|
BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILI'ER DELCARATION
<br />I hcrcb! inirm utrdcr pcn.lry ol lcrjury lnd I an cxcnpt lrom rhe Coorrrtri Li.n\c Law ror rhc r.lloPinS rcrsn (Sc.?01r.5
<br />Busin.s\ and Profcsion Cod.). An, Ciry or Counry sh'ch rqrt.l I Frnir h, con{rucr. aller. improvc. &drli\h or mFn Jny
<br />{d.rurc. trinio irs issu.n.e.nlso rcquircs thc lmlicnd lor sucn pcrn kr filc a sirn.d {lrcftnr rh,r rror sh. n licctr\cd Pusua
<br />ro lhc pn,vi{ioi\ of rhc Conracrofs Lic.nrd lrw (Chaprcr 9. C.mnrncirS wilh Sccliof ?0(l) o{ Divi\ion .l ofrhc Bu\inc\s rnd
<br />holtssions Codc ) or lhur hcorrhe Gcxcmpr lhcreirom lnd lhchrsis for thc rll.gcd cxcBprn,n. Any vnrhrionofsc.lionT0Sl.5 by.try
<br />rpplicanrfdafi:i,nirruhjccrsrhe lptli.nir io,ci!ilpcnalryornor 'nm'hrn llvc hu rcd doll&s (S5tD).
<br />l. u\ owncr ol rh. Ir)Irny. or mt dn,ptoyc.s wirh *ll8s\ a\ rhcn v,t .unpc * i, . wiU do rh. work !trd lhc (mlure is nor
<br />inrcndcn oroficEl li,r slc (S( 7r)4.1- Busircs ond ftolcssions Codc: l,E ('onhcx, s l,iccnr Ii* does nnr a0ply b,tr.wmror
<br />rhcIF,lEny wtn t{ilds ur i't,)ntr$ rhcdrn. jrd *lh dds skh {o him\clforhcGclforthmuAhhharh.ro*ncmpkiyccs.
<br />providcd rhar ruch imprcvrDnh m mr inrcodcd or ofiircd t{n eh ll ixNcwr. rhc hillling or inprcwmd ir $h within onc )qr
<br />of.onrprcriotr rhc owncr BuildB rix h.vc ItE hur&n of lovin8 rhd tuor shc di:i mr hild or irymrc lhc popcny tor !h. ru+o{ or
<br />l. r\ou n.r olrl[ nnrFny. r crlusirciyconr.i.ri',9wirh]i.cn\cdcoDrr.ttr\!)..nrtucrrhcrnir.r(St. ?r]rt.3tr{N\\
<br />n,l sh. .onrrrr\lnr{'!hJn.jc.r\sirhr(itr on\) liccnscd pu rx n'rhcCoihr.rn's l-rctr{ Lrs)
<br />I rn.xcupr trndrr Sc.ri.n
<br />o,r",{ 7:L1-Lo/R
<br />I2ICLAAAIION
<br />I hcrchyrtlnn,un{lcrnc lryof pcrjurr-omof r[cn,ln)\irE,lcchrrrii)n\
<br />I hlvc rnd+'ill nnrinhin rCcnificsrc fConscnrroScl,lnircf{nsorlcri.onrcisrri,ri.x\lnivntcdfi,hySccrionl7(x)ollhc
<br />l,rb.rCode. turrhc poro nrn.{ol'rhu sr lnr *ni.h rhc t.nnlr is n{'cJ
<br />Ihavcondwillnrn rin w.rkcrl c.nrNnt(n nNmncc. d\ rcqulrcd by S(r ion 17ft) oi rhe l,ihx Codc. ior I lt $rt)rnrn.. of
<br />rhc wurk in whichrhisr$n r t tsucd. Myqorkcis .o'np.tr\dion irjurM.c.{nicr lnd Nltynunrbcr rc:
<br />I ccnify rhrr in rhc pcrr(rnuicc ofrhc a.rk lar shich rhis pcrmir i\ is\ucd. I shrll tror cmpl.r 0try p.isor irr rny moNr
<br />so$t'hc.otrEsuhjccltothcworkcF.onlrtrs{t,onhs(.rC.liroaria.rnir$rccrhiriil\houldbc.om{hFrnrrhc
<br />* orkcrj co rjr $ri, trovisions ol Sccrim lTlD ol llN tit r Cbdc. l shrll ftr lhr irh .onrrly wirh rho{ prtr ilnns
<br />\\ \R\l\(, 1..,i!..! ".tr'.$,"1.1 ..trt \ t-' ., r1,- | Jrr:.('Ll ,.rl .tr
<br />-r'l 1.,r. tr.n ... l,trJi. rh,nr 'l lJ'.,\l,uul , .,.1,,^,r.,1.'..-
<br />.,. *, r,r,,.,r.t.,,,,J ,, -
<br />'
<br />,.".t ., , , , , . ,r1
<br />'t,,1",'7 -l e-z^otg,..,,,*/ /'u$#JffiIfur&-
<br />I suhtc.t iD cnlnoyer l,) di,nitul n Mk
<br />solilf,lljllall.lurlNliaclNl:l
<br />I hc6by affinn und.r Fnal(y of n rlury rha hcE is s .onsdcrhn lcnding 0gcn.y for thc pcrformrcc of lhc rork li,r shich rhis Fmir is
<br />kruedlscc :1097. Ci!. C ).
<br />L,ndcfi Addrc$:
<br />-
<br />AIzuCANIDECIdNAIUTN
<br />I hftn, rm und$ Icnrlry of Frjury onc olrhc r'olk*ing dNlrarions:
<br />D(,mlition Pconih Ashcdo\ Norificrriin lcdcral RcBUhln'ns r'l illc.t0. Pln6)
<br />Rcqutcd lrrtcr ol Norifi .rrbn
<br />-lcmirylhrr
<br />rhclcdcalrcgulalions rcEndins !$c{os r cnmv.l arc no' xppli.xhlc b rhhrroj..i
<br />lccnil,v rhxr I hilt.crdrhi\nr d (rro r,rrrh.rlrtrt iDlo'nflri,,, \.o'r..r lig,..rr .o\ry sirh rll ('iry rtul Connry
<br />o:Ji',xtrcc\ tr{iSrnc l.r\\ rLridg ni vcsofllrirCityrtrd CN ryi, cnrcr ulnn rhc
<br />rhovc m.trli,nrd pn,0criy hr
<br />^DDlic..l
<br />or AScnl SiIn.hr Lt,t" -l -lA- LDiB
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />lvlasonry
<br />Pool Fence
<br />Handic ap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Cerlif
<br />FINAL / /-2-r l)Lz,d-L1
<br />Certiticate ol Occupancy
<br />--..-Notes, Remarks , Etc.
<br />T-Bar
<br />I hcrhrrtlirmrndcr prulryofpcr.iortihrrI r li.cn\cdtrnd.rrmrisn,nofChfl.rs($trnMncingqirhSc.rioi7{xXrroil)lvnion.l
<br />ot lhc Buincsund Prorisiorr Codc. a,n n,y liccn\c i\ in fullrorcc xlcrtccr
<br />Li.rnscch$ t i.cn\c Nu tE(il
<br />I)3lr: (onlrud0r
<br />f-------T------
<br />tt
|