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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE IDiSIG.COMMENTS OWNER BUILDER DELCAII 'I'ION
<br />I terchy atlto undcr !.n!lly ('i pcrjury rhlr I !m cxcnrlr iron rhc Conlrrro6 l,iccne ljw fo! rhc aollo*ins rcason {sr 70.115
<br />Br\ihc\! and lhfc\si,n Culc) ny Cny or Cotnry whi.h rcquir€s a plrni, ro d)nir cr. ,lrr, inpmvc, dcmlish or rP.ir M,
<br />slru.rur., pritr ro ns issuan.., nls.cquics rhc appli.rnr rt, su.hr.mir ro 6ld a siencd sl,lcnEnl rtu hcorshc ir lianscd ,unulnt
<br />ro lhc Dovhio.s ol Iht Connrlff\ Lictnscd L.* (Chiflcr 9. Com,ncncirs eilh Scclion 70OO of Divisi.n :1 ol lhc Busihds rnd
<br />Pm{.*n,ns C{xlc ) or ihar hcorrhc t .xcmrr rhcrfrom nnd rhc hr\i\ lbrrhc rlhB.d.r.nun,n Ahy vn,hrion ol Sdn)n 701I 5 hya.y
<br />#ffi.ffi 'ffi#ffi ;ffi;;dffi $,ilr:'T*, ",rhc pnlpcny wio huilds or inDmrcs rhcron. lnd who &,er {ch w* hnnsclr.r ncr*lror rhRrgt nir or ncro*n cn'pl,,yccs.
<br />providcd rhlr such infrovemnh aF mr i.tcndcd o. oficrcrl for nrlc Il h.wcvc( rhc hui(irB or nnporcNd n wU rirhirr om )ta
<br />ol$mplcrbn, $. Ownd Buikld wrll hrvc lhc hndcn ofptuving drd h( or sh. did nor huild or in{role lhc nmldy lirr rhc lDqx'sol .
<br />l.!\owncrofrhcpmpcny.rm.r.lu{volyconr&rifgqnhlicdtr\cd.ornfttrsrr&tr{,x.rrl..rn&.r(scc.7(!4.Du'iic\\
<br />itrd firlLasarflcodc ThcCotrlrrcl,tr s Liccn\c L0* rloc\ nor.nDltr' rnowD( olpronnysho huild\o. imp(,$\rhcrdnr,
<br />,nd *lD .o kx.( f{r \u.h nn)j.{h airh a Cotrrrcr,( s) li.rtr{,l rur\urfi r, r hc C1)nrnutr s Li.cnsc ljw )
<br />/\;
<br />t,L(x 0s z/r {,\
<br />D!!t.!!!rrar
<br />I hcrcb, afllrm uod.r pcnlr, of tdjury o.c ofrhr folk,wing dcclffirion\:
<br />I hNc ,rxl {ill mimdin , (]cdir*ar. .t Cdn*nr k, Sctf ln\uic td workcs- ..nlE.s.ln,n. rs tmvidcd i'or hy Sccrion l7(X) ot rh.
<br />Libor Codc. toi lhc pslortuncc .r rh. work r{tr which rhc pcmir i\ i$ucd
<br />I h.v. rnd *ill nrinrrin wortum .onpctrsalion insurtrmc, as toquncd hy S.crion 3?m of lhe Lltn Code, f$ rh. Fd.rn,tuc or
<br />rhc work lor ehich rhisprnrir is issun. Mywo*c6 comrcns.rion insumncc eric. and policy numhcr a.el
<br />Poli.yNuilb.i ExDtcr
<br />4:rClb '*, . *" **",Nn(c,,r,hc {orl ror whEh rhis rcrn,ir i\ i\\&d. Lhrrl Mr d'nrk,yaiy,,c,s inrtrynwm!
<br />o J! ro hclom ohJlrr '. rhc u o ci( !n 'FncJr'.. liws or cdlirnnil aM agrc r har il l lhould hc..m subjccr b rtr
<br />workch compcNdnrn pmvrionsolSctmtr 37(x)ofrhc ljbor Codc. r shrll. aorrh*irh comnl, wirh rhos pmvisn,i\
<br />WARNINC: Flihrc ro scorc worleri.o'np€isarioD colebac is unhwliil. dtul shnll subjc.l m cnll]b)rr xr criDiral pcMllics ond
<br />.nil rnr\ rn b otrc hundr.d rhou\ nd dollrs (sl(,().(r)(r. i'r rrlJ i(r r! r ryW:"Wft*,*
<br />n:EE+,<
<br />I hcrhy rflntu undcr pcn,lrrofp.rjrry rhxr I a'n li.h{rl undcr tnovni.n ofChrtrcr 9 (.unnrrncine *ilh SccliD ?(x)O) ol I)ni.i,'n -l
<br />ol' lhc trucincss nnd ltonssiorr\ (odc.3rl nry licc0{ i\ ir inll tur.c ond crlcrr
<br />COXSIBUCIIONIENI)IXGAAENCI
<br />I hcrcb, lllirnundcr pcnihy.t!.rjury rhlr rhcE is! con{ru.ri{,n hnding acc'ty tor rhc ncrr.i,Mncc ol rhc vo* lo! whichlhi\ tctmil is
<br />tsuc{ (SL{. 1197, Cir. C.)
<br />AITITANLDECIABAIIAN
<br />I tErcbt amnn undcr pcnrhy oipcrjuryotrc ol Ihc followirA dcclomtions:
<br />D.mrIn,n P.rmirs A\b.nos Norificarion Ptdcral Rcgularions (-lirlc 40. P0n6)
<br />Rcqrir.d lx f .f N.riU.didr
<br />lc.nilyrh.rrl[ltdciil,c8ullrions rcsardins ash:(os rcn$ul rrc nor rpli.ahL r, rhir rmiccr
<br />i,D i\ corcd. I l3la r,.onrly sirh all Cntrnd Co!trry
<br />o. Q,
<br />.irhn ( iry,fd Corirr ro Mrcr qxn' ihrf--u. r, ,n, , n*. ,. ,. ,,n. trpp'L r \rxh rhrrr'.:r^.\rtr i,J'
<br />$'iir*W&'n nol ,l-N'/1v
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />D rywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\ilaso n ry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL rottE//{filw*'/u'
<br />Certiticate of Occupancy [/,
<br />Notes, Remarks , Etc.
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<br />Pool Fence
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