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BUILDING. INSPECTOR RECOBD
<br />SITE-WORK DATE ID/SIG COMMENTS ()tvNtR B( .t)tiR t)t,]l,(
<br />^Rt
<br />I tor.'
<br />I hcrchy trriifln uMcr Nnalty ol'Ilcrjury rh0' I cx.n$ lftnn rhc C.ntrh6 Li.cn{ ljw rd rhc lollosirs rcr{ (scc7l)rl5,
<br />Buiinc\\ md Pu'fcsion Coilc): Any Ciiy or Counly *hich rcqunc\ i r--nnir lo onsrtucr. .lrcr. i'npKxe, dcnx,lish .r rcfnir My
<br />snrcltrrc, niior r. irr h\ur,f,c. rls. r.qnnc( rhcnmli.rnr fir \u.hIcnnirt) lllca \ig cd {dr.'ftnr rh.r h.or dr h li.cncci !trntrMr
<br />b rhc pn,li\iois of rlE Conlnct, \ l-iccn\cd l,!w (Chaprcr 9. C.nnrcncins wirh sc.rion 7(xxr oa l)iviion -l or rhc Busincs rnd
<br />Prolassiotr\Cod.)orrhrrheor\hc ir crcnifl rhcr.liomud rhc hasis larihc rllcg.d crcnrflion AnyvblalidrofSccrionTf,ll5by.ny
<br />arnlicdhrrt)tirniisuhjfthrhcrpplicrtrrkriovilpcnrlrynfiottu,Erhdnliv.hrndrcddoll*\(S500)
<br />l. or owncr oalhc prcpcny, or mycmpk,Fes silh $!rcs rs lhtn sob mnrp(nsilion. rilldo lh. wo* and rhc nftor n d
<br />i c,rdcd or .6cr.d for tulc ( Scc 70,1-1. Busi,rcs {nd Pml.sio.s Codc Th. CdnrN!tr's Li.cn$ tjw docs tror rmly ,. an owmr ol
<br />rh. reFny *ho hilds.r irom@s rh.rn. ud rtF d.Es flch wolt hnnsclfor ner*llor rhmust nis or ncrosn cnplorc..,
<br />prcvidcd rhar Nch i,nphlcnf,ns @ n, inrcMcdoroff.ftJ tu rak.Il hoMvci rh. huikiinA or nnpmh.r.r i $U Birhn.,nc F.tr
<br />ofcotrpLrhn. rtr O*mr Buill.r Rill hrvc rh. honlcn ofptrrinC rhar lr or \1.. did 'i hild or i'rqJfl,v. rhc tmFny for rhc !uqn{ of
<br />l. ir osncrolrhc rx)ncny. amcxclusivcly co,rtr0dira sirh li.cnscd.onrodonro con{nrct rtE pn,rcct (Scc 7OlJ. Busncs
<br />n l Blfl\si.n C.dc Thccl ra.ktr s Li.cns. t-r$ docs norrtpltrn anow crort()p. yqho huildsor inr|)(xs rhcrcotr.
<br />!tul who.onrraclsl'orsuchpmjcch*nhrConrracru(nli.ctrrdpur\u.nibrhc(bnrncroisl.t.nselr*)
<br />-l
<br />imcrc {l n cr Sc.l
<br />Drt.: O$n.r
<br />rvoRxrdr. (:{ rIr Pi]NisAT()N
<br />DECI.ANAIIgN
<br />I hcrchy affnnundcr l]cn.hrolpcrluryore olrhc lollowin8 dcclar.tions
<br />-lhovcinilwirlmi
<br />dnrCcniftr.rcot(ttrknrrosrlrln\ur.ror{ork.(..rr!.nsdn r,.\ FroridcdlorhrScclt,nlT0lroflhc
<br />trb.rGnlc. forrh.t rlnrdant.frhc so'k f{n qhicnlnc pcnnir h h$rd
<br />!, * r
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<br />*o * u, *"r.. * "rkcN
<br />(.nrlr{tr\irnn rn$rJncc, 0s nqurcd by Scdn,tr l70O of lhc t{bor Codc, lor rhc lj.rtim,anc .t
<br />/ rhc *orl n{ *hEl rhs @mrr ri rsKt. M\ wnrtq. tunl|.n{irtr'n rn\urJncc(iricr.tr'd F lty nu'nh(r arc
<br />",.*, ,9ln"le F"^- "(3 -t-/9
<br />I .cnify rlur in ihc florfoflmncc,)frhc w.rk ntr whi(h rhi\ lcrrnir N issucd. I shrll nor ctrI'loy any Nron ir nny nrnn.r
<br />s r\ ft, hccom \filcd ro rhc trorlcn conlnlnsari'in h*\.1(-rlilonrin. {Dd agrcc IhJr il I \h.uld tr(rE $hjcd b rh.
<br />sorkrr con]P.n\lr ior pmvision\ of Sccrim :l7lx) ol rhc l jiir Onlc. I sh'll. lnnh*irh .. rdy *irh rho$ !'.vni.n\
<br />WAllNINCT l,iihtrc h uurc wolkcr\ mnrn.trqnotr .ovcrulr j\ d' l.'trul. tid .lIll luhncr J, ctlflr'Jcr to mninrl ncmlri.\ ild
<br />civil rnr\ up t, otrc hundrcd rhoulitrd dol)aF ($loo.0(nr ,',l,lrn,rr, \r? r,,r.ry+.nliiin.,lrn !c. r\ rroynted nn rhc
<br />scJrntrx'1i4rrh.Lhr(id..jn'cr.r,tr .11i.\,r.r. //, {
<br />",,..-9-)'t I .,,,*,",,X lrL\t'
<br />ulliNsEllcoNrx r.laf,
<br />ItECtAEdllltN
<br />i h.nhy rl6rm und.. p.nahroipc.jry rhrr I !m liencd uricr prorision of( hrfrcr 9 (connmDci'r8 (irh Sr.ri(fl 70Ur)ofONtion:l
<br />ol lhc Busin srrnd Pnn $nnrsCodc. rrd nry li.crsc is ii hrll tur.r nnd cllarr
<br />B Ks?ry
<br />conrrucror )4
<br />saNElf,.lcu0IlJMllri-d{itdrr
<br />I hrtubtaflt undc. Fnrl'!ot F.rju'yihri rhcr. ta.a,Dntudi{,n kndi Er8cic,r(trrhclrnnrrr.cofrhctrorknn*hchrhhI.nnirilk{td {Scc :1097 Civ C )
<br />AITUI,ANLI2ICLIAAIII)N
<br />I ttrclryalllnnundcr pcmhy ot p.rJury onc ofrhc f{,llo{n,g dcclrari{,nsl
<br />Dcnrnilion Pcrn h.Asbc{os Norifictriion Fcncr.l RCEUlrrioflslIiilc.l0.l'nno)
<br />-Rcqutcd
<br />Lrrcr ol Norili.di,n
<br />I.r,r,lyrhrrrh.l.,ldxlrtguhrtrins '.IrdiDg r({n,^ 'rnntrrlrr. n,I rtp]i.nhl. r, rlr^ t !r.r
<br />Al rc'r'l_v rhxl Ihrlr 'ciklrhn xl)0li.rrif(n (l{ cr is.or..r I rll(r r,).oDply \ irh rllciry rtrJ (ntrfi!
<br />rtrc.s rtrd Srdr Ijq(6lari'rEio huildnrf.o iurrDr Tc rcprcsctrhrivc\ olthis Ciry md (tunrylo enrc. qrotr ihc
<br />rholr nrrri,nrd pn't.ny ntr n,\p1di(rlrurFxc\
<br /> DDli.nnl r,\s.nl Sisnih'ft X
<br />pemrre name rpao,,{- -A3 -LL -aAA)
<br />s1?
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsu lation
<br />Roof Sheathinq
<br />Shear Wall
<br />flqming 5/2 Us.51,3 u4v44
<br />lnsu lation/Energy t,a-l /
<br />Drywall 4 DD
<br />|/t4'o1L t8.11,)
<br />Brown Coat
<br />_____1)b./s S'txrrt-;"-K-ttw X'**c* 5,t 4L'lq < ->=-rzr;-:i7E I
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />En gineer Final Report
<br />Flood Zone Certif
<br />FINAL [o/%/lb s\\96
<br />Certificate of Occu 7pancy
<br />-+
<br />Ext./lnt. Lath
<br />Notes, Remarks, Etc.
<br />',,"'9-9't€
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