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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE COMMENTS OWNER BUILDER OELC]ARATION
<br />I hcE$y rlfi,nr un'l.r rn.lry (, p.rjury rhar I m cr.nu rn)n rrf, G)ntr.ckm l-iucnsc L!* tu rhc nrbwi.! t !$n (Scc 70ll 5
<br />Bunncis nnd Pr,tcsion C,{c): Any Ciry or C.unry which rquircs r F,mii b con(o(r, ,lrd. ihprovc. dcmolnh or rcpatr !try
<br />(ru.rurc, pri, lo rr\ nsr oc. rlso r.qrncsrhc 2l,pn inr fu suchrnnirk' lilc, sic.cJ IdcmN lhar lrorshc is lr.n{d tu^rinr'
<br />kr thc prrvtnns or rlrc Conlr.dor's Lienscd Law (Ch! q 9. Commcncms wnh S.crid ?{xxj dl Divis$n .l ol rh. IrusiRs md
<br />Pr,ft$nns C,,.lc ) or lhlltEorshc hcxchpr rlrrcrrumanJ rhcbrris lat rh. rUclcd cxcnrtli(ln Any vi,n!lionoiSccri,n 70.11.5 brany
<br />appliuanrlh r I}ermir slhjccls rlr amhcnnrtl rcrv'll.trrlryornor nrrcrhin hvc hunirc,l{tollr\ (5500)
<br />L ds ow cr ol rhc tmtcny. or myc,nploye{ wilh wr8cs $ rhctr n,l..ompcn$rtr,n. $ ldu rlt wdkdil rh. sluxE is nor
<br />inr. c'l orolfcrcJ tur qlc (Sm 1}{4. Rusincs MJ Prof.*(m\ Cql. Tlr Conl.tutx s Liccnsc Lrw iocs nor rptly h in ownct rf
<br />rhc pn'Ocny wh build\ or irpro$s rhcED axl wlnr it(r\ \uch w, lrnNcll or hf{ll or rlnongh hr or hcr own enll{,yccs,
<br />!x,v'd.n rh.r nrh i'hnn,v.m[r m nor ir celol nr .ftc6l Lr slc. Il ht)wcv.r, (h. hu hg or rll)Fwrnr is \o!.1 w hin N. ]u
<br />ol complcri()n. rhc Owncr Buil'tcr will haw rh. hlrJ.n or pNvhg rhd h. or dr. Jrl ft, tn'ikl o. inlporc rhc polrny tur rhc nu$,s ol
<br />L a\own(olrhcll()t rlt, rtucrctusivclycdnklulurt wdh l,echscd cotrltucnn\ b con(rud 11[ pft,rccr (S\- 70,14, Bunnc$
<br />a'xl PdG{nQ,J.: l hc Conkacnx'r L(..s. Lrw J(rs nor rtfly b M own.r of noNrty wh,} hu ilds o! impn,ves rn.ron.
<br />lnd who udnr!..k rtr ruuh F1)jcck wnh r ConrEcn4, I'c.ns.J pu(lanr ro rhc cint&ktr's Ldnsc trw)
<br />-l
<br />an crcnpr unJcr Serb!-, a & P C. tur lhls rclson.
<br />ua8trE[5:tau&NtauqBu[gAaaro!
<br />I [crct'y aftrm unJcrycnalr, ol lcjory onc ol rh. followi,A JccLraLntrs
<br />Ihavcmdwnlminr.inaCrcrriticlrcolC.n*nrbS.lf-lnslrctur*orlc^..mFns!oon.a nruvidc{ litr by Sculi,n 1700 of rhc
<br />Ltrbor cdlc. r.r th. ,.nomfrc ol th. wort lor whtrh rh. !.mi is nsurJ.
<br />l1l havc ,nJ w rll mrin,rm workcE' qmFn\,rbn o\uraR.i ,3 i.qu Rd by Scurtun :l?00 ot lhe LaiDr Ct'J., rd. rh. Psr..nrfrc or
<br />Ntr inr {nrcc .rmcr nt I}n'.y ntrmh.r rc:
<br />Z z /rs /z z
<br />I .cn il y rhrr in rht p.di,rmrn.c ol rhc work ktr Rhrh rln\ l.rn, ^,\ rJ I dull n l cmtl,,y atry penor in rny hannct
<br />s' ,s lo h.com srblccr lo rhc w(ntcr' com!'cnsarnn hws of Calnnrnin, 3nJ agrc rhar il I lhould bccom \ul,jccr b rlE
<br />wortcr'.ompcnslliorpnrisionrolSsri,n.lT(x)otthcllhtrCotlc,l\hrll,tudhwirhcohPlyqlhrh)cpmvisr)ls
<br />WARNING: Failurc b *curc wDrk.6'.om!.nsalrr.ovcntc rs unldwlul. $rll \uhj..i rn.mtk'ycr n) dim,nd Pcnxlras ud
<br />uiv'l l,ncsupt,on hutrJto{ rhousr,l Jollrs (S100,00o),,n.dJin)n n) lM.od oi compcn\alon. dama8c(.s noviJcn tor rhc
<br />oEctdS4rlaN
<br />!trdcr povti)n olChrflcr 9(c,nwn.ine will Sculiofl 7000) olDirtnD lI h.rchy alllrnru,rJcr nctr{lly.l p.riury
<br />ot rh. Bu\incs! d Pnna$ons Cdc. ird hy lacnsc is in ,xll ltrcc ard ctlccr
<br />ts ,/e3g?
<br />t'Je-
<br />I lrNhyrlt,nnu cr FnrllyofFlLtrylhll lhcrr rs. u.n$nL!.n lcn ling a3en.y ti). rhc Fr,nrn,u( otrhc qort ntr whi.h rhis lcrmir Ls
<br />^ttUc^lLDECt
<br />BATION
<br />I lant'y,llimu lcr p.n,lry olFrjury onc otlhc hlhwnre dcuhrlli,,ns
<br />tumnnnD PcrmirlAsh.no\ Norilicrr$n Fclcrrl Rcguhrkrns (T'tlc 4tl, Pdr6)
<br />-Rcqurcd
<br />lxrrcroiNdifidrir
<br />I ccdfyrh rhc rialcElreeuhrn'ns rcrdins 3rh(io\ rcmhlsc nor atfhablc lo rhn pn+cl.
<br />ll!.nilyrhilIhrlcrc irl'rlmlrdtr,nr narcrhr rhc nhvc inn,mulnn t romcr. I .rm b co,nrty wirh aU cxy connry
<br />oklmakcs d Strlc tjws ellliry lo burldrn3 uonsln'.lro[ &l h.rchy rurhni2c rcIr\c $vcrolrhNCnye Cruntytocnlc!uBn(h.
<br />ati,v. nrnrixrJttun ny ld m\pccrioi
<br />AIpli.ml rAq.ntSaEmlurc
<br />Set Backs
<br />UFER Ground
<br />SLAB Floor
<br />Subf looriVenVl nsulation
<br />Rool Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsu latio n/Ene rgy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />flgod Zqpe Qertif IWt l*tt(hWk?'dltttv)4 lWdhta rff\
<br />),,d
<br />FINAL ,1ryruu lWtt&tt,LW
<br />Certilacate of Occupancy
<br />Notes, Remarks, Etc
<br />ID/SIG.
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />,,,,, /./tt/z-
<br />hsldl {Scc, 1097. Civ, C,).
<br />L.n,l.rs Namc:
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