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BUILDING- INSPECTOR HECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsu lation
<br />Roof Sheathino ail6e)
<br />Shear Wall
<br />Framinq
<br />lnsu latio n/E ne rgy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />[/]asonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Reporl
<br />Flood Zone Ceftif
<br />It
<br />FINAL bru
<br />Certif icate of Occupancy r' ( '"
<br />Notgs, flemarks, Etc
<br />.-t
<br />OWNER Nt][DER DELCAIIATlONi
<br />I h.rchy rllirn rtulcr pcnalry ,,t rcrJtrry lhar t r cxcmt lronr lhc C.nkr.b^-Li.ctrs. tn* tot rhc n,llosirrS rc0on (Scc 7{r.1r 5
<br />Busincs\ rJ Pofc$ion C,xiu): Ant Ciry oi Couniy qhich reqlirc\ r Fnnit lo connrucl. lrcl nnPn*., dcnnlhh nr EFt rnv
<br />ntu.rurc. Uior lo ns isuoncc, aho tuqund rhc ,,'/i.Mi Inr such F.m u filc a siSncd shlcmcnl lhd hd ;r shc t liccnscd lunnml
<br />b rhc pn,viii,ntr of rlr Co.ir(.lois l.i.cn\cd Ii$ (Chrprcr 9. Co nncncin8 wirh Stcri t ?fiX) ol Divi\ion 3 of rh€ E.sin.s\ ind
<br />Pmltssion\ Codc) or rhal l'. or th. is .r.mpr rhcr.funn ind rhch(i\ in rhcrlkgcdcxcnrPri A.yviohli(,norsc.rinr70ll r hj^try
<br />llplicanr turapcnnir sobjc.s rlr rpplicanl l. a.ivilpctrxhr-ofnor xtcrhin live hund.cddoiles (55m)
<br />f
<br />l.isowncrorllEpmpcny,ornrycitPloyNswirhsrScsrsthcnvrhconPcnsdi{ .eilldotrf,wotk dlhc{ndu'.ari D,
<br />inrcndcd orollar.df(trelc(Scc7(}1,l-lrusincsrndPn,fcsrn,n\Codc'rhcC.nlracrol\l.i.antlradocsMinllylonn,,r !ihcInpcdy who h'ilds or irll)rohs rhcdrr. rkl who dN( such trql [nn\c lf or hcr*ll or rhurgh hh or hcr owi . !ro].c{,
<br />,n)!idcd rhnr\u.h irtrDrornE !ircmr inr.nJd or.llcdl nn *rk Il lh$.vcrilr hillins or ihprtntrm.r is n)ld sirhinoic rr*
<br />olconDhrir.rh.OuturBuildcrsillltrt!rhcburdcnolpmcingrh h.or\h. did nor hui .rn IRnt thc ln,IEiy Iu rn purrxx.of
<br />I. {sorvNr.ilhcpropcrly. amdclusirelycorkr.ri'rt*irh !(cn\cic.Dtrcttr\k,cui(ru.r rhc prqccr (Scc ?(!{ Btsirt(-
<br />md Pn,ltf,si CdcThcCotrrmcn)irl.iccnscl.xwdoc!ior.f!lylorno$ncroipi(,t^.-nyahobuilds.riDpmlcslh$con.
<br />nM *no conrrxc(ror su.h pn,J.cr\ sithrConlflcronr liccns.d pursxrtrr t'rhcConlrucioi\ l-icie trs)fffi.Lu**.
<br />nQBfirast.louuiNt rto!
<br />DT(L.A.8AIIO!
<br />I h.vc rd *ill nri lin tr Ccniaurc or Cons.trr tu Sclf.lnsurc in wolkc6 comFnr.rnnr, .s Povidcd nn hy Scdion .lT(Xr oi thc
<br />Labor Codc. for lhc pcrformricc olrhc work for which rhc pcrnrir is hsncd
<br />x^,,,.,iJ*ill ui' air vorkcs' c.mncnslrion ir\unnc.. as r.qnirc.l hy Scclion.lT0l) frhctjh.r(bdc.1l'rrhcPcrlnnru..cor
<br />lnr whi.h rhi(lrrnrir is isucd Mysorkr^ ron1p.triil iotr nNnrNcccadcr xl B,li.y nu rb.r I
<br />c'O €.S <2A r-t'/ce
<br />Iccnilyrh!linrhcpcrfo unrr)frhcsorklbr*[i.hrhirIr!rnir n i$u.d.Idrllnor cnDl,'y rny pcrn{ nr rn]_ n'rnrcr
<br />soa\(,bcconrc\uhJ..rL)rhctro*c,('conrtn\!ri,rhs\olCJlitunrir.rn(l4relhrrill\ltr'!ldbc.onf,\uh]ccrn'ih.
<br />workcr coml[n\arn,n nn^nr)tr\ ol SNthn.17(x).t lh. trhr Codc.I\hll. hnhsirh conrPl, qirh rh{ |)rni{ion\
<br />IYARNIN(; lifllurc ro Krrc ntrkcrs ..nDrns$lrr.ovcriSc is unlxslul. aM shrll s'hjc.t rn cmPl{,lrr o crinnml Fnrki.\ rnd
<br />.ivil ftrc\ ut n, om hrndrd rhotrsrnd do1la6 lsl(x).(xx)). in rtldiri( k, rhc .o{ oi..nrPcnsrri{{ r rB.r rl tnvi'lcrl ntr rh'
<br />rTL i crc( Md lrktrfcy s li.\41r
<br />lll:llaxfi!!l\
<br />! hcrbt flnn uMf Nn.liyol p.rjuy rhrr I xn llc. *d rDd.r flovLsion oiahrrr.r 9 (.o.rnf,n.in8 Lvilh Sc.rion 7000) ol l)iv]\iotr I
<br />ol rhc tl \irc\\rnl Pr.fcssior\ ('odc. iM my liccnsr i\ in lull ntu itrd cflacr.
<br /># c37 o Q<./
<br />f-a/t dre
<br />(oi,tslltlt(ltoN utNu!!!i lc.[litl
<br />I hcrcby atfiirn undcr nenllry orftrjury rh rhcrc hsconnruclion kidins.!cmt forlhc Pcrinnmncc.rrh. w..k iorshichrirk pcnnir is
<br />i\rud(sc..109?. civ c ).
<br />APPLICANT DECLARAl'IIIN
<br />lr.rby.nhnu crpcnalryof I,.rjury.n orrhtr(rbsnrSdcclfflrtn'r
<br />DcmolnionPcrnn*-AshcstosNoliicaii,,n Fcd.ml RcSrhrionr(1[h.rJ.,'rn6)
<br />l{.q, i'rd l..rr$ rl Nlr ri(.(i,',
<br />I enilyrlr( rhc l.drrrl 'cfrlnriotrr rcgffdine r$.{r\rcflx*Jlxrr tror Uplic{hlc 1,' lhn P'(iorr
<br />Iccnifyrhorlhavcreadrhtsppli.arn dldsorcrl$rrhc nvc iftonndi,,n i\c.dccr Inarero<nnpll'wirhallCirv0ndCounry
<br />ordimnccsrndSrrrcli*\rcbrinpt,huildiiScotrinrcri,nL iNlhcrchy urhoriTcr.ltcsc
<br />,,hr. rc 1. r(lt,rfticrryli,r \)..rh,
<br />Ap0li.hnl trr *nl Sitn.t
<br />I
<br />Z*L/ -/ /k>44 <
<br />**'::';:'-;"""'*"
<br />];G,MFM
<br />Forms/Steel/Holdowns
<br />?onq lR .
<br />T-Bar
<br />@ (,,t/o,)/a)
<br />tcrd '\ \.t.t,.a. _
<br />tt
<br />I
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