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BUILDING- INSPECTOR RECORD <br />ID/SIG.COMMENTSDATESITE.WORK <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVlnsulation <br />Roof Sheathin <br />Framin <br />lnsulation/Ene <br />allD <br />Ext./lnt. Lath <br />Brown Coat <br />Mason <br />Pool Fence <br />T-Bar <br />Handic R <br />De Final Ret rt <br />En ineer Final Re rt <br />Flood Zone Cerlif . <br />Att3CttFINAL <br />Certificate of Occu anc <br />Notes Remarks Etc. <br />o$Nut{ tli ILITTR t)Et.(AR,\ltoN <br />lh.lcbyufiiiinuMc!Ilc,llry.lF.rjuryrhdlrmexeq,rt.rnthcG,nrocxFLi'enscrlqlorrhcfollo$in!rea$n(5"70115 <br />Bu{nms .nd Prcl'cssion Codcl Anv Cirv or Colmv wnich rcquirc. ! Frnrii ro stslrucr' trlrcr' inPmvc dcrmlhh or rcIrt rny <br />{rucrurc, prior ro irs Gs!an.c. rko rcqrte\ rhc 0rnliclnr ior su.h pcmir b filc a stncd salcmnl rhar hc tr sh' t lics\cn prsut <br />ro rhr Imvisbns ofrtr Conlra.rdt Li.cn*d lrw (Chq'lcr 9- Cotmcmins wnh Srlnrn 7o(ro of Divkion 3 of lh' Buliae\r dnd <br />pn,fs;ions c.dc) o, rhDt tE dsh. t crcry, rhcrciro,n ad rhch,sn for lne ![c8cd ciemprn]n. Any violrtionofsftrion?0ll5by.ny <br />0lpliclnr ror r p.rmil slbjtrsrhc applicanr rotrcililp.mxvolnol ntrcrh!tr fir. hunded dolls (5500)' <br />-I. <br />js owncrotrh.lfoleny. nrmycmplo)ecr eirh woBcs as lh.ir snlc comFnsarion- willdo lhc wor( arxl th' srBrm k mr <br />-nkrdcd d"n Ed ln sn" (a"r.7oi.L Biisircs lid Pot siMs codc:1}l. conr'acrors l-icn{ tl* dos mr ar/v ro an 6{n'r or <br />rhc ptuFny wrFt ilds or ii{,mki rlENn- lnd sb des suh eork himsclf or h'sclf or rhbugh hh ot hd own cdplo,ccs' <br />p-i,iala rri"r *"r, inwovcmnr uc mr inrcndcd or oficrd fo! sh I I ho$crL rhc lDitdirs .r itrlmlcmd k $rd *irhi,, onc ,!s <br />;f conrrbrion. rhc own'cr B!it.rc. wi1 har rhc honletr of ptr,lihg rrul tE or sh. did tror huitd or impror rhe trupcny lor rhe puqxN ol <br />-1. <br />a\ owi.r or rh. nopcn y, am crclurivcly ..nu!cr ins wir h licrn€d .onri.ror t'] con(Ncl rh' t)('i\1 (S( 7{144' BNim$ <br />trnd Pi.l6sm Co.lcr t hc C.nrmcttr s Liccnsc tiw docs nor atPly lo an osnd 'l lmpdy {'ho blildr or numvcs rhctcon' <br />trnd *h. otrlmcls for such l,m,cck wth a (inhcro(s) ltcnscd rxnut.r lo lnc Contmckn s Liccnsc b{ )' <br />_l r rcxcnrpr undcr SNr <br />Drt€ . <br />- <br />o*ner <br />wonxrn-s crilrt Ptr't.slrior <br />DIII.ABAIITN <br />I hcrcl,yutnmundcrpc@lryof Pcrjurroncoflhcn hsi.8it'c1'rrrion!: <br />lhavcsJdwill,Minlaina(tdificalcofconsnlloselflnlurcl,or*ort.r.comp.ndnrn.!srovidcn.olbysalion]7mol'hc <br />rjh.r Codc. nr rh. Pcrformft. orlh. *oII for whi.t rh. Irrmir is iscu'i <br />-lhdvcandwillmtrinrainBorkc.omFnsnrioniisutrncc.rsr.qniBdhvscclion3700(rrrhcL'horCodctt'rrhcInlrf'ntuntorG work lor shEnrhisl.rmil ii hflcd My sork.rc' cosPcnqrion insumN cnricr !d Bnkv nun$'t trc <br />LiccnscChsrr .--- <br />D.ie: -- Contn.ior.- <br />(()NSTRtTCT(rN Ll.'NhlN(: AGFN(lY <br />I hcrchy nfln utrdc, pcnrhyoltcrju,yrhd rh;;c ha..nnflcrion hidin!r8$cy fdrhcncrlb'nrnrcollhc aort for whi.h thh lr.rnn is <br />tsrcd (Scc 1097. Civ C ) <br />L.nJ.''\ Ad'h\. <br />ihxl I lr\c r..nl r[n {tli.)r irlon dr n com.r I r8r.cn,..nrPly*irhdllCil) r.dCoufrv <br />okl dNclrn,l Srrrc L.ws rcldi'rs r)rurM'r/( rc|rrc\cir.rir.\ otrhis Ciry rntl(i vro. rdrJr'frlr <br />Jtxtrc trdrinrcd fn,ncny lor ir <br />lplicnnl or ,{Senl Si*nnl <br />0 (NE!- <br />l fn-l ft <br />Shear Wall <br />-lcenify <br />rhir in lhc pcrf.i,ruNc oflhc work tu nhkh rhN F.rmi! F trrucd' I shrll n't cnlltluv rnv lEson i' Jnvrunncr <br />**otio**r,r.ircrr'"*lnL.omnctrs''onlo*sofcDlilomr0..trdsPntrh!!i'I{r'uldhccomquhGrrorh' <br />wo*sa ..mtcn$iir,i phvnions of s(lion 3?m .r rhc tihor C{xi.. I shall. Ln hwnh ompt, *ith rhos Pmvisionr <br />WinlnC, r,ir,. ,o *.r* *orkcs' codFnsnlion covcme. i. unlastul. a sh{ll \ubjd !n <br />'mFlovcr <br />lo diminal FMxtsr und <br />"i,lii nrc* u,' r,' n* t'uoa,"a rhousdd dolGis (gloo00o). in lddnioo lo rhc cosr oi comFn!0lion d'mgcs &s Pi'vidcd rn rhc <br />sccrinn to76 of rh. Lrtw ('.dc. inrocr rnd anomj'r tc.. <br />D.te: _ Applic.nl: <br />LlcExlDDioNrM!:trlB <br />IECI.ABAIION <br />I h.rby oflnn uMcr t nshr.r pcrjury rha t anr riensd u-c po"isio or chlnrcr I (osnEnci'g wilh scden Tuil 'rDivision 3 <br />or rhc Businc* and Pmfcsions Codc. a'n m, lt.6* k i, flll for.c ud cnd <br />AEUIAIIDECLAtrAII!}! <br />I hsrty ltIm undcr tcnalry ol Frrury orc ol fic following irl'mrio'li <br />O.ehioD PcrnnsAshcstos Nolificrtion Fcd.r,l Rcgulll ions (Tnt 'l0. Pd6) <br />Reg!ncd ktrcr of Nolif'. ion <br />-l <br />.dify rhlr lhe acd.E! E8lhrhB ES.tdins ,$.xros rlmldl !E nor !Ppli'!6k lo rhis pmiNt