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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Rool Sheathinq
<br />Shear Wall
<br />Frami
<br />lnsu latio n/En ero y
<br />wallD
<br />Ext,/lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil
<br />,G))FINAL 7-?--/e J).Gl
<br />Certificate ol Occupancy
<br />Notes, Remarks, Etc.
<br />Yg 6.b
<br />944Ua
<br />0 \ra44
<br />nttrt,
<br />/-0
<br />z.;l- ote'-
<br />oE
<br />OWNF]R AUII,DER DELCARAI'ION
<br />IhcrcbyatltnundcrFnahy{nFrluryrhdIa'n.xcnrprrru'nrhccontrior'Liccn\cIrvfitrrl'crull,,si',ctcrn is...70ll.5
<br />aulirlcsr sld Pror.\si.n codc) ny Ciry or Connly qh'ch r ,o urqtud, trhcr, 'n{n{c, ,lcnnf}h or rcIdn any
<br />slruclurc. priort{, ils nsuarcc. aho requncs rhc !!plE r for suchFmir k, fih. siSncd slarcnrtrr th hcorshc h liccn\cd nrr\lair
<br />b rhc rolision\ ofrh. Conkncror'r Lic.nscd trw (Chaprn 9. Connmrcir8 wirh S..ri{J. 7(XX) of Diviriotr I ol Ihc Busincs ud
<br />Pn)r.ssnrs cbdc ) or rh hcorshc iscxcnu lhclcrromand lhe hasis lorlhc all.gcJcx.mPrion Any\iol.rionolSdion70.1I5hyany
<br />aplli.3nl ior r,)cirnit subjNls lhc attlicanl k, rcivilncnalrrol nor '*r. rh,n fiv. hundrcd dollm lS5r)0)
<br />-1.n\
<br />o*ncr.frhcpn)p.ny,{r rt c rdo\r.r *irh wr8cs is rhcir \olc comp.nurion. vill d. rh( *ork md rll nnErurc i\ n,
<br />i cdcd .r oiir cd fq slle ( Sa 7Ot4. llu\im$ and lhrcsi.nr CGlc Thc Cbnrxckn s l.iccn\. tjw docs nor lllly b an o\rncr of
<br />rlr. nn)nrny wh( huilde.r irnlmw\ rh.En,, uxl sl$ d,rs \uch sort hnnscll.r h.relf,r rhrcu8h his or lu o$tr emPloyccs.
<br />povnbdrhar\rchnntrovcr.b0rctrorinrcndcdorollcrcdfosblr-h,ac!cr.rIf,t{ildirBorin{,mrcnE nstwilhin,,N)er
<br />ofconDbtiotr. rhc Owncr Duiticryillharc rh. bur(kn ofpovirs rtu( ht or \ht dxl Nl build or impm\t rh. pDncnr lor rhc turF,*.1
<br />LasowrcrorrhcpR,pcdy.inrcr.lusirclrconrrudirssilIl]c.n\cn.oitrcrorro.otrNnrcntElmjcd(S( 7044. Bd\in.s
<br />and ftotssir Codc thcC.nrructois l,i.cnr.l-rw dMs ior dmlyro inopncr olprop.rlywho huildr or nnPmlcs rhc.con.
<br />rnd who (,nrd.h for su.h pmJc.n wnh r Gnlruchn s) liccnsci l)unurnr b rhc G,.tr.roi\ Li.ctrsc fr$ )
<br />I aD,rrc ,pr tr dcr Sccrn)
<br />Irntr ()$n€r
<br />]!a8"KgN_!OtUl:Lt 1It2!Oli(l -EiIIta!
<br />I [.rchv xlnm und.r p!nr]rt ofpcrlur!.n. olrh. fi)lkNirA d.chrrri,r,\
<br />-lhnvcudsillnrint'i,rrCcnifi.rrc.fC.tr{trrroScllltrsurclor$orkc6
<br />$rnl.ns n,n,ar !tuvidL'd lor bySalio 3700ofrh.
<br />titxn Gxlc. for rhc pcrio'nrncc or rhc *.rk rd whi.h rhc Frmi h ksrrd
<br />rhc $ork ntrwhich rhi\ Ilcrnriri\ i\\uL{ My\orkc6'..ntrn\r'ri,,n in!u.rnr.u'ricr rkll})li.y ntrmhcr irc
<br />ffjlarryrhorrnihcncrlonrrnccnfrhcs,trrrur*h'rhrhispctnrnnsucd.Ishrllnorcn,Ik,yaiyr.r$ninatrtmrnrcr
<br />{,U.h }\",tr \ 'hrrr x, rh" { 'k.1r,.nu{i{r.nnlrs.ol'('alrrDrnu.on.la!'..rhi'rI.hnuldh\nm\uFr(r'orl-cJ-l-\,."-n"".dh"p"".''nrol\.r,nn|tro^lrhcLnhr(frlc l.tll l',ihs h.n rfly* hrh.{nlr\iol.
<br />WARNINCT FriluE lo sccurc vnt(crl conpcmlri,n c.v.mgc i\ trnla*tuI. n d shrll suficr on cmplortr b diminrl ll.{lrics a.d
<br />, iv'l lnN no ri on. l,undr.,l rhotrud dollr rsl bn Io rhe cosr ofconrpcnsrin,n, datrg.s as proridcd tu lhc
<br />Zrtg,
<br />A
<br />nFvi\ion.lChrfld 9 (connmkinl $ilh S.(linr Tllx)) ofUiri\i,nr.l
<br />ui rhc Busincs ind ProlcsionsCodc- and h,licnsr n in full r(r.c ,rd clltct
<br />@ r+az-?,
<br />I hcrcby ftN trodd p(nrlryofpcrjwyrhrrr Lr ng nscky lor rhc pcrlhrnD'rc ofrhc work lor whic[ rhi\ Pcnni( i\
<br />n\urd (Sc. 1097. (,\ ( )
<br />Gndcr\ NJm
<br />-
<br />APPLI(:ANT DECLAf,ATION
<br />I hcEt'y !finn undcr ra.nh, of rrrjlry on. .r rh. rolkrwiiS dc.l.r.rnns
<br />o.nNliron PcflDih.Ashcnos Nolificalion lcdcral Rc[Ullrions (Till. :ro, PM6)
<br />Rcqun d ktrcrolNotiicalion
<br />reguldrioN rcs,ding a$.*x rcrmv.l arc nolapplicablc lo rhG ptuj..r.
<br />snDplicorionandnarcrhlrrhcslne.i.fornDr n (coast. lagrcerocomlly
<br />rcpr.{nlJrivcr ol rhi\ CirY
<br />f,=-
<br />J dCru yrolcn'cruF'nrhcLlW
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />T-Bar
<br />Ih.ruh' rlljrDUmt.r |t lryol l)cr.Jurrrhir I D
<br />(a)p
<br />I
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