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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE COMMENTS OWNER BTIILDER DEL(ARATION
<br />I hcrchy ofilm unlcr pcntrlly.l Ftury rh.r I m cxenrl lrcm rhc Coftact,n l-i.co\. tiw rur rh. rdbwir8 rcuso. (Scc.7031.5
<br />Businc$ and Pnrisi.n Cdc) Any Ciry or Counry shich rcqutcs r pcnnir k' .o.nfld. ,hci, i,nProlc. dcmoli\h or rcPat uy
<br />{ru.ru6. lJrdh irs ii\urn... lko cqrncsthc rrpli.rnr fitr so.h fnnir k,lilc a siSncd st.lenEnr liflrhcorsh. is lic.n{cd frr{r r
<br />b rhc pd,virk,ns of rhc Conricrofs t-i.cnscd liw (Chur.r 9. clDnrcmire vilh Scclion 7ll(x) ol'Division:] oi rhe Bu\nts rnd.
<br />ItolcssionsC.nc)orrhai Mor\hc texcmllrh.rcliom!!d rhc hrsi\ lorrhcallcE.ddcmrri(,n. Anyrnnrrn,rofScdiorTlllll5hyrny
<br />rppli.rnrfin a tcrdir subjcckrhc rtpli.ani ro a.irilpcmhyotno( m.rcrhnn livc hundrcn doll(s(r5m).
<br />l. .s owncr ol lhc pnJrny. or [y cnplo]€s *il h saScs as thcir rolc conucn\0r ioi. sill do rh. sdk turl thc nrtum h .ol
<br />inrendd or ollcrcn Io, slc (58.7044, Bx\ine* lnd Pofc$i,Ds Codc Thr Contr.ror's Li.cnt L.w docs trot trpply ro m o1vm, or
<br />tltr FmFdy wh) huilds or improvcs rhcmn. rnd qh dos nrh wlk hinscllor hcncllor rhmugh hir or hcr own cntllor.c!
<br />tnlidcd rhar *ch impok'ftnhEd inrcndcd orollcKl forsk lL lt,s.\ ci rh. hriUid8 or n$rr.vcrEd t hU sirhinorc lrr
<br />otconDbrion. rhc Owmr lruildcr will navc rhc hnlcn ofpmlins rhor hc or shc did n.r tuild or i'nl,rovc rhc tmpoly lor rhc puqx't oi
<br />_1. x\onmro, rhc |m)pcny- imcrclu\ivdly.o.t,cii'ig s rh lirctrsotl.otun.ror\ r,.otr{r.t ll'c lnorccl lscc. 70tr. Busno$
<br />r Pnna\\i Co .: Th.Cotrtr.ktr s l-i.ctrrc Lrw doc( trorrlplyr. rnoNnq oltropcnywho huildsor i'npri,v.\ ihrrcotr.
<br />nnd {ho conkrch ftr su.h lrojcckBirha Onnr.t.t,rrsr liccnscd lursurnr k) rhcConta.ttr\ Li.cnsc Lrw)
<br />I rmrxcnlnr undcrS.cri(
<br />IlaBf,!&t-s}lltElSATON
<br />DICLA.B !!l
<br />I hcrhtrltunutrdcr pcfrlrrorIlrjuryon.of rhc tulloqingdcclaflri{nr\:
<br />lhrvc Md willn,iinruiraCcdilicrcoiConsc ros.ll ltrsurcttrsorkcrs'.on|tn{rt,r\nr'vnhdtuhySu.rnrnl7lx)otrh.
<br />llhor Cdlc- ror rhc p.nbnuncc oirhc Nork aor*hich rh. pcanir t is,cd
<br />I hnvc rtrd willnki (in sork.rl.onfctrsnlion iNurdtr.., ds rcqutcd hySccli{inl?(x)olrhc lrh.rCdl., fd rh. Pcrli,nMnccof
<br />rhc work larwhi.h rhh p.nnir is i$ual My work.^'conrF.s.ri( insutun.cc.tricr ind dtynumbcrrc
<br /><.2-
<br />c6 /'6@f s Lo
<br />-l.cnily
<br />lhir in rhc pcriorroNc ol rh. w.rk nr shi.h rhis pcflnir is istr.d. I shll n.r.'nrloy rn, ncrn,i ir ary nunncr
<br />q, rs t, hccoft s,njcd n, rhd sork.r\' .. u.ns.ri{ hw:orcalinmd.atr iErcrh ifI (lruilhc.nm n,t'jcd hrrf,
<br />worlcr\ compci\rri(,n ln,!isnrfi .r Sc.l i(ri :17(X) ofrh. tnbr C.d.. t shnll,lonh$irh conDly sirh rk,{ pm!itnrr
<br />rv,{RNlNC lrrihtrc ro {rurc \orkcrs .onlp.n\rrion $\cr0gc i\ nhwful. d $rll nrbJLtr rtr .mflo}!r lo cnlrinrl r^-nrlri\ ril
<br />civil nks up h onc htrodrcd rhousand dollas ($1m.lxx)). iI io, t, rl( .on rf.. rNns.i.tr. rr8c{ r\ nroriJctl for rln'
<br />'"il';\y')u"
<br />DECIdB6IION
<br />Ihcr.bytrlftnuidcrlcnlryofpcquryrhdIanli.cn{rluMcrnmvhionofChanrcr9(conmcncingwirhsc.ri.n70m)ofDivtiotr:l
<br />or rhc Busitu*md Pmf.ssionsCod.. aM nryli.rns i\ i'r full for.c rnd cllccr
<br />a 4/.-
<br />oz_
<br />".,",s/j;*
<br />(I)NS'TRt](:'IIoN I.ANDIN(i ACENCI
<br />I hcrcby aflirm undcr pcmlry .l p.rrury rhr lherc is a cordrudion knding 4cncy f(r rh. tdrdnuftc of rhc *ork fitr *hih rhi\ Fr ir h
<br />i\sucd (Sc. 1097. Civ C.).
<br />I ."J.''\ Nim. _
<br />lxn.lcr\ Addrc\\
<br />-ATTIJCANLDICLABTIION
<br />I lrmbyrlit trnJcrI).nrlrr.f ncrju". col rhc lnllo{n,g dr.lrrrri(rtr
<br />D.nn,hior Pcrorir\ Anr{os Noiiliflli,r t'cdcr l llcAuhri,rr ll irlt {), P:tr16)
<br />R.,tuncd Grr.rol Norili.rr.D
<br />l.cdil_vlh{ rhc,cdfirlrcetrl.iiors rct{dirgNbc{o!rcnFv{lrrc nor xpplicxhI t, rhi\ tn,jr.r
<br />_lccnir rh{r l hlc rcrJ ihis rpplicarionaftl{Icrh rrh.nhrlc i'nnnndi( n.or.cr lo8rcckroardy*irtallCiryrnd Cou y
<br />ordi',rn.csrndSrorcl.aNsmlaringt)buildi'r!con(tu.rn,ndh.r.byrurln zcrcprcsctrl|rir$ol'lhl(ityarlC.unryroctrrcrutionrhc
<br />rhrc nrtrrir(d nn{rny 1,tr 'n.redilrznoar$
<br />noorr*a * n**rtt ***d /
<br />pemi,ennmciprin,,r( -h"/Y/r'
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq tt l,,,//4 5'\6 \ t F<V-%
<br />lnsulation/Energy
<br />Dryw4[-
<br />Ext/iit,Lalh (n l* e .ura F474v
<br />Brown Coat
<br />lVason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Beq
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL 't/ts^ / E,-;\66
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />-+
<br />ID/SIG.
<br />Subf loor/Vent/l nsulation
<br />t-+
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<br />tt
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