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BUILDING- INSPECTOR RECORD
<br />COMMENTSID/SIG.DATE
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />/ot/-Za'ao
<br />Shear Wall
<br />Framin
<br />lnsulation/Ene
<br />allD
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Mason
<br />Pool Fence
<br />T-Bar
<br />Handica Re
<br />Final RDe ortU
<br />ineer Final Re ortE
<br />IFINAL-2,L-b
<br />Certiticate of Occu anc
<br />Notes Remarks EtC.
<br />OlVNFII BUII-DER DI:I-('At(ATIoN
<br />I hcrchy 6lird utulcr p.nllry or Pcrjrry Ihal I {n cr.m[ ln,m lhc Coma.b6 Ltusc lrw lo! rh' n'lbwin8 rcavr! (Scc ]l 5
<br />Busincs dBl Pnn'csion Co.L): Any Cily or Counry qhih requici , Fm:ii b .nnslruct. altcr. inP!'v' d'molish or 6Fir 3nv '
<br />sro.ror.. ltrir ro ns isruane, .L$ rc,tutcs rhc ,ttll*ad nn such Fmr tu ilc, vrn d natmnr rh'r ht or sh' is li"htd l'unua!'
<br />ro rl* pnrl\ions of rhc cin rrcttr\ LiccnrJ Uw (Ch!flcr o. Connntin8 *irh S..rNn ?U)0 oi Divisntn :l ol rh' Rn(rn's n'l
<br />Prulcsnlns Oxl.) or rhal h. orrhc il crcnpt llsclroi rnJ rh. b!si\ lirr rh. alk[cd crcmprnrn' Anv violnrbn dl Solion ?0'] I 5 hy 'nv
<br />appli.$rtar i lcnnil subjftN rh. nflliulnr k, {c,rnFm[yolnor d rc rl[n tir. hundrcd Jollars (5500)
<br />0(t.n. '"*,"r'r"n-xnr.,nmy.n rycc\srrr'*,3.'r\rncu \rlc, mFnsdrrr {'U'l''rr*'r[{r]rrr{duErn
<br />Frc.r..r u"n.rc1roi *r. rie 7u14. BusN$ r.l Pn,lc$n'n\ CGlc:'Ihc ConrEck,i Lacns La* dNs trot
<br />'Pdv
<br />t' anow'cr oi
<br />rhcplstEny sh) hlrlds or iryE)rcs tt R,n, ani wlY) J,f,s {ll}l u}d( himklf or hcscll or rhoulh his o' hcr owh
<br />'mplovccsp.,viacd rlrar su.l impn,{nEnls dt rn inrcndctl or olLEJ lor salc Il. howcvci rnc tdildiry or ihlbvcmnl s sold within nc ,tr
<br />;l cor{,ler n, rhc o*n;r BniLkr will h!rc rbc buticn.l tfti4 rld h. o, shc Jil n, ${,lI or inlmlc rhc t'n Fnv fitr rlt IntrFos ol
<br />-1,
<br />a\ow cro,lhcF)p.dy,, cxclu\ilcly.onk.Lli,rs wilh li(.\.tl.o r,.loF t, c nnruul rhc nn'J'cr lse..' 7044- Bnsn's
<br />.,nl m,ls,i,n C.4", il'" Cu',r,u"rors Liccnsc Lrv d,x\ noi xpolv ro an oqncr olFrPcnv who builds or inprdvcs llrrc'tr'
<br />rnd who co,n.cls t)r such ttoF...rs wirh a G,.hct)nO lic."rJ pu^uanl l' rhe C'nr'ciitr s Litcn* Law)
<br />I xn,.rnrpr trnlcr Sc(rnl,. l4/./!n.n,
<br />DECLATATION
<br />I hc,cby ,ffirm lndcr ,]cnalry or psjury o* of lh. ti,llowine dal&tionsl
<br />-ltdv.&rlwillminrain,CcdnElr.olCon.cnllosclt.lnslEiotmrkcBconlc.s.rbn,!sIn'lidcdtirrbvScclbnlT00'rrh'Ijlxr Co.r.. for rhc pcrlo,rlrlr! of thc m* ,or whih
<br />'hc P.mir t L*!ctl.
<br />I h.ve and will m,inrrin wo*.^ uomtcnsolioo inrurakc..s rcquicd bvSelion:r7oo tthc tihorG!&t, turlh€ pttlbM' of
<br />rhc *o,k for which rhn pcmir ii i.suol. M, eoikm' omn ns.lion insurM.. .ni( ard Plicv nudbcr dc:
<br />CMi..--
<br />Pol!.yNumb.rr-11Ptr.\
<br />h ccnily lhal i,r rM !.darmrNc oi rhc work rd *hi.h rhn l.nn is issr,i. I shrll nol c,npk'v rnv pcrm in ov m'lnncr
<br />;.s l ' *...-* nrl'l.ci r, rhe wlnl(.r'$miEnslro. hw\ ol C.l,r'omr, rJ +N ll rI' I \buld hc'om hlcd torhc
<br />w.rkcr( conrFnsrtr n toririon\ of Sc.l$n 1700 ol rhc Lfitr (iic, I rhrll. tun hwirI conPly with rlD* ltuvisn'$
<br />WARNINC: i'ailurc b *cuc wortcn comrcnslri.n ovco3c n unhwhl a shrll suhjc'r an c'nPlovcr lo cmnrlrruhic\ MJ
<br />c,v Un.s ut looN l,undrcd th.usanJ Jollds ($lur,llol)),
<br />'n rldirr l,' !h. ..{ oi ctnrpco\rrion Januacs 's Fr'vklcd n)r rh'
<br />S.rrtrnr l016.lrhc I rhtr L:txtc.0rl.m{ rRl IIorn.Y s l.cs
<br />, t/i //9-olo *e'
<br />r ft r,\\rr)r'()\IR\{ ]I)R
<br />DECIARATION
<br />lhcrbylrmundcrpcnalryorpcrjuryrharlamli..n*Jundc,pn,vNnr.lchrprc,9(.onrNnuirawirhSethnTfllo)'lDivnion:l
<br />ot rhc Buiift* atul Pmlcsn,ns co<ic, srl my liccn{ s tr' tull n)rcc a .rlicr.
<br />Dsle
<br />-
<br />Cont
<br />gaNrucrortlEllllc-AcIEN!1
<br />I hcmty allirm trndcr pcn.lly ot FDry lhnl rh;
<br />^
<br />r (,Nlfl.rm lcn,lins deckv Lr rhc I. tumnncc ol rhc work li)r *hih rhn lcmrl i!
<br />r{d (Sc( 1097. C'!. c.).
<br />If,nJ '-. Ninr: --
<br />I" c, \AJJ...,
<br />AIEIIIrINLUECBBAIIO!
<br />I h.tr$y lllim unJcr !.nrlty ol r^_riury.nc ot rhc ti,Uowin8 J(ldauons:
<br />D.mlii(nr Pclnn\ Adrnos Norif'caron Ecdcr{lRcSuhton\ (Tnlc 'l0 Prn6)
<br />Rcqnn.,l l.rrcrdf N rilic{ri,n,
<br />-l
<br />c.nrry lhir rhc lcJcrrlrc*uhlions rcgar't rgrnEsi.sr.n$vrl,rcnorrfl]li.ahlclorhrpojc'r
<br />)!rd,ry,hr I hr\c rcr.r rh,s,gr'(ri.n ril src
<br />onnnrn.c\ rnJ Srrrc Lw\ Nhrim ru hui!.lin! !nndru
<br />rhrllltr r)vc dhln dtr sconc.r I asrc. i)comnlvwilhlllCilva Cduitv
<br />.i()n. l hcrcby rdlvtro. rcFc\cnratrrcs otrhN Cily.nJ Cou.lv lo cnrcr uf.n rlr
<br />rbolc nrnrrnr,l prc|tdy Lr
<br />Applionl or i\g.nl Sit .trr
<br />-)w:^^--d
<br />,'- )
<br />SITE-WORK
<br />Roof Sheathinq
<br />Flood Zone Certif .
<br />v
<br />*,", )/t/2d2.,
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