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BUILDING. INSPECTOR RECORD
<br />SITE-WORK ID/SIG.COMMENTS OWNER BUII-DEX DI:I-CARATIoN
<br />I hcrcl,y rlnnu cr pcirlry ('f p.rJury rhnr I dr crr rpr linn rh. O'ntr.h6 Licns. t'w fd rhc followi.S rc0sn (Scc 70.115
<br />au$rcrs md Pn'r.sio. Cudc) Atry Cny or Coutriy wh'.h rLrtuircs . jriinir t. cotrsrru.r. rllcr. imrovc. dcmlhh or rcnJn Jny
<br />{ru.rurc, rhrlo ils hsurmc. ak. rcauncs rhc.pdi.! t)rruch pcrnri ro filc r siEncd (llcmnl rhar lE or shc n licci{d por\oanr
<br />t, rh! nmvtion\ of rne c(,nracd \ t,iccn{d llw (Ch+rcr 9. Conncncing sirh Sc.ri('n 7filo of Divisn,n I of rhc ausirr$ and
<br />PflnassioneCod.) urrhdr h.orshc isrxcmpl rh.rcfro rnd rhcbrsi\ ntr rhcJl.gcd cxcmptiun. AtryviohrionofScclirnl03l.5hyony
<br />rmlic.nl nr a lcirnir subjccBthc iptliconr lo rcivilFnrltyornor Ntrclhan fi( hundrcd dolllrs (5500)
<br />l. rs ownci of rhc pn,Fn y. or rt c lrloy..s wnh wrgN * rhcir v,l. o rpctrr.riotr. will do rh. q.rk 0nd rh, (Mlurc n nol
<br />inrcndcn oroficrcdri,rsle(S€.70,l,l.lru\incsandPmlc$ionsCodclhcA,ntrldoisl,iccn\cli*doesnorqrply'oanosicror
<br />rhc pDpcny {ho Snilds or imprcrcs rhcR,n. dd $ho dm\ \Eh sorl him\clf or hcr\clf or rhn'u8h his .r hcr ow cnDk)]ccs.
<br />uf.onlnlcri[ rhc Own.r Buiki.r willhrvc rtf, hunLn of Fivir! rhar hc or sh. did frn horld or iremrc lhc pm&n, tor rlt purlnsol'
<br />L rsnsncrolrhc pr'liny. rcrclu(ivciyc.nl!.crin! wirh ri.ctrrd ..nh*,n to con{rucr rh. pmjcd (S.c 70'1,i.llu\ms
<br />!ftj PolishnCodc:lhcConrrrroisLiccn\cLlwdocsnollprlyrorn.sncrolpropcnyshobnild\ornnpmv.srhcrcon.
<br />r d sho (n ocrslnr\khpn'j..twirhrConrla.tr(r)liccn\lylpu xrir k, thc Coikr.ttr s Li.cns l-trw).
<br />-l
<br />adctcmpr lndcr Secrion I & l)( l.rrhn rctrn,n
<br />uoa6Bs:!:auElE:arloN
<br />D[ClA-8rtIIoN
<br />I ltrrcby rrlnn trnil.r |ttrrlr!.fpcrjury.ic ofrhc nnL,wi'r! d(hrrrn)n\
<br />l luvr rid will nhnnrir rCcdrllcrrcofcoNcnr bSlll l \urc lin so'kcn .unll)cDs Nn.ns prolrdcd tu hySccrion:l70ootrh.
<br />l-rlxrCo{lc. for rhc prrfonmm.ofrtu suk lar whichrhc |(nni{ i\ i$trcd
<br />ffa* " ,, " ', ...r, -.,lch' ! n,n,,.nsor '.n nsu, ncc. .\ rcqu ncd ny sd ion -1700 or rhc lilx, codc. r{t rhc lsrd.rncc or
<br />Itl!:'/(nr( n{ qhr\rhn Nirr r. r.ucJ Vyl.lor r{nntn'arn,n 'n.u'r'.cclrh' DnJ,r'irnumh"' c
<br />-l
<br />ccnllyrhlll if rlt pcrli,nMnc. olrhcw.rk fitr*hich rhn !.nnir ir l\\urd. I \hrll tror cflPloy aiy nc^otr in rny nrtrDcr
<br />$ n\ n, hcc.m {'blccr t, rhc $oitr^ co'np(i\rin lrw\ of Crlilamir. r rgtorrh ill \k,uldh*nmnrhFd torhc
<br />*o*.r\'conrt).nsxrnnrrrtrvi\ion\ofsccrion:l7u)orrh.l.rhtrcodc.l\hrll,n)nhwirh.o rdy wirh rho*fruvisiors
<br />wARNIN(; Frihr k, s.uro s.rkc^ .otrrP.tr\a.otr colcrxlc i\ unlnwful. ,M nrall $rhjc.t ar ctd.ycr t).rimi'il pcinlra Md
<br />ciuil ftr\ up b onc hundrcd rhon\aid dollur\ lSl{X){XXl). n, rddri(,n b rhc.on ol.urltxtrrilidr. drnn8cs 3! t,n)vid.d l,n rhc
<br />Sc.rn 10?6ol rhc l-ltxr Ctdc. ir crcirnd rnoirry \ l.csfl+>ltL
<br />DECIdN{IIAN
<br />I hcruhy amnn undcr pcnalryofpcrj!,r rhar I !n lienyn undcr provhioi ofChanrd s (onntRinS wilh Sdrbn 7(x)) ofDirnion l
<br />ol rh. Eusincssrnd PmnssionsCodc. mxl myliccnsc is in tull r'orcc ntrd clld.
<br />a Lcr>.3 3 )
<br />t/42 /rY
<br />CANiIf,IJCUAN!EIIIINCIIiTNII
<br />I hcEby aifirm und.r Ffuliyorpcijury rhrr rhcrc h a.dn{flcrirn Lndine i8cncy lor Ihc pcriormncc olthc {ork nr ehich Ihi\ Frhir n
<br />hsucd(s( 3097, civ. c )
<br />ATILICANII}:IIABTUA!
<br />Ih.EbrnnmuDd.r|xn.llyolpcrjuryoncoirhcioll.wirsdcclor nrn\:
<br />l)cnFlirbn PcnnirsAshcn.s Norificlrnrn l:cJcral Rc3nhrions tlirlclo. Pfi6)
<br />-Rc{tuircd
<br />llrrq oi Noli,iclrion
<br />lcrn,l.vrhrrrhr tcJ.rxlrcguhrnr\ tottudnrg x\trios rcnn,rrl rrc trorrfl'licfilc k, rhlr Dmtr.r
<br />I ccdilyrhd lltruc rcad rhtrppli..tinn ikl{rrcrhrrrhc ihrc infonnrti.n ncomcl I !3N ro conDly sirh rll Ciry nid Couiry
<br />'trrltr r(\n d Srrrr L(r\ '.hri'rI r, htrikiirA.otr{ru.!!, . x d lrrrhyrurhoric rc0tu\rnl,trivcs oirhi\ ( iry rn,lCo!trr) ro c rt' utrnr rlt
<br />rl,fR trrnri,rod p()t)cd1 ,nr i'Inc.r
<br />Alpli$nl or Aaenl Sianilurr
<br />fum rre n{n.(Drinr):ttb slzyll
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathino
<br />Shear Wall
<br />Framing
<br />ln s u lation/E nerg y
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />N4asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />rl
<br />FINAL gllblt9 hn*4 91,/
<br />Certilicate ot Occu nc
<br />Notes, Remarks, Etc
<br />DATE
<br />LaDdcr ( Addrcsq
<br />-
<br />Subf loor/Vent/l nsulation
<br />Flood Zone Ceftif .
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