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BUILDING. INSPECTOR RECORD
<br />SITE-WORK ID/SIG.COMMENTS OWNER AUILT}ER DFJI,CARATION
<br />I lrrchy alrtm nn,ler pcnalry ol pcrjury rhrr I ri cr.Dnr tft,m rh. c.nrkn)n Li.cn{ L,w n)r thc loll,,wina rcxvr 1scc.70-r1.5
<br />Bu\incss xul Ptufc$ion Cdt )r Any Cily o. Counry whf,h rcquics a tErm n' .onsrrurl- .lrcr. imti,v.. d.molish or rPlr .ny
<br />rrucrrc. pntrro rls Nsu!tre,.1$rcquncsihcappli(anrli,rsu.hFrnnrbiLx\'gn.ns.knrnr rhnr h. or sh. i liccnsed purn'anr
<br />b rhc [ovNnrr of rlE Cont..rois LBnrcd tjw (Chrtlcr 9, ConrmcncrnS w h Sc.ri,'n 70110 of Divisbn ] oflh. Busi.cs ,n.l
<br />PnncsnrnsCo!c)orthathco.slrctcrcnl|,rrhcrctromr.drh.hrs\li,rrh.rllcScrlcxcmplnnr.AnyvnalnnrolS.crion?0.r1,5byuy
<br />applicanr for l p.rn suhj(G(hc nmli(anr b aciv,lpcnilryotnor fttrc tho nvc hun'lrcd dolhn ($500)
<br />l, rs owmr il rhc pn,F.r y, or nry cmpl,,yc\ ,i h trrsc\ i\ rh.'r vrc co'nl,cnqrtr)n, w l d. rlr { lt u.l rtE srurm is nor
<br />i' cRlci or olidc'i t}r \alc (S!!.?(N4. Bn$n6s and Pnnassons C:,rd.: l hc Cbnrrrel(tr s Liccnsc l,!s dmr nor atrdy kt an ow ( of
<br />rhc pn,r.ny wh t'uilds o. inlpn,vcs drE,q u'l who Jocs s!.i w)rk h'hlclf or h.r\cll or rhouth his .. h.! oen cmployccs.
<br />B)vklcJ rh soch ihtnrvcmnB e ftr hrcnlcd oroiaed lor salc ll, hNcwr. rh. 6nil]ing or in{ftrkmnt n'ld * hm..c }er
<br />ol .l,nPbron, rhc ow.cr Buil]tr uU hrvc rh. htrni.n of l'.vng rhar h. .r shc dkl mr tuill or inrJ,ovc lllc pnEny l(,r ih. I)urF)s uf
<br />I..sDwncrolthcI]n)!crry,!mc\clusivclyconrra.ring*trhli(n{'l.onrrrn'cbcon{tucrrh.!n&cr(S..7044,Busucss
<br />a.n Pn,lssi)n Ciic: -thc cl,nrrrttr's l-ic.ns. Law J(f,s noratply!, M Dwncr .l !n,pc,ly wlF huilds or inpovcs rhcR"n.
<br />rtul who (nrncrsLrsuch pNJcels wrrh ! Cinrrm.lon, lactrr'l purtrrnr k, ihc ConMcntr t LEns tjw)
<br />I nnrckrnpr trtrdcr Sc(ir . B. & t'( ln' rhLs rcxstri
<br />rvoR(Em
<br />BEC!d8AM!
<br />I hcrcny anirm und., Fnaltyolp.riryonc otrh. Lut,wn's Jecld n,ns:
<br />l hav. dxlwill mlmra { Ccniturrc ol Consenr k) Sclrlnsurc ,rtr qrk 6' $npcnsario,r. rs r,ovilqi lhr t'y Sccrbn lT(xl or rhc
<br />tjhtr C,rlc,li'r lhc pcrl{mrn.c olrhc wod ltr qhiLh rhc pcm t s{EL
<br />rnJ wrll mhrain workcs comp.nsatsn insumncc. as rcqutcd by Sccr i,)n lln of lhc tjbor Cod.. tar thc pcnimune oI
<br />ld $h'(h rhL J*mnr F 6$cJ M) uo \.r\ (.mFnvrtun hn'r,n(c \anrr r F,liynuhh.rr.
<br />.'iq-l€ r.^nd/c,-,..qJa 1a3E 1l /c/ 2A
<br />_l.cn',i rhrr m rhe l].rfortuncc.f rh. work foi wh(h rlns frnnf s ssucd. I sh!l1nor cn,In'y ]n, Fr$n 'n
<br />any nr{n,Er
<br />y, Nrobcu,mc uijsr t,rhc wo cn d'mp.nsarn,n hwsolCal',l,nm. diJ dlRcthrr rrI dnNld n.{omc \rhjel hih.
<br />wsrkqs dDp.n\riion povision\ ofS.cri,,n lTnof rlr blt, Cirlc,I slxl[. n]nhwirh.onl['ly wilh lhor nnlisn,nr
<br />TV RNING: Folurc b s.u.. MrtcE ronpcnsarn,n .ovcngc ,\ unlawtul, arxl nuu ruhJl-tr r'r c Pl',yct rr unmd !.naltics mJ
<br />eivil ,jncs up k,.nc hunlrcJ lhous,nJ JoUs ($l($.o(x)). in r'tJii(,n b rhc.o{ ol.onrFnlrlion. laroges ff ffuvi]cJ rd rhc
<br />Scclon 10?6 or lhc ljhtrA c, mbrcn md *om.y'\ ,c.\
<br />,a1()
<br />DECIAEAIIO!
<br />I hcE6y atitm untlcr Fnaltyo, leiury lhll I anr liene.l u.,lcr l)l'eti{,norChafl.r 9 (on'Encio8 with Scction ?00n)ofDi$n,n.l
<br />of lhc Busincs Md Pftntsions Codc, &l my liccn* h in tull li)rc ul cllm!.
<br />/a350/s
<br />t )q)
<br />A G 's!!N]X!(.f!!][lr!12!!!iMN1f
<br />I hcrhy nlftm und* l.mliyolpcrjury thlt lhcrc is r.onnruclion h nu rscrey itr lhc pc.lirnufrc or rlr work tnr which lhn lrmi n
<br />isucJ (Sq.1l)97, Civ. C )
<br />AfILICA{LIECIJAAIIaN
<br />I M,y aliim und.r pcnilly ol Frjuly om of lnc lhlhrvin8 dc.hr ion!:
<br />D.mlition Pcrnfe^sb.stos Notili.rlion Fcncnl R+u,ulnN i'r(t 4). P!n6)
<br />Rcquncd t ltcr or Nriliulion
<br />l ..l1 irhrrrhc ltdcrilr.suhrtun\ ftEd'tirs adrros mm)vrl *. h, at'plirahlc t,'rhn p,ojc0r.
<br />-l
<br />ccrlilr lhdr I hvc rcrd Uis.pplioarnnr and stllc lhd lhc atDvc inhmarioo n cor.d. l rg& {,r coq)ly wlh.ll Cilyan! Counry
<br />oilm.hccs dd sGrc uws FEriry to buildins consrdcrn'n, ! h.rhy Nrhotu. rpo\d ,h!cr dr lhs Cny Md County to cnlcr upon tlE
<br />ah,ve m.rion.d ttup.ny rur in\p..rion puqN.s.
<br />,4,,,,.,,, .. n*"", ..,*,nu,
<br />l\*,**,",,".,
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsu lation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulationi Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />/l IA /-.
<br />FrNAL i/61 /)o)4 q
<br />Certificate bf Occupancy
<br />Notes Re arks, Etc.
<br />2^,
<br />r{
<br />DATE
<br />Set Backs
<br />T-Bar
<br />.t1, t u I 1l )-L/?)
<br />L.nJ.i\ AJJrc$r-
<br />,r*,-.,L-d-i.(!
<br />I
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