<br />.nrurnucs nnd Srirc l-iws rchlin!k,rrr nfrl lrrchyNrholic rclnc\.nrliv.r ol rhr C(y rn(l Cornly ro.Drrr ulir rltr
<br />rri,vc trknr(Ni pn,p.ny tu, n)nlzsl t\prliunr,tr Arr lSirtr l IL
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<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 /2-zl- t ol 2.(Lt ,/V€4o > 2ry
<br />Certiticate ol Occupancy
<br />Notes, Remarks, Etc.
<br />DATE
<br />SLAB Floor
<br />wo,kcr( con['cDsilrnrnovirn,n\ofS.crnn r7(X]rtrhc
<br />L.n,icr. Namc:
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