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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framrno
<br />ln su latio n/E ne rqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />T-Bar
<br />Handicap Req.
<br />Depuly Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />I i
<br />FINAL 9lt>,0.71o hAao-
<br />Certif icate ol Oc&pancy
<br />Notes, Remarks, Etc.
<br />OWNDR BUILDER DEI,CAA TloN
<br />I hcr.by rfilnn uid* ltnalry .r p.rjury rh l in crcnln rR,nr rl'd O, ircn,N' Liccn\c Ltrw rbr lhc ri,llowin8 Bav,n lscc TOll 5
<br />tlusinc$ rd Prolts{ion Co,lc) Any Ciry or Couory which r.quircs {ciinir b con{dcr, rlrcr. nnp(,vc, dcrmlish ur rclr r rny
<br />itucrurc- pri(rt, irr issurn d, trlso rcqunc!rhc imlioir fff \uch pcrnirh llh a signcd st cnrnt ihal hc.r shc is liccnsd pursulrl
<br />ro rhc povkiotrs ofrhc Co.trchls Licctrscd Law (Ch.!rcr 9. Comnr.cins {irh Seclii,n 7d)0.f Oivi\n,n:r orrhc susnrs and
<br />l,roltsions Codc) or rh,r hc o, shc iscxcnu thcrcfrom md lhc h$h lorrlrc allclcdcrchpri{,i Anyvn,rio rScctionT03l.5by!!y
<br />rrplicmt fuapcmir subjNh thc rtplicdni ro aciilp.nahrofnor 'tur.rhrn lluc hundrcddolltrs (S5Lt)).
<br />l.* owncr.r'h. pr.p.nt. or my cnpl.yes wnh wxgcs ia rhcir k,lc.ompctrsdnnr. Nill do ihc pork atrd rhc sldrue i\ nor
<br />intRd or oilced for slc (Src.?U{t. Ausircss lnd hofesions Conc:'l hc Conracrors Lic..sc L:s &rs nor +pl, lo atr osnctof
<br />rh. rhl.dy who boildsor inpbvcs rhctun, rnd whd do.\ sn.h trr,rk hinN.lfor h.rcllor rltrouSh hk or hcr own cnDloyccl.
<br />nravidcd rh \uch nnrornrnh @ Bn inlcndcd or.ffcrcd fo. {h li lx)scvs. rhc huililing or in{ot'ftnr is {,kl wirhin dnc tr
<br />ol coryktiotr, ltE o*trs Buildq will h!!c lhc hrdcn ol tovirB rhat hc or she did nol tDiB or irpmrc rhe pn,rcny ror rhc purlD* or
<br />-l-
<br />is ownsofrh. I)'orny. omcxcnrivcly.o.tructing wnh li.cnrd conlrldonn, con{dcr rhc l]n,jNr (s.c 7ut, sumcs
<br />md t\lfssbn Codc ThcContr.roasLi.cn\c Ln* docs norryIlyb rnow.cr oflropcrly*ho buildsor im,rovc\ rhc.$n-
<br />rtrd who cofltru.n rbr such ptujcd s wnh a ( o.tm.lon s) licctr*d l]U urtrrlolhcCodrlcn, s l-iccisc ltrw)
<br />-l
<br />amcxcmpruMcr Sccrion-, A & P.C. lnr rhis r${nr
<br />]daBf,[f,llrouflNsA]r0N
<br />DEIIAXAIIOE
<br />I hcrcby.iltfl und$rcnrlrrolF.turyoncolrhc|ollowinBdcclar n,ns
<br />I hdvc Dd willmimd. aCcdif].dc olcoi{nr ro s.lf ln\ur. trqorkcts.onD.nsrlion,!r providc{l ior hys.cri.i.l7(x) ofrhc
<br />trb.r Cndc, for rh. lcrfomncc of rh. worl for shih rhc l)cmir ir issucdY
<br />l-\ h!\c rfrltr,lltrEinh'n trorlcr' \nn'I.n\irtr,n insur!'tr.- 0s requiKlhysecrion]TmorrhcbborCodc.lnrrhcpcrlarnnnccoa
<br />comprn\arioo in\uruncc crricrrndll'Ii., trunrb.t c
<br />77-9614-fu71 1 2-O
<br />-l.cniiyrhrrinrhcncrtnrnun.c.flhcworkfor*hichrhispcrnrir
<br />i\ is\ucd.I \hrllnoi cnrploy y ftjr{,. in .ny nu.Nr
<br />v, rs r, b.com subii b rhc sorkcts .onrp.i\ rn'n hws orcrlironrin. Md +rec rhrr i,I rlbuld h(oN rh}'d ti rh.
<br />sorkcri Lannpcn$rion pfl,li\nJni ofS(rnrn:1700 ofrh. tjh, Cod..l shrll. Ldhwiih conrtly with rhos lrovhion\
<br />W RNINCT Frilurc ro surc wortcN comDcn$Iion covcrlse h unhwnl. rnd \hrll suhicr an c'npluyd t, dinnal Fmhiis {od
<br />civil fiocs un t) orc hnnJrcd rhousund dollun (Srlxr,qxr)- in.ddirion ro rhc c.( olconll)tisrrioi. drmreci rs [ovidcd ior rlrc
<br />Scction 1076 olthc libor (].de, inlerc\r and allonEy \ fec\
<br />,^",/2j/z.tz
<br />I hcrcby allirn uMcr !.n,lryol Fcrjurl $!r I
<br />of rhc Ausitu\sand lhfcsnnBCodc, nl
<br />u dcr rrcvi\iu.l Chiptcr 9(lrrnn,rNin! sirhSc.ri{'i ?(XX)) ol D vi!i. r l
<br />h.LN. s n llLllnr!. x rl ciltlr
<br />ls /03A,37L
<br />",," /fo/"-,.""** - CL"^t^l'*f--.rtnt
<br />CONl1trICU0NI[N.PIN$rrliEIrI
<br />I h.rct'y 6.rnundcr Fnalryofp.luryrh{ lh.m taco.{dcrio. i: ing oscmy tor lh. n rlornBncc .r rhc sort ror whkh lhis Frmn h
<br />i\soql (Scc 1097-Civ C)
<br />AIIUCANLD&CLAE^II()!
<br />I triby rflirm undcr pcdrh y of Frjury oft of rhc following dNlftrl k sl
<br />Dctrrliln,n Pc,nrih A$eslos Noli6cdn,. ftdoal Rcguhit'ns ('rnh.l0. P n6)
<br />R.quircd lxrrcr of Ndrifi .ari[
<br />-l
<br />ccnifyrha hc ledcml rcsuldions rcrardins asbcsr.r rcmovrl nc nor npdicabh t, ihis tojd.
<br />lrz'f-.cniry rha' I h,vr rcJd rhtr +I'hcrr'.n nnd {rrc rhJrrhc trh)vc ini.rmrion h cotrccl. I rsre lo comply wnh DU Cirydnd coxnry
<br />ofllinamcs dnd srar. hws ehrinS b buildi.8 consldcrnDnd hceby d&izc rcprcscnrdivcs ol$n Cirylnd Coutrrr ro..r.r upon rh.
<br />atl,vc nrnrioicd ptur.dt tnr insr..riotr
<br />/Q,,Vr. /<n )LT ",,t/z:/*
<br />II
<br />Pool Fence
<br />,\Dpli.atrl or A,:.nl Shnohrr
<br />I
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