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BUILDING- INSPECTOH RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILD0II DEI,CARATION
<br />I hcrcby.flirnr under rcnllry of D$iuiy rhnr I aD cxcnrl 66n' rhc ftnr .^ Liccnsc t-r* Ior rhc roll.wng rctrsn (Scc7031.5
<br />Eusinc$ lnd Profeslion CLxl.) An, City or G'unry *hi.h r.quircs I pcrnir ro conslrucr. ,lrd. inuovc. d.n{'lish or nlltrn tny
<br />ntu.rurc. rri.r b nr is rncc- slw, rcquncsrhc aptrlicrnr lor such lcrnril b lilc r sisrrd sl cnEnr lhal hcor nr. i\ li.ctr€d nufud
<br />b rhc povi\nrns orrt* aonkrcro.s l,ian\cd tr{ (Chaflft 9. connrcn.ins sirh sccri( 7ftn ol Divhion :1 or rhc Bn\n'.r(.nd
<br />PrcLss i. trs Codel or rhol hco.shc iscrc'nll thcrcri{nr thchrstnrrhcdllc8cdcrcmnli.n. Anyli{rsrt,nulsedi'tr?0315l,vtrnv
<br />aDpli.llr aor!pcrmir \ubtds rnc r|)llicatrrr' acivilpcnrlryolmt nMc thun livc hundrd dollrs(35001
<br />l. !s osmr oi I hc prcp.ny, or dy.'nployccs silh woscs a\ rhct slc conD.N,r irin. *ill do llr work rl rh. $mNrc h n,r
<br />ir ctrdcd or oflcrcd fr sdlc ( Scc ?044. tlusinc$ and Protc$nntr Cd. 'rhc Contrscr,, \ I jccit Lrw det mt lplly ro tri ow cr of
<br />rh. popcny wh. trildr or iftqmws rh.mn. $rl *h) dms sxh (ork hinFcllor hcGcll or rhrouah hh or hd.wn cn{kryccs
<br />trorid.d rhnr su.rr impmvcrEnrs m rcr iircixlcd or otlcrcd lor slc. lt to*dti, rlT btrrlding or i pnNcnEor i! e'kl wirhin onc vtor
<br />of.onDlerbn. rhc Own r Buildr will hlK tlE t udcn .f povin-s rhar h or shc d n mt buiu or i.qtow rhc lmFny for rtE lurln{ dr
<br />L nsowtrdolrhc pmpc.lr- rnctclusiftly.ontr.rir!3 wirh I i..nscd co trtrck,* ro conn ruc I rh. lojccr (SN.' 7iX4. Dunne$
<br />and Pn,fc(\ionCoc:ThcConki.ro.sLicctr\cLawdoc\rcrrpplyr.rtro*rcroloroPcny*hubuildsorinrprovcsrhcr..i.
<br />ad who cohrmcts lor ruch rmj..N wnh, conhcronn li.crr*d p!^dnr t, rh. C.nk{crois l-iccns.ljwr
<br />Lmcx.trrpr undcr Sccliotr
<br />D6r.: Osn€r:
<br />woRKriRlir a(,ili'FNsarloN
<br />IIEOJ.BAION
<br />I hjicby.lnflnuodc! F.olryorFrjrry otrc or'hc rollosi.s d(hralbn\:
<br />Ihnvc ldwillnminlairrCtnifi.,rcorContitroSclflnsurctorNorkdr.onrpctrerion.as Pmvid.drorbySNri,n:171$oirhc
<br />I rklrer{c. L{ rhc ncrld,nrJRc nlrhc ult l, sntr$ rhr,q r F ri'cd
<br />V r,'
<br />"
<br />un,r * , tr -,.,., *".lci(' (unrrcnsrrnn
<br />'tr\urJncc- rr rcqxn d b! sar ion l?(x) ol rh. hhor Codc, tor rhc Pcrrortu..c .r
<br />lhc sork t, *hich rhis Frmir is n$cn. My !o,kc^ c.mpcnssrn,n insuruncc clricr Md Fli.y nun$ct rc:
<br />c,.,,",Silt(_AotS3"J (l\6tolo 4a
<br />I ccdirrrhor in lhc !.rt rmln.cofrhc aork t shichlhis Firnii i\cDlnlo,rnyF.rv'nrnymrnD.r
<br />so tr\n,h.comsrhjccrk,rhcuorkcrlcomP.neri,n, lrN\ofcrl I \h,u!d hcconr ubjccrt, rlk
<br />+orkcn' conr!.n\rrn ftuvisi(ins.f S.cri()n.l7OO.lrhcLilrtr('.cl)n{ly $irh rho{ pmisnnr
<br />rvARNlN(: l'riLro k) {.tr'r }orkur\ ..tr'|x r{triln! .ov.,rr rtr cnrtloycr r'.ri'niDrlpc' lri$ rnd
<br />ci\rl li^c. ut r, , nc l-uiJ'rJ r1uL..'trJ J, l'. . ,1l,l,.rx/"
<br />ssrtr,n l(r7r;orrtu lrttrcudr
<br />'.,",11"a1'4
<br />nrlcrc{ atrl,ltoIr! s iccr
<br />I turhr lllrmu r Jicnrllyoipcriu'y rhar Irm liccn (hrt)(( 9r.onrn.D(1,! tirh Sc.ri.r Tlxxr) oll)irnn l
<br />ol rh.llrsiLrc\s md Piol*iqsC.d.. rnd nry lic. \t
<br />qbq,gb>
<br />Dnrc -1 zal4
<br />I h.rby alttm undcr Fnrl'y ol Frjuty rhar rhcrc n a cond
<br />issucd lse. 3097. civ. c.).
<br />ion Ltulin8 asrNy li). rhc !.rfor trNeofrhc work for shich rhis Fnnil is
<br />ltlrP! lcAN]. nF(lI ARAI',I()N
<br />I h:Nhy.,limun cr pctralry orlcriury utrc ollhc hllowinr dcckrari.is:
<br />Dc r,lirn Pc nir+Asbcnos Norificarion Fcd.ril Rc8ulnrion\ (tirlc 40. PdO
<br />Rcquired t.cl1crol Norifi0r on
<br />Icrdil,vrh r rhc lcdcrrlrcgubri{nr\ r.3
<br />l.drilirhr Il !o r. lhN nntli.iln,r r n com.r I rrr.r k) conrnly wirh llC[yi.d(onrly
<br />ordinarccsa srirc tiw\ t,rrinF ro build trizc rcprc\cnl,liv.r of lhis C
<br />Del':
<br />l},vu ncnlioncJ lro|Eny lnr in\pcrn
<br />\pplirnnr or ArEnr sirtr'1\rc
<br />,"-,U "" ,rr'" , rn",,, t/A z*ttz-iLTf"
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq /2,?t/l{ --z M'D
<br />lnsu latio n/E ne rqy
<br />Drywall I/o/t ,/, / lf -,)d-t;-t--
<br />Brown Coat /1,/to';/t? i Jbin
<br />[/lasonry '\7 -v
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Cefiif
<br />I
<br />FINAL vlrq /(4 -'vM,
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc
<br />Irndfl " AJdrcn
<br />-
<br />Sublloor/Vent/l nsu lation
<br />Ext./lnt. Lath
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