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BUILDING. INSPECTOR RECOBD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNEII BI]I LDI']R DELCA NAT!(
<br />'NI ltr.hy afitr u&icr Nnnlty or trriury ltu I cxcnpr lror rhc ( qrrr(ron l -iccnr l.a* n{ rhc bllo{in! rcrmn ( sc. 70 l r 5
<br />Atrsin.s\ nnd ltofcsi,n Oxlc) Ary Cil, or Counly Bhi.[ r.qrnc\ trnnir k) conifl.r. rlr.r. inlrov.. dcrmlhh or tuprn iny
<br />(ru.oc. flior k, ir\ i$ua.cc. !v, rcquires rhcnnpliciDl lor suchrirnnirb lllc, \iSndlstdcrmnr rharhcor shc i\ liccns.d |{rlu.nr
<br />t, rhc polirioN ol rlt Conrhckr s l-icctrscd t-rw (Chrprcr 9. (inn'tuncing wirh Sc.rion 7llllr ol Oilhioo :] of rhc Brni.* xnd
<br />Pn'l.si rsCodc) or lhlr heorstu h crcnfl Ihcrcliorrnd Ihc hr\h nrrh. ill.p.d.rmprn,n Anyvid.rnn.fS..ri,rT0llSbyrny
<br />rprlicidturircnnir\xhj(rsrh.rf'nlicrnrbrcivilfcnaltyor'nol.xrcrhNtiv.huHlrcddottir\(S5(xr.
<br />L ns owrtr olllE popcny. or nry cnrployr.s Lvilh wr8cs n{ (h.n yrc.onltl.nsr!r.r. *ill ',u rh. work nnd rlf srftrurc i( n{
<br />i cRlcd orofi.icd fn$lc(Sr 70{.r. Br\irc$and lh'fe$ions Cnlcr Thc C.M..rois Liensc L1q docs nor q,plyioanotrrcr.1
<br />rhcpmpeny *ln, builds or impmEs thrBtr. .nd qlb J(a fuh m)* hinrcll or hc clrorrhnrFhhisorhcro*ncnlpk,ycc\.
<br />phvnicn riN \uch nlll)rornrnF tr. nor ime Ld or onircd lirr \rlc I t h.wckr. rh. toildirs or impmum Gnnntrirhinone}[nr
<br />of.onllldion. dr O*dcr aui[.r$illhrkrhctnndcool'rrovirs rhat h orslrd nor buik] or nur)rc fic pN!.nr lor ih. purBr* ol
<br />-1.
<br />is ownn ol rhe lr,lcny, rm.xctuiivdl, conr Bcr inc wilh lic.ned conki.nn h .r'nstrud llE r,f iccr (Sa nlr1. Bu!nc\\
<br />aid Pn,fdsirnCodc: lhcConlrNroi\ Liccnsc l-a*d..r not rlrtlyk, rnown.r oltr.pcnywh(, buikh or nnnn,vos rh.r.oi.
<br />!trd *ho ..rkn tsror su.h th)Fch sirhICofrmcr,ll) liccnscd purnlnr r'rheCo rrrols l-i.ctrr Last.
<br />I rrcxcnrl u cr S.cr
<br />l)rle: OEne.
<br />woRKFes'c{} 4.Ns/{T'i0N
<br />DII;LABAII9N
<br />I hcrchy 0ilifln trndc, pcMlty.lpcrjrrotrc ofrhc rnlk,sing d.clarrri{nx:
<br />lhltclulsillmri.r.inrCcnitlcnr.olConirfltuSclfl'Norctir\orkcr'coarni{ri,n.r\lroriJcdlorbySc.rnrn.lTlX,olihr
<br />I a$or Codc. rd'hc pcrfonnrn.. ol rh. wolk ror which rhc pcnit is Gsued
<br />'l'..
<br />q,{l f.r ql,tr h,'n. n.nni ,s -{trrt M\ q,rN.'., rr'rJrh.rtrar','tu.,'n-.rnJF,li)nu
<br />,,.,., .Q".t< C{,. ee.sa\r.,. 1n3!1a,^c( 4r.,il- i5 016 v t.lErtn s
<br />-l.cnily
<br />tl[r nr rh. !.rfonutuc orrh. *ork f(tr *fiich rhir lcrnrir h n{ucd. I shrll i.t cmpk)y.ny pcrw,n in !try nunic.
<br />k) Nbt.6nr\!hJ!trlothc*orkc6'complnsdt hssofcrliturni..,trd l3e rhnr ifI dhuld h..onf, ruhjccr hrh.
<br />sorkcK.o'np.n\riionpnrli\nrn\oiScdn,nlTurolrncLrEtrcodc.l(ull.tunhwirh("'ntiywirhrh.ctmvhnnr
<br />WARNINC: Fiihrc r. surc {.rkcrs .or1lci{rioi mlcrrsc is unlawrul. rnd sh! I suhjccr n cnrploycr nr qiminllpcn hic\ !!d
<br />. \i 11".s ut) n, 'trr l[f(L.c{l rhotr\x (l rlo]r'\ llrrr).rxn))rd(lri.n r) th. f.i or .otrl Ftr\rr.n. nann!.\ i\ fn,v dcd ritr rl(
<br />s..rnr 30760lrhc lrhr chdc, ndc{ rM nnor [!4$tvl''
<br />DIiSTTBAIIAN
<br />I hcEhy iinDnndcr Ftrnhyol n$jury rhai I nli(D$dtrndrrpmrisionofChalrcrr)t(nmmn.ing*irhSccri.n7fin)ofDivi\irnil
<br />.l tk Busnr\snn Pmrrsrn,n\ Ci)dc. ud my liccnsc t i'rtul|lhre. cltcr
<br />^c-3q 11t(o 19
<br />rlrfu
<br />I hcrcby.rfinn undcr Jri.xy.r|frjrt rhar rhcrc i\ r consrrucrion Ltrding iscn.y lor rhe pcnnnnnncc ol'rhc sork n, $hich rhi\ lemir is
<br />i\sucd rsc. :l0r)7 Civ C i
<br />Iril.,\ AdJic.r
<br />-
<br />ATILIgANfDICIABATAN
<br />Ihrhyn,limrnd.r pcMlry ofpcrJury o.e ofrhc iol!.wine dcchrdi.trs:
<br />Lt nt,lirn P.rnrirs As$c(os Noliiic.rion lj.dcrrl RcEUhri.trs (Tirlc,l0. Pan6)
<br />R.qtrnc lrrrcro, N.rlfHri,n,
<br />l.rnil.v rhrr I lrc rcrdthis ifJ,l
<br />onli, mc\ rtrd srdc lr*\relxli[3 tr]
<br />ftot nrnriorcd lx)|f,a! li, iNp..r
<br />i. ri,ra.d{ crrIhrnlr,!c irronnrri(nr i\.otrr.r I a!r.c k) conrry $irh rll (-iry itrd cotrnrv
<br />sctrr.riv.s olrlrh airy and Counryro cnrcr ulor rh.
<br />,\t'rliunr or ,\,:r r Sixnn
<br />,l0. L
<br />5f'l lv
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf loor/Venl/l nsulation
<br />blzot IE dcsT
<br />Shear Wall
<br />Fr amrng
<br />ln s u lationi E n erg y
<br />D all
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lvlasonr Y
<br />Pool Fence
<br />T-Bar
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif.
<br />FINAL 7-3-lB J)rSa -a€r)
<br />Certif icate of Occupancy
<br />UFER Ground
<br />Roof Sheathino
<br />Handicap Req.
<br />Notes, Remarks, Etc.
<br />_l ccnnyrhrr rh.litcrnlrcguhrhns rcFddinE r\hr{os r.nnnrlarc norlppli.rhh h rhis lnrFcr
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