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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUII,DIIR DI]LCARATrcN
<br />I hcrchy ilfinn unlcr pcnrlry.l ncrjury lhrl I r cxcmB to'n rhc Cotrnrcln Liccn* tiw i,tr lhc rbllo$ins rcrvn,lscc70.ll5
<br />srsi'rcss r Prnt$ion C(!lc): Any Ciry or Coutrry $hi.h rclunc\ r n flnir k' con\rnrl. alrcr. improre. dcnhlish or rcptrn rry
<br />{nr.tuc. trirro irs n\urncc. rhd rcquircs rhcafrli.e ntr suchIlt tr,irt' fi|..tr \igtrdl n r.rmd rhd h.or \h. I li.cns.d lunxrnr
<br />t, rhc pn)v^t,ns of rhc Conkact, r l-iccnscd liw (Chrprcr 9. Connn ncing *irh S.crnrn ?(xX, of Divi\ion :l of rh. Bu\inc$ rid
<br />PrnlasnnrlCodc)orrhrthcorrhcncxcmllhcrL.iomrndrhch\nfdrh.allogcdcxcnlriotr.Anyviolali ols(rion701I 5hytrtry
<br />applicanrLtraFrnrirsrhjcchlhcrpplicanrroi.ivilpctrrlryolmrnnrcrhrnfivchu rcddolla (35(xr)
<br />Las.*ncr.rrh.lmJrny,orny.tnlortc\wirhwa8csr\rhct$1.con,lcnsrii.n.willdorh.wo*anlrhrec_runiitur
<br />inrc c.l orolttrcd for slc (Ss T(}l.l. Busincs trnd l,rorcssirtri C,xlc IhcCoikrcror'sLi.cnscLrwdocstrori|flylo!nonncr.l
<br />rhc Dmtrn, whob{ildsor i'nrn*trrhctu)n. Md who do.s such *oi( hin,sc lor l[rrlforrhn,ueh hi\orhcr o*ncnrtby.cs,
<br />,n'v .d rh r su.h inDmvcnrtrh ec nor inr. cJ oron'cKl nn v,lc ll h)ucv.r. rlE huihE or i'nprcvcmnr is mtl(irhinon. )rror..'4Lri,n. rb. osrcr Buildcr sillh,w rnc $urdcn ol nrcvnlg rhd nc or lhc did mr hild or iNrror! rhe lmP.ny for rtr purr.r ol
<br />l. \o*ndofrhcln)!cnr.r,cx(|0\ivrlyconrrciin!\ithli..nscd..nkar[*h(,nnru.trltpr{!c.llscc ]o$.3unn.$
<br />rnd ln)tsirn(inlc lhc (-orlr&l,tr r l-iccnsc Lawdocs n.rdDt)lylo rt.ancr olpr,,rcnyqh. hulldsor irnprov.s rhccon.
<br />ind *ho $nt cr\ fd $rh troi(lwirhr C( ract,nn li..n\cd ptrntrrnrk) rhr(i, nrkr's l.icc $ l-rw)
<br />-lrnr
<br />cxcnu rtr(lcr Sc.rn
<br />D.r. o*n.r
<br />IIAtrEBS:IOMTENIA.IIAN
<br />I hc.cby orfirn und* F.ahy of p4u,yn*nrrn rnL,*nffi#lll)N
<br />-lhavc
<br />n will minhin 0 C.niltdlc ol G r{nr r. Scl nsurcforwork.n'.onlrnsdion.as,ft,vidcd{orhySslionl?(XJofrhc
<br />tihtr Cftlr i,tr rhr Frlo' m(. nr rhc witrk lo, sl-kh rh( p{fl nt i\ h.ucd-/'!urh$ c and r rll m .mm s, vkcF' . nntn$rIn rnidrtrtu.- ac rEqutcd by sc.rhn ]7m or $c tjhor cod., for rhc t'sloflnme .l
<br />IUywork$r.o rp.i\rrion i'Nrrk crrifiurdI,li.y trtrnih(r *c
<br />4/D Y/, t 4{*"n ilyrhd i.ihc prrflnrrrc ofrhc *.rk tur Nhkh rhi\ r^-rmir i\ n\trcd.I \hrllnor cnlnor_ rtrt p.i\o hdnymMrcr
<br />e,Nt'h.{omsuhjccllolh.Norkq\comnctrn'tionlnqsoicililornir.nndl8rc.rhiliil\houklhcconrc$'hFllorhc
<br />\orkcr( .orr|]cn$lionpnivnhns.iSccliotr.lT(x)ol'rlt htrtrcodc. I \lul ilh c..rd, wilh lhocfrovhi0nr
<br />WARNIN(; Farl rr !, 'c.tr( {orkc^ .o trd\ rtrni.orLrr8r n u I {uhl.cr in cmrloyf ro rinri,rlFtrrkis dnd
<br />r. ,ft hurdr\ rhor!i rl dolln'\ ISllrlr.l)1X)). irr ol .o rtxtrlrlnr drDngcs rs tmvnlcn ld rlrc
<br />irlcic{ atrd fiorfty\ Lc{!-
<br />\,
<br />I)t:( t..rR,\11l,N
<br />of dr au\iic\sr Pmfu$n,n\ Codc- n,y liccnr i\ in ltll fore rd clfecr
<br />a-71 )272?ff
<br />I hc(by rflnn undrr pcnrlryofperjury th3r rhcrc n, condru.rior lcnding rEcn.y lirr rhe pdnrroncc orrhc {ork f(tr thich rhn !..nrir is
<br />i\\ucJ rscc 1097. (-iv c )
<br />I Ln'h, . \rtrc
<br />-
<br />_l ccniryrh.t rhc fcderrlrcSulrlions rcBdinS.sbcno\rc bvrl ,rc mr ippli($lc io rhis pojccr
<br />lrcnrli rl r I h}c rcrd rhi\ x nrolion tcon(l I n8re ro co
<br />ordimnccs rnd SIalctiws rchlins ro
<br />.bvc mcnln{cd pmprny hr iNp.cr
<br />Xprcnnr or,rsenr sisnnrure
<br />*"-',,*..",",,,.,,,
<br />,n2
<br />mplrwirhlll Cnyrnd Coulry
<br />::';z-;tr;.
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/lnsulation
<br />Roof Sheathinq I Tw/u- t 7-,h/tDfb /6-2--
<br />Shear Wall
<br />Framinq
<br />ln s u lation/E nergy
<br />D all
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL t /'tr40 J kL*{ve
<br />Certificate of Occu pancy
<br />Notes Remarks Etc.
<br />Z{)
<br />a
<br />Set Backs
<br />Pool Fence
<br />?._
<br />2
<br />\.^..,,.,
<br />^r^,"?I
<br />l.cndcr's Addrcss
<br />AITLICANLDEIIdB{UAN
<br />I lrNht alllnn u nd.r lcnrlr, oltrrrrry onc ol rhc lblb*ing dc.lrtrrrion\
<br />Dd xnirn,n Pcrmih shc$o\ Norificarim FcdcrxlRcEul!rions ( lirlc.l0. PrnO
<br />Rcqtn.{ ti(cr of N ifi cdion
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