|
BUILDING. INSPECTOR RECORD
<br />ID/SIG.COMMENTSSITE-WORK DATE
<br />Set Backs
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />SublloorivenVl nsu lation
<br />l-b4p
<br />'r6,111'
<br />l6t PACr.fi- 3lla<*rr.tr, tan rr-r&,Rool Sheathinq
<br />ec?r-'- ia ,.ya tDShear Wall
<br />.Wr l.o> t-..q-z.Framino
<br />lnsulation/Energy
<br />Drywall
<br />Brown Coat
<br />lr/ason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />zM lotFINAL2i6-2D
<br />Certificate of Occu anc
<br />Noles, Remarks Etc
<br />0rlNIR 8r lt 0l R l)lil.( ,\R'\ l ll)N
<br />I lml,y rtltr rndcr lcNlly {n I'crj!ry lh l cr.mpr liom rh. c:,)nlra.bF l-trc.ic tiw inr rhc tulkJwmS tc!s\' (Scc mll 5
<br />Bu$n.s a Pdc$n,n Cu,ic): Atry Ciiy or Cotrnry qlrch ,.qukcs I Pcmir kJ .onslruct. alrcr nrrruvc- tjcmolnh or rcBi lnv
<br />sin(tuc, prin h ir\ i\sudrc. ilso rcquifts rh.nNlicrnr lor suchFmir() ilc a sienc,l (,r..rnr lhal hcor sh' is l'ccnsc'l l)ursornr
<br />6 rhc ndvNon( oi llE O,nt.ctn's Li.cn*,i liw (Chllr( 9. Commcrcine wirh S.cxon 7fiIl ot Drvtgbn I ol rh' Busnrs ,nl
<br />Pnnc\sotrs Co,ic)orrl,ar hcorslE isgcmtr rbctclion.nd rhc blsir tu' rhc,llc-!cd cxcnPtron Anvrnnarnnrofselon'0'll5bvrnv
<br />rmlic!fl ti)r a ptfln nrhj.clsrhc amli.anr h a.ivrlEnrlryoinor 'norcnrn irrc hunJtd dDuds 1$500)
<br />l. N .wocrol rhc ptuFdy, or my cnPloy&r srl q.8cs as thci, v,lc comFtrs.lion. will J. rhc wrk an'l6c qturun tr an
<br />inr.nkl or.ltarcd f;;h rSE-, 7044. Busincs ind r}rna*bff Cdicr Th. Conkr.tn's Liccnsc ljwdocs.or aPFlv lr' 2n owmr of
<br />rh. t)n,Fny wln) tuil&or fi{n,rcs ltFNo. ud whl &n such q)* his\.ll oi hcrrll or lhdgh hr or hcrovtr cq)I)v'cs,
<br />pn,ui[,] fi nBh nupmumnk m tur rtcdol ot oltird lor slc.lt, hourcr. rhe bt'Uhe or r{xurcmnr t $Ll w[hinonc Fr
<br />if complcrion, rh. ownc. Builtlc! v'U hrvc rrr hilcn ol Pmvhs rhrr L or rhe lit B, hudJ olmlorc rhc rqEnv tut rhc IUF * 'r
<br />r... L'
<br />Zl.;s "".- ", rhc pn,Frl,, dm crrlu{vclr .onuallua w h Intn{d .onr8.t,6 b .o.sldd rlE [,r*cr (s*. ?(}4'1. Burin'$
<br />-anl Pml6iro C.J.. 'rh. ConrrJuors t trcnsc Lr* Jd( norl0llyn, an ow.cr olpnlpeny*lxt build\ orimp vcr lhcrcon-
<br />uJ *ho conrn$Lr$.hlm,jd\wfha(i! Ertr)(, l(n{J t]ur suxnr ki rhc Contdctn s
<br />tvonKERs cotll'llNsATx)N
<br />lrE!! E{Ilgr
<br />I hcrcby xtltrmunJcr Fn,h,ot Fjury onc oflhc tullowinS d..larati.ns:
<br />-l
<br />hav..rd will roinrah rCcnficrlcolconsenr ro Sclr-Insurc tuwo 6' conFnsarion $ t'tuvidcd lor hv Sccrnln 170{} or rh'
<br />LdEr Cdd.. Lr lhc pcriomc. or !h. mrk lot vhich rh. p.mir i( L$uc'l
<br />I harc !n,l wru @'nuin sorkcrr .onr.n$rion insurarec, {s tcqurctl bv Ser ion l71D dl rh. Lllu Cod' tor lhc PcrinM' or
<br />rhc w.rk ntr wh(h rhls !.rmil is isfl.n My workqi qrmpcn\arion ,nsuru.c trif .nd noltv num$ct dcl
<br />-l
<br />ecnllyrhrl rnrhc pcnnrmnLc oi lhc work lbrwhch rhs Pcrmrrh nruc,i l drll.or cq,nry an, Pcs'n in3nyntdnnd
<br />$ s r. hcom {hj&l k, ihc wo'kcB con$nsdbn laws ol Cahlomix. and a3rcc rhir 'fI sh.uld h.comc \!
<br />wo.tcn $ rtf,tr\drtrnrpn)vinotr\ol S(rnr l7(X, ot rh. l-rbr G!dc. I shrll. tunhwih complv wirh rhdr
<br />W RNINC l'(ilrc nr wurc workcn comp.ns.non (ovcrasc is trnhwhrl. anl shall \ub
<br />('!,1 ltri.r uf n, onc hun'tr.J lhou\uJ Jolld\ islrx)lI)0). trr !(ln nn, i) rlr c.{ ol
<br />DECIAMIIgN
<br />I hcrcby alln'm unlc! pcnalry ol !.riury lhil I aE lidns.d undcr F)vi\n,n df Chaplcr 9 (dh@n in8 *ith Sccrion 7L{0) of Divirn)n :l
<br />oi rhc Bosincss ind Pdistlns Codc, a ny liccnsc n ir iuu ri"e Ml ctiact
<br />tlste:- Cotrltrlor:-
<br />coxsr8uqrlaNulllNciclNc!
<br />I hrrchy,finmutulcr pcflahy or p.rjury rhar lhq. n a con{tuclirn hndins,s.Ry lor lhe Pcrfo@M ofrhc wotk r'r whiuh lhis Fmn n
<br />hsuc! (S( 1097. crv C.i.
<br />Lcnnci. \,tr
<br />bnJfl'\ A&trc$:
<br />-
<br />AIILICANLDICLA84IIO!!
<br />I h.nny !,lim unJ.r peiahy ol iEUury orc of rh. fdhwinS !elaBrn,n\:
<br />Dcn$ldin Pcrm(s^sb.no\ Nofficilion ltdc.al R.lulnlion. (!nt'l0, Pd6)
<br />_R.qutrc tr(.rol NdtltrDn
<br />c.nilirhat thc ladc8l r.go[rnrr! rcBrr'liry ishcn.sEnbvaldc n.rq]Pl'cahlc to rhn pn,J.ct
<br />r.d'lyrhrl I hrrc rc rhRrnPlM(i,,n a'rl {arcrhnrrlr x)vc
<br />.Nl Srdr.l:ws rcLtry 6 huilJiry co
<br />rh,vc nf,nlk)nc.l popcny l{,
<br />A00li. lorAse.lSisn$lu (
<br />>0
<br />U
<br />UFER Ground
<br />Exl./lnt. Lath
<br />Flood Zone Certif .
<br />Li.cnsc C1!$:-l,i.cns. Nnmbcr:
<br />-
<br />.-
|