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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG,COMMENTS OWNER BUII-DIiR DELCARATION
<br />I hcrchy !firn undcr Fn!h, i,r prjJry rhr I csnu rmr lhc Gn rncloF Li.cn{ liw ror rhc rollowiDi rcrson (S(.?u:11.5
<br />Busines\ rnd Prurc\ion CGlcl Atry Cny or Counry *hich rcqutc\ r Fnnir ro on{nd, rltcr. nnprolc. dcmli\h or rcnrn rtry
<br />nnrruro. l)norlo irs hsurN.,rhorcqunc\rh.attlir r an \rch l).ihirto filcrsisnci allcmnt rhd h. o, \hc a Iicnsd Purs,nr
<br />io rhc povinotr( orlr Co.lrrcnn s l-iccnsed l,ar'(Chaprcr 9. Con,tun.iD8 wirh Scclion 7O(x) ol l)ivision ll or rh. Bu\incis tnd
<br />PrclcsionsCodoorrharlrorshcisd.mttrh.ftrturniMrhcb,sisiorthcrllcscdcicnunni.AryvnnatDnofSe..lion70.ll5hyotry
<br />applicanr ror r p.rmn \ubjNh rh. antticrnlto !civilDcnlllyofnolfrncrhrn fivc hundrcd dnllan ($500)
<br />L ,s osmr ni rhc pnJpcny. or nry ctrlp!,,tccs wirh wagcs $ rhcir q,lc .onrFns{rion. will do rhc sork dd rh. slulut '{ nor
<br />inrcni.d orollir.d rir elc (Sd 70{.1. Burin.rs and Prolcssions Cq,c: !hc Contacnn \ Li.cn* trq (()cs.ol EPlt h 3n own$of
<br />rhc nmFr y who hikG or i'npnws rhctu$n, and wlr, dd( such q}* hinNcll or hcmcla or rhrcqh hh ot hcr os ! cmpk,!cc\.
<br />pn,vidL{ rh r su.h irnJ,n,vcnE.h arc nor inrcnicd o r oilcrcd l(rsalc Il howcrcr. rhc iuilding or inumvc'tunr is$ld wilhirotrc rt't
<br />of.omoErion. rhc L)*rcr Buikh willhnw rh. budcn ofrtuvir! rhrr tEor \hc dil n t{ild or imPrdw rhc pmrdt lor the Purlr)s ol
<br />-l.rsosncrolrtunmpcnt.rrcr.lu\ivclr..nti.rirgtrirhliccn*dconlacio^roco.{rucrrhcnrciLtt(Sc.704,1.Bu\ik.rrid Pi'r6si G)dc: IhcConrrrlor\ l,i.cnsc I ri docs nor aptlyti dtrowncr.ll]tupcnywh{) hrik(or inrr(rc! rhcrcon.
<br />un(l who conr'n r\lor\uchpnic.rrwirhrci, r cl(trrs) lietr$d Nr\urtrr h rhc conlrtror \ LEn\c hw).
<br />I utqcnrnr undcrs(rion ,a & P.C. Lrlhn rcn$n
<br />l)rre o*n.r
<br />$trR'(LRS COn PFNaAT(lr,j
<br />IIECLABAIION
<br />I lrrchy.rfi nn undcr Fnikyolncrjuryo.c ol'rh. follo*ing dcclnrrrn,is:
<br />I hal.and will mrnra,n a Ctd i,_rcatc ol Conscnl h Sclt lNurc for woikctr conf.nslri.n. o\ Ptr,vidd turbySccrion 17(tr ol th.
<br />hbor Cqlc. ,o, rhc lcrforERd or rhc work fo. which thc pcrmir t hsucd
<br />-l
<br />hrE and *illnri'nrd {o&cr{ cotrrpcrsatn nrlu!trncc. rs rcquircdhysc.ri(rrTlDoirhcL or Codc, tn thc P.rrornr(h-c of
<br />rhc *ork t,rshirhrhi\ pcnnit is issNd My$orkcs compcnulion insuraict.rd.r kl policy nunrl,cr !rc:
<br />Exfncs:
<br />-lccnilyllurinrheFlf.rruccorrhc*.rklorw[ic[rhnfcnnir
<br />i\isu.{|.Isl lltror c\royrtrypc^on inlny mMmr
<br />{, as h hr.otu \uhjccr ro rh\ qorlcF comncn\rr ion he\ ol Crlil(triix. rnd i8tot rh$ il I sbuld hccom \uhl..r k, rlt
<br />w.rk(ri.orlEnsdnnr!rcvisi(itrsolSccrnr.lTlX)ofrhclrhnCodc.l\holl.linlh*irhcomPly*irhrho{lnrvisidr'
<br />\IARNIN(;: IrxilLrc r, *.urc \.rkcr\ .l trr .ov.rr!c l\ tr hsful. rnd s cirPk,ycr k) dimitul |{trrlrts Md
<br />.i\il firL up ro oN hundrc'l rhu\itrd
<br />Srcri(D.1076.f rhc Lrhtr CGlc. inlcrc{
<br />ion- thmrFcr rs tmv cd nn lhe
<br />IIECI,II.BAIIIIN
<br />I hcrhy a nmundc!r,cBlrrofp.rjuryrhnrLmliccns'dundc!FovhionofChrprcr9(comnr.cinSwilhSecli,n70(I))orDilisionl
<br />or rhc Busi.csand Pnrt$ions Code, ud nyliccn* i\ in tull ror.. axl cffccl
<br />/x)qb
<br />I hctohy al,lnn und.r ltmltyof F-rjuy lhar rhcrc n rcon(dcri,. Lndhr8 rscncy fn rhc Pcnnrron.e orrh. aork n" shich rhi\ If,rnir n
<br />ir{icd rS.. .1097. (\\ ( )
<br />l-.rd.a\ Nrnc
<br />A.IILIIANfDICLABAIIA!
<br />I hrdry rnim undd F.dkt ol p.rjury onc.frhc followins d6luarion\:
<br />Dcnnlition Pclnits Ashcsros Norifi.,rion Fcdcrul Rcgulariotrs (Tillc40. Prn6)
<br />Rcquncd Lxtrcr oa No'ifiurkn'
<br />-l
<br />rcnili thrr rhc rcJcnl rclulrli{N rsl(linE r\hc{o\ r.nrvllrr rcr xt1l)li.nhl. ro thh fojccr
<br />. inlnir rr( n.!rr.cl ll
<br />y lurh,izc r.prdicitdircs ol
<br />""'""'""s("l/ulAvra
<br />rhnc
<br />tly srh ,ll Cily .nd Coutrly
<br />ily lnd Cohryb.nr( ur.n lrr
<br />SlLI,
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Roof Sheathino
<br />Shear Wall
<br />Framinq 4 i-7-1R.J/424 i">\
<br />lnsulation/Enerqy a-?-/6.Jl,gt4./v* \
<br />Drllwall /.,-//-/9-lJalopt,'t'i+ )
<br />6xt Ztar-]-attr-/^-<-/R
<br />.l)^1"{-/
<br />Brown Coal
<br />*Aasoflrr' 9eie.[,*L-1- t6 J)e.dl o&9
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL 1l-/G/9 J).-(>t -@l
<br />Certif icate ol Occupancy
<br />Notes, Remarks, Etc
<br />UFER Ground
<br />Lrtrdcr'. q,lJrc,.
<br />-
<br />rr€1
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