|
BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I hcrl,, llrtm lo,icr pcnahy oI Frjury rh.r I d cxcryl rn n th. Cuntdubu Ltcnsc tjw ln, rhc nnn'wirr rav,. (S.c 70.1 L5
<br />Burin.* and Pn,f.ssk'n Cclcl: Any Ciry or Coumy *h,uh rcquRs , Fml t,, c{nsltu.r. alrer. iipni!.. rkmola\h or ftl'air Mt
<br />srudxr, prM ro ns r$ur{, ,lso rcquncs thc amlicanl t{ su.h rxmir t, l,lc, un.ri {ar.mnr rhr h. or shc is liccncd lumur
<br />b thd pmltn,nr or rhc Cohtrctri Lm,ed kw (chilrcr 9, C.mmrcins ,irh S{crion 7000 oi Divilion I oflh. Busims a j
<br />PDrcssonsCodc)orrhltlEorshctqemflrnsc,iomanJlhcLasi\ti,rrhcxlhs.Jcxcmplron.Anyviobtn,nolSc.rion?0.lltbyany
<br />arplitrii lbr . p€mit subj.ck rh. ,t li.antroa.,vilp.. tyorNr mrc rhan fivc hun'ir&! dollai\ ($5001
<br />l, !s o$nsoiihc pNllcny. or ny cn,ploycr wirh qagds ar rh.ir nnc eon\Entnron, wrlldo rhc woi( ul ih. dc*rm t nor
<br />idcBlcJ or ollcr.J ri, slc (S&.7(N4. aurrcs {n'l Pnttsrios c(rlc: -l hc Contncror'r Liccnsc Llw doc\ nor rpdy b ow.cr ol
<br />rh. F)p.dy *ho h'lJr or imfruvcs rh.Ntr, nn l wh) {$ suuh w)* ['mscllor h.rsclfor rlmuSh his or her own cnPl,,yccs,
<br />pn)vdcd rhrr srh inrnovcmnh m nor inrc'rl.J or of.6i ntr srL ll h'wcrcr, rlr huilrline or implMmfl n oL] wnhr unc fd
<br />olcompLrotr, thcowncr au'Uq wr h.vc lh. burJcn oip$vins rh.r hc or shc nil sn huix or inF,v. rh.I,lFny tur rlE,{qr&ol
<br />l, $owncrol lh. F,pcny, a'n.r.lu$vclyLotrt&hng wirh li(cn{J cotrt..bF l() condorr rh. nfl)jccr (S( ?(x4. Bu\inc$
<br />ani l\Dli\\rn CGlr: Thc Cont&ktr'1 L(cnsc L.wJds noltplrlyl,' r*Nrol tn)I'.nywhr huius.r lfrln'vcs lh.rcon,
<br />rtul wh. conrrlcrs ld su(h plr.crs wirh i O,nrB.tn(r) hcc \.'l N^urnl h,rh.Crnlracnrs l-i.cnr liw)
<br />I rnrc\.mFr uBlcr S..r
<br />Drte- o
<br />IIII8(E8S:.CO!!!E!SA!I0N
<br />DECLAAAIIAN
<br />I hcrcby atltrfl u.dc! pcnrlly.l pcryury onc ofthc lnllowns Jc.larrrn,r:
<br />-l
<br />hdvc arilwrll u rhaCcnrlicatcolCon\c n, Scll- lnsurc lbr *orkcr' co rFn\arnnr. N lovidcd lnr hy Ser nn I7($ of rhc
<br />lrhtrC(x1., turrh. pcdnnnDcc ol rhc wo* htr whrhrhc lfnnil is r\ucJ.
<br />)4.u""!trd will nrai r rn worlc6' ronrpcnsxLon instrrmcc. rs ft,t! trc,l by S.crut r 7(Ir oi rhc Lr[or C,xh. lf rhc trd,nDncc ot
<br />lnr whi. I rllir r--nnir i\ N:!.d My work.^' .o rNn{ari(,. in{r!..cc c.ricr lnJ rnicy nu Bhfi rc]
<br />AvvtLvr ran ?!vtLl,,t
<br />\r.I ( <0211 tntz \
<br />,/Ircn yrhr'r'h-Fh,rfurcrlthcu' il,{whnh nFncrtr. s 's\ucr.I \l-rll
<br />(U r\ ro h(um.ult!r,o,hc w,{la. vnnrn.dn' lJs., Cu I'xrn', inJ.rC'c^ rhrr
<br />wol*en conrpensarn,n Frvni{}ns oiSc(rion.}1x)olihd Inhr Oxl..I drll. tunhwirh
<br />WARNINC: Frilrc b scu,c workcs con\pcnsd r..vcm3c rs uDhwtul. !.,1 shd
<br />ndr cfrpl0yrnytcnon ir any manncr
<br />rlI shoul,l bccom suhjccr u rh.
<br />.orply wilh rl!)e pn,vi-\ioni
<br />I suhjccr dn.nrtloycr ro qiminal pcnalri:s 3nd
<br />riv'1 lincs ut i, otrc lruiJrd rhotrsrtrd d.lhrs 1$100.0{I]). rn
<br />s.d n 1076.1rhc ttrhtrc.rlc, mrcrc( lnJ artrEy\ lbc\zo
<br />I h.Eby al lto unJ.r p.nlny of p.rjurt th{ I im lansi un lcr F}vtbn ol Chrprd 9 lcormn in8 Bnh Selion 7O$) oI Divisnr. .l
<br />ol rhc lrlsiNss $n Phr.$i'nr Cod., . my li.c.sc is m tnll ture anl cftNt.
<br />C 4VaVSU
<br />Z 70 \/tut t^t lolaA-
<br />glBsralgllrN.tllDlllaaExlf
<br />I hcrby afrrn rnJ.r (tn ry of pcrjory llul lh.rc n ! $ns!ru.ii)n lcnlin8 4. .y Lr thc iErlorroncc of rhc *ort tx shich rhis ,.rmil is
<br />issucJ (s& 1097, civ. c.).
<br />^!t!!c
<br />Nr_uEc! 84r.&N
<br />I lrNhy allllD nndcr pcnolly olp.rjury onc ol rlE lb['w'ng dcchrarnn's:
<br />Dcnblirn{ Pcrnnr$Ash${os Notilicrri,nr F.Jcrul Rcluhrfns ('l 'rl.4l], Ps6l
<br />R.qumd trrr.rol Noriltf,rir
<br />l.c'rilt (ld rh.lil.'rl r.guhr otr\ rctr.l$! rrhc!ds rcnDvrldc ndr JI,nli.rhlc ir rlln Oojcrr
<br />}\..,',rhrr I hrv. n&l rhl\,rml(Irrr r'!l !. .ilrcc r).omnly wirll ilCiry rnJ C.unr!
<br />trd shrc I-!ws rclarlll3 t, tuilii',9 ol tht Ciry.nd Cotrnryh.nr.r u!r'nrlE
<br />xbovc nr.trrn,n.,l nn)t.nyni \r.ho o
<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 />Framinq
<br />lns u latio n/Enero y
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Cenif
<br />FINAL 1t I DROO oL-++71
<br />Certilicate of Occupancy T
<br />Notes, Remarks, Etc
<br />t---+---
<br />tltu)
|