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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE COMMENTS OWNIiR BUILDI]R DELCARATION
<br />I ltrrhy trllt rndcrpctr(lryofNrjrylholIurcxcmprlnrnrhcCofta.ktr\'l-iccnscl-ssli!rhelollowi[grcr$n(Scc70315
<br />Irtr\ircs rnd frofcsion Cdld: An, Ciry ot Coutrry whsh rcqutcr r F-oil t, .otri .r. rX.t, i Provc. dc&,lish r ftNi rny
<br />dru.!ur.. p'i{, b irs i\rurrc..lso rcqutcs rhc appliclnt lor s!.h Frnirb fihr i8trcd satnrnl rhar tcor\hc t li.cnscd IUBUr.r
<br />h rlt provhiqr otrh. Conts.rofs l.iccn$d llw (Ch.nrcr 9. Conrmcnci',3 $irh s.ct.n ?ux) of Divisi,r :1 ol rhc Bu\ind* and
<br />I'rolasiotrsCodo)orrhrr hcor shc hcxcnDr lhcrelronrnnd rhe h'si\ frtr rhc illcgcd cxcnDlior. Anyvn,hri,rotScriorTr,ll5hyrny
<br />it'plicanr lor a p.nnir hjcc6rhclptli.urrDacivilpc.rlryolnrnxmrhmlivchuidrc d.llnn(risoo)
<br />I. os ovnc! of lh€ pmrErl y. or n,y cntbrt \ st h wiScs ts rhcrr $lc ompcn\xin,n. *ill do rh. wott dt rhc sMrm is nor
<br />idcndcd or oilcrcd l$ sale (SN 7044, susin.ss atrd Rolcsions Codc'Ihc Coorrnck, { Li..ns. tjq docs nol lmll b d owtrd or
<br />rh. lnrl.ny who builds or inV'rolcs rhcNn- ud sfu) docs slch *\!k hinrll .r hctscll o' Ihmugh his or h.r owtr cmploy..s.
<br />pr.vided rhrr *rh iryroRnEft m Bn irncndcd or.ficrcd lbrvk ll huw.rcr. rhc hoikling or i'npmrcIenr h srkl w[hinonc tcd
<br />olco'qrlerion. rh. ()vnf Boikh Rill hN rtf, hordc" oir$vinS rhd hc or lhe dil m! hoikl or irqrror rhc pmFn, for rhc fdrfo{.f
<br />l. rsoqncr.lrhc ptulcny. aDcxclu\ivclyconrraciing Nirh licriscd.oik..irtr! k).on{n'd rhc tnojNi (Scc 104-1.8nrNss
<br />i l ltrli\si'tr Codc ThcCo td.t s Liccns. Ld$ doc( n.rlpplyb trtros.d of!r(,t. yuho huildror i'nlmvc\ rh$con
<br />rrd who.otrrrctsforsuchprcjcl\sirhsGnntukn(nli.cnscdNrsrnlrolhcContact,'st-i.cn\.14tr)
<br />I dnicx.nrl tr dcr Scd
<br />D{rc O*n.r:
<br />woRKERi caNrPtrNsA'liioN
<br />l2[cLI&UloN
<br />I hcrcby lr'iir undcr pcfulry.r pctjuty .m ur rhc nnbs irB dccltd nr:
<br />-lhavcudsillnun
<br />lin s Ccniff,dt of Conicnr b Scll.lnsuE for $ortcr' <nnrnsarn,n. as pmvAcd lortrySecrn,n.lT(l0.irhc
<br />tjtrr Codc. lor lhc pcrfonMncc oi rhc wo* for shkh rhc lmir h issucd.
<br />-lhilc and sillirnnanr sork.s ..n{rtrs.rio. irrurrrcc. rs rcqutcd hyS&rn lTm.lrhc LntorCod
<br />thc +qk torshichrhi\ prnnir is L\flcd My wo*cr\' ..n{f,nsatiotr irr\u.rrc. c tricr drl!.li.y mnrhcr c:
<br />\(-
<br />€x,sct\6lotO
<br />-*,..,J
<br />20t
<br />I c.nify rhar in rhc l)crrornuncc otrhc wo* ntr whi.h rhis lirnrir is nrucd- I \hrll nor dnlll.y.try pcr$tr in any mani.r
<br />$ s b hcok \ubFd k, rhc workcr{ co.rlEnsarion n ws ol'C,liturnir, trtrd .srcc I \hon luoDr {rl)Nrrr,rh.
<br />*orkcis .onrfcn\arn,nrn,vhionsofSc.li{nr1700orrtu lrh,(
<br />IVARNIN(;: I'.ilurc b scu'c *ork.('.onrr.n\arnr.ovcogc
<br />h conlPl)- s irh rho\. |n'vi{i(rrs.
<br />.nil turcs trt, r. onc hu rcd rh.uvnd dollds (11{l).([X)l
<br />ll suhj(r .n cNploycr lo criminrl N'ulri.\ rtrd
<br />.f.o Bn\arn).. dlnugrs rs fioridd nr rhc
<br />G c, inrc..d,nd atr.i,ry\ res
<br />?l tn
<br />I lr'rl,y aflnn utrdcr p.nrlryoipcljuryrhr l rn liccn{d und$
<br />ol rh. atr\irr$ rnd Pn,rcssidNCodc. ainry llccn\c i\ in lnll
<br />tr.1Chiprcr9(co'n r'tinAqirIScdion7l[X))of Diri\n,n:]
<br />)
<br />qb\ bqs
<br />:;,Y
<br />I h.rchy rlfirm undcr FnrlryorFrjury rhd rhcrc is r..tr rudiu bntln,grlc'Ry nn rhc pcrlormlmc.frhc *ork ntr qhichlhis Pelrnir i\
<br />i$ucd (Scc. 109?. Civ. C ).
<br />knd.r. ti.nf,'-
<br />AITUCAILDECLAAAIION
<br />l [:Eby.mnn ulldcr pcnah y.r p.rjury oft ofrhc n hsinSdelmlb.s
<br />Dcnrlnion PcirnirsAsbc\ros N.rificari,n Fcdual R.!rhrbns (Tirlc 40. P.n6)
<br />-licquircd
<br />l.c(cr of Norifi cdiur
<br />I..nily rh,r rhc fcJcrllicrulalions rcslrding,(/'. tur rnf '.rhl. [, rl,Nf(!r..r
<br />l.cnib rl[r I hrvc rcad rhi\rrplicii,ni dd rhnniri,D n.orc.r l.Crcc n,.omfly sirI rllCiry rnd County
<br />ordiritrcc\ rtrd Sirrc tnN\ rchring t' huiltltr,g
<br />rhlvc f,trriondl proNny li,r instdi.n
<br />^Dp
<br />unr or {senrsiennrff E
<br />r.-ir". o-. 'p.rnr, t/AtlL (*r\zA Li-z-^*,1 I*i,L.
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFEB Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Shealhinq
<br />Shear Wall I
<br />Framinq /o/tC/t? .4W/I
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath 'o/21/if -yffi1it )
<br />Brown Coat .2 ',/ag,/,tV --*;'f,)
<br />It4asonry ,^--_..:''(-.
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certil.
<br />I
<br />FINAL z-/ru/ t4 ,4/ru?,.)
<br />Certilicate ol Occupancy
<br />Notes, Remarks, Etc.
<br />ID/SIG.
<br />tr dcr \ Addrc$:
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