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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.OWNER BUILDI'R DUI,CARAl'I0N
<br />I hcrcb, afin undcr pcnairt ()l pcrjrry rhar I am crcmpr ln,n rlf cotrkr.bn- t-i.c sc trw ntr lhc nnh'in8 rcrvrn rsft70.ll 5
<br />B!\nRs\ ,'d Piina*ion Codc): Any C[y or cl)utrry whtrh rcqunc\ a ncn.t to strdrud. alrcr. impovc. cnblhh $ Rnrt , r\
<br />sflcrurc. prior ro ils nsran.c. (lso rcqnircs rhc rrplic$r lor !'ch Fnnirt,lil.a si8n.d sarcnrtrr rhd hcor sh. h liccnscd Punurn!
<br />io rhc F)visi.ns ol rhc Contractois Li.cnrd tjw lChlprc, 9. Conrmrcing sirh S.crn,n 7O0O ol Divi.ion I ol rhc Aulincss ttrJ
<br />Prcicssn,ns Codc)orrhrr hror\hc iscic'np' ricrcrromtrtr rhc hasis rn rh. dllcScd cxc.rtridr Anyvlol nnralScdt)n7O.ll5byriy
<br />rprlicaniftnrl.rnrir\Dhjc.rsrhcnptli.,nrror.ivilp.n,xyolnornxrclhanlivchu rc! dollrtrs (Strx))
<br />-l.a\owncrolrhclolicny.(trnry.n,Il,tccssirh$rgc\a\rhcirrn..o
<br />|tnQrirnr.*rlldorhcwtrtrullhc(ruduni\nor
<br />i'n.'dL{ .r olLrcd lor {lc (Sc..7(x4. BusiDcs rnd Pnlar$.ns Codc I h. Contacftn s Lic..\c ljw dd( or rmly b rtr owtrs ol
<br />rhc p'.t^-ny who huild\ or inrpro\r\ trR)[andlhodcssehw.lkhi'n\cllorhcrsc]lorihrcu8hhhorh.rntrrcnrnk,rc.s.
<br />!(,vid.d r hJr ruc[ iDln)vctr*ti( rE tor irkodcd d oiiarcd lor {rlc li txN.\rr. rh( huildirS or i'rll]nntnt hsokl}ilhinoncFr
<br />oiconulcriur. rhc O$ncr Btildc' willhxlc thc tnrdct ofpn,ving rhd lf.r shc dtl mr lrild or improt lhc proncny ir rlt lrlrF,{ol
<br />l. d\o$nd.frh.pn,I,.ny. rmcrclusilcly.onnJcrtrg wnh hcctrsd cotrrrcroF ro .ondrucr rh.I'i,jccr lScc 7(}l-1, Bnnncs
<br />rnl rhisrirCndc:1hcConr.acl{r\l-icc0scLnNd{x\trorrprlyn,dno$n.r.rOopc(,whohuikhorimprcvcsrh.'co.
<br />rnd sho conrach ntr \u.h t)nr.Jc.h wirh r Contrt,ns) li..rEd puGuanl l rhc Conrrrt, s l-ictr$ liw)
<br />I ncrc,npr undfSccrioi a & l)C nrrhir r.rvtr)
<br />l!AA[E&5].cl)trlMsrlll9!
<br />IEI;I.ABAIIAN
<br />I hcrchririnnundcrrcrdlry.Ilcriurv.moilhcnnh!'irsdrcLrrrion\:
<br />I h,rcinl willnun ainlccnificaleolCotrrnrroS.lllnsurentrsorlrn c.nlprns,rtr'n. N tmridcd ior by Sd ion :17(x) of
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<br />tibor cidc. ror rh.Idforrokc of rworknnqni.hrhc!.nnil is isuc(l
<br />I hi\ trrl $ lln[inlrt, s. crr..n,J[n\ rim i'i\trrn.c. r\ ..qun h]_
<br />rhc *orl ior *hich rhi\ pci,nir i\ i\\ucd Nly*orkcr\'.onlllcn\ainnr i'r\urr .c
<br />.,,",", Co.,r s^trc< t UltrstY
<br />S..riotr:17(X) ollhc l-al,or Codc. in rhc pcrnmr nccof
<br />.mid rd fnicy Nnttr uc:
<br />lrrl rrilco I qjq -lg *l ,,",3
<br />I..nify rhnr in rhc N'foi,n!,r.c oirhc woik for which rhrs rcnnil is t\ucd. I shrll n!r rmrloy aiy Itrrwr in rny minN.
<br />h N r,) tEconE suhrtl ro
<br />'hc
<br />$orkcn .ompcn\rrion hw\ olCrlirornil rnd +rct rhd ifl shou[ tiBrE n'hrc(r t, rlf,
<br />workcc c.mncnrarion nrovnhns olsccrt,n]?motrhc llhr Codc.l shtrll.ladhwirh cotrply $ilh lhosc p'ovi\i{)ns
<br />WARNINC F.iluo o surc sorkcF mnlrtrs0rion colcm[c is unhwltl. rid \hrll lohicr r. rtrll)k)rc, h rin]inxl PcMiric\ $d
<br />.ivil fi(\ ut) h o r lrtr rl'.tl rtunr{rrd tl.ll r rSl(xr.lxrl)). tr irlniri,,n ro rtu.fn olo ttrr rn . Jn r!.\ 11J,'.vi(ld kn rlr
<br />::- ul ii'il$'"-"":;:";,
<br />I lr'.hy rlfi niuDJ.' t^- lrr_01 t)r'irtrt rl,rr l xnt li.(n{J r''o\i!i,{ol(h,' crI(.,trnDrr,.i',Jr1! hSc.rotr7(xxr).1 l)ntidl.l
<br />ul rhc hrircss n(ll'rofcssi,)ns (inh, r trrj_ li.ri\. n i',lullld.r kl.lt.rr
<br />Ys8ll.3
<br />CS(E Co.$-+r,!"
<br />EO.NSIAIJCIIANIENDINCrr(iENIT
<br />I hcrchy aifirm lndcr pcMlryof Frjfiy rhat ihcrc i( i.onirucrion LMiry i8cNr_ I{tr rhc pcrfonndco ofrlt s.rk ior *hich rhir rcmrl n
<br />ATTUCANI.DICLAEAUON
<br />I l[Eby rllifln u nd.r pcnrlry ol !crlury otr. ol rhc Llk)*in! dc.lrrri,rN
<br />DcnFhri( PcnDic.Arbc(os Nolili(ri.n [cdc.!l RcguhriqN (TnLc 41). Pfi6)
<br />Rcqui.cd lrrcr oi Notifi cirion
<br />Ic.dilyrhJrrhcIc.rrlftguhri,)nsrcFidmgn\lI{'\rcnrilirctr,ixI0li.rhl.hrInI(+.r
<br />**rilyrhd I h.vc rcrdrhn lFplicrrionrnl{icrhrrrlrrh)!c trrfo'nr (nri\.orc.r l srNloconrPly*irhrllCItrnd(dtrry
<br />! rnd sldc Irqsrclalirs x, buil(lln! con{rlcror. r'nl hcrchyrdho',c rcprcsctrrtrivcs.lrhi\Cnyrnd Counrri).trrcrrlx rrt
<br />rh)vr rfrntrtrd flft)pn! lor ir\
<br />\l,t,tn nr nr \sNr si! nrtrrr
<br />t.j,o\s--.
<br />,,.,. b I rrlru
<br />Set Backs
<br />Formsi Steel/Holdowns
<br />Ereclion Pads
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq
<br />Shear Wall Rlilr r f1), *-'/t'rf7
<br />Framing
<br />lnsu lation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL {,--l*e4,u/0-/,6?
<br />Certificate ot Occupancy
<br />Notes, Remarks, Etc.
<br />u)
<br />",. .w ,/
<br />COMMENTS
<br />. ., . B*clq
<br />,-, tftif tb
<br />L"hlci.Ad.lrc$
<br />-
<br />UFER Ground
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