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BUILDING. INSPECTOH RECORD
<br />SITE.WORK DATE I tG.COMMENTS
<br />Set Backs I !tq
<br />Forms/Steel/Holdowns I
<br />,lA
<br />frt,Erection Pads 1 o fl,,t) l <4
<br />UFER Ground 116 vv 4t/
<br />-)tu ryl
<br />,/.:)
<br />Roof Sheathinq 6 I(( -.t-u<r/?_
<br />Framino f-l lPfi 7
<br />2lnsulation/Energy ,J DJ,:,,2
<br />Drywall a)trt I
<br />Ext./lnt. Lath t /B tJ z7'
<br />Brown Coat ,l t1 t(L n L')
<br />Ivlasonry I u\
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Fleport
<br />Flood Zone Certif .
<br />tl
<br />FINAL IA a IV ',4Arlklitk l(-) -.'
<br />Certif icate of Occupancy . \I7 T7
<br />Notes, Remarks, Etc.
<br />oWNER BUILDDR DI:LCARATION
<br />I hcrcbv rmfln undq ,.mhy of |fr)uy rhr I m ctcnrr nom rhc Conhclm l.icci\c u* r,r rh. tullosilE rciwr (Sc.7011 J
<br />Br\inc$ $d Prolcsinn Code) Anr Cirr ,tr cou ! which rcqtrirc\ r pcnnn ro coi(tucr. nlrcr, nnpn)vc. dcnrlilh ,{ totrir ry
<br />etucrur.. triort, ir\ i\\uaicc- ako rcqutcs rhc aDnlicanr for su.h pcnnir k, lilc r \igtrcd nrknrtrr rhd hcorshe ir liccrscd nlrun
<br />n, rhc F,vi\i.trc ul rtu Conra.k 'r t-i.crs.d If,w rchdflcr c, Co ncnrir! $ilh Sccli,ni 7(XrO of l)ivi\i.n ] o{ rhc aulnt$ rnd
<br />rpfllc!!lktr!ncflnilu6tccr\lhclp!licrtrrk,r.ivilt'cMnroln.lnnmrlnnlivchuirdldolrrsll500}
<br />l- as osmr orrhc pmlEny. or mr cnfk,r\rr wirh (rgcs as rl[n $h.omFneri.n. will do rnc sork dd 'lI {turn n fri
<br />i.rendcd ororlcrd lor elc (Ss TOt4.llusi',cs{ lnd Profcsions Codc: l hr G,ntacroi s Lkcnsc l-rs d({( rcr apply b rtr o(tr{ of
<br />Ihc pDnln, Nho hrild\ or improv.s rhcEm.3'xl*h) dms such \rnk hi'n\.llor tursclfor thn{,8h hn or her.*n.nrLycc\.
<br />Ircvidcd lhar \u.h imlovc'Enlsm nor ir cd.d orolIcNl for sak l( h)$ss. rhct ildi'rgor i'nfn*t rflr is wkl $ilhir.n. )!lr
<br />.f.onllcri.tr.lhc OuNi Auihr willlntc rhc hrdctr ofpbvii! rhdl h o! sh. did frn hoiu or irlll(N rhc ,fr,Fny for rtu Ptrqr*df
<br />l. asow'riol rhr F'pc t..ncrclusivelyr.itsdingwiihliccn*dcoih.hnrocon(rucrrhcn.ntccr(S.(.7(}{ll.Atrln.$
<br />and pi'olcsionCodc'lhcCo"rracroasl,icc!{l-aw,locsnorlpllyk,atrowidr.fFiop.nyshobuildsorimpr.v.rrhcrcotr.
<br />ond who c.trrrcrs lor su.h tnojccls wirh r (\trhck)n s) lienrd pur \u.tr o thc Conlmcktr \ l-i.ctrE ljs )
<br />I nm cxcnn, nndc, Sccr k;f I,DIIE Lt*-u-
<br />lt
<br />I hcrcby riniln urdcr p.naltyoipcrjuryotrc oirh. rolloslng dc.l,r{rids:
<br />-l
<br />havc t*l trillrmim.in aC.dificar.ofCons.nri0 Sclflnsur frtr w.rkdj .onp.6.ar ion. as pmvidcd lbr t y S(lion :l7ID or rhc
<br />L.tor C.d.. for rh. nrformftc ofrhc \orl Id *hich rhc pcdn ir i\socd
<br />I hav. snd e ill mlinllin $o.k.rs c.mpcnsariotr insur.Nc. .s rcquncd hy Sarion :l7m .l rh. I lbor Cod., ror ihc l.rlohtuMc or
<br />rh. sdrk foi which rhk F.oir is isflcd M,workc. con{i.osario. inslEncc.qricr arxl p.lky nnmbcr dr:
<br />! ccniq rhnr in rhc lxrfornutrc {,frh. *ork f.r which rhh pcrnir i\ nsftd. I \hrll norcrploy rny p.^otr in any mrtrncr
<br />$ h lic(nrc shj.cr ro rhc sorkc6' ro'nncn\lli,nr ra*\ or c.rirrtr li. !trd rsm ihrr ii I sh.uil hlcom hiccriorhc
<br />{ orkc( .omptnsrr ion pmvtions of Stcri,,i -l7O{, ol ihc trktr C{xlc- I shrll, nrnhtirh .onl,ly wirh rkE nioisnrN
<br />WARNINC I'nihrc r{, $curc *orkc6 c.nrpcNnri.n .orcri8c is utrlnsrul. ,nd (tull subF_r on cmplo$r ro ai'ninxl|cmlrirs nd
<br />ci!il Incs ur h onc hundrcd rhou\rnn doU!6 ($lix).lxx]r. ir rdnilion ro rhc con otconrc.\!rion. dnnu8.s rs l)n'vtrrcd Inr r[e
<br />::-"'i7i,ili-*^i*;i**,**l_'"A,*41-u.*
<br />I llcrchyarfirnundcr pcnalr,orp.ryuryrhd I r r li(.{d uiJ.r pi{,rhi(,n of Ch.pts 9 rcofl.f,rc ing sirh Sccr hn 70(0) of Divisio. .l
<br />ot lhc Au\iDcss d PnlesionrCoic. !frinry liccnsc i\ inlutllar( rrtlclllcr
<br />--r
<br />APILISAILDIICI.AMIION
<br />I ncr.ty llfim u.dcr ncnllry ofpcrhry.n. orrhc rinlouins dcchrsri6nal
<br />D.nrlilion Pc nn*Asif,(os Norilicarion rrdcral Rc8ularions (Iirlc 40. hn6)
<br />Rcquircd t n.r of Norif{.rion
<br />_l cclrilyrhlr rhc lidcrnl rcruLrbn\ rsrdi.s r\h.nos 'cm,r.l rrc nollp0liclblc lo rhk pmjccl
<br />I ccnnt rhm l hrvc rc.d rhh rpplicrii{,n !ft|srorc rh:r rnc ah,!r innninri{,n is.omd.l i8m ro.onlply wirh allCiryrtrd Coutrry
<br />ordinu.c\lndSrarcljw!ml,linSlohuiklin8cotr(flction.udhc.chyruhni/ereprcscnrdivciofrhnC y dCountylocnleinl)onlh.
<br />ffi,:ilil:"*V]* fu^t IL 1'le* 'lt'tor.mi,mnsme,prin,,, h;l+C-Ual-fru K^E!)
<br />viwg
<br />CANIItrI!:IIaNIADINGACENCI
<br />I hcrcl,y !mn. u(lcr pcmlty o, pcrjlry rhar rhcr. n amn{d.ri6n lcndinS dgcft! lor rnc pcrionmncc ollhc *ort fo, shich rhi\ pc.ni( is
<br />tsncdrscc lo97 Civ C )
<br />I \)
<br />o
<br />SLAB Floor a
<br />Sublloor/Vent/lnsulation
<br />Shear Wall q
<br />t
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