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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BTIII,DER DI]LCARATION
<br />l hcrcby rlljnn !nd.r |f,nalry oi ocrjry rh l !m cicmfl rn,.r rhc C. ri.lor'Licdhsc us Iorrtu lhllorins rcr\rn (sLt703l5 \
<br />tlusinc\\ a i Pnnat\i.tr Codc) Any Cily or Cou t whi.h rc!ur.\ I ltnnir (r .ofsnrr. llrct. imptorc. dcnnnNh .r rctrt Jn)
<br />(dcrurc. prior b ns hsEncc. rlso rcqut \ rh..9pli.Mt l {'ch Dcnnir t,lilc a siSncd \rrrc rctrr rhd h.or sh. i\ liccntd nursu r
<br />to lhe lDrisions of rhc conticrols t,iccnrd Ilw (ChrPrcr 9. C.nnncNin8 wirh s.(lion 7{xn) oI Dili\nrn .l 'frh' Burincs rnd
<br />Prufcs\i()n\Cod.)orrl rtEorstu iscx.'npr lhcrcf.ornrnd rlrbr\i\ ttrrhc rllcScd cxcm ion A lvidrri.nofsccrinT0ll5byrn,
<br />iDpricrnrntr a p.nnir sxhjdl\ rhc iltlicrnr ro rcirilp..xxr.r.dr rmr.thitr llR huMrcd dollir (S50(D
<br />I. is owner of lhc proncny, .r my rmployes wirh slscs 0\ rhrt {,lc .omFnsarion. willd. rh. qork and lnc rituJum i( 'rrinrc'id or otT.r.{ tr elc lSe.7O44. BusirEs\ Md k)fcsio.s Codc:'lhe Contuktr s Ltcnt li* do.s nor oPplv l. an owftr of
<br />rhc fn)Fyly wtx, ttrild\ or inv.vcs rh.en. 0ftd who dm\ su.h *(rk hinscll or hcr*lf or rhrou8h hir or hcr osn cmnlovc'\'
<br />flolidcd rhrr such inDrelcmnis m n, inrcidcd ui oficNl fr, slc li no*dv.i thc huildnE or iqmwftnr is sld wilhin onc rttr
<br />or co!ryldion. rhc O*m, Blikid will h,h lhc hlrden oi rovins rha! hc .i Gc did nol huild .r nq,Dw rhc lmFnv lor rtr Nqr$ .r
<br />-1.
<br />r o$n(orrhc ,ln)p.ny. !mcxclusivrly..trtr.rin8 wnh li.cnscd conta.k,n hconstru(l llE ptrlrc.r (Scc. 701-1. ltu\in.s
<br />md hotu\sion Codc thcConro.ktr s Liccnt L!* docs nor aPnlyt, rnowm!ofPr)Pcnywho huildsor i Prov6rh.rc.n.
<br />nnd who onrmcs ror ru.h Dn,i.ch wilfi a Contrbn \ ) li.cnscd tunulnl lI rh. Cd r.crois Liccnrc lls )
<br />-l
<br />nn.r.'nlr nnJcr Sc.riotr B & PC turrhi{ovrr
<br />Dnler ()*tur:
<br />wt tnKFis_ ctrl,rptms/i.rxrN
<br />D[rlA&rIl9!
<br />I hcrchy alfinnrnd.r pcnahy ofFrjuryorc oirhc blloairB dLthrlrions:
<br />Ihrvcsd*illnminrrinaCcnili.roofConsctrrr.Sclilnrurclnrworkcn.onDcr$lio,. \ liovidcdlnrhvS(ridl7(Xlollhc
<br />l llx)r C{dc. fdrho pcrloflninccollhcso'k f(tr whi.h rhc Firnir is h\urd
<br />rhc w.rk lbr whi.h lhi\ p.rmir i\ i\\u.{. M! vorlcrr .on,1}.nsrrid, i'Nur cc cnder ud Pli.y nu $crrc
<br />I(cnilyrharitrrhcf.rbrnuflccolrhcworkI{rshichrlrisl.irnilisi\a'c.Ishrllnoiclnplo,rnv|rtrv'nnrmvnttrrur
<br />s, tr\r. he..nrsuhJ.crk) rhc workctr .otrrPctr{rior lawsoiCrliln ir. rndrgrccrhar ill shotld tE om suhicr krhc
<br />rolk.r.onrcn$lioopmtisn,nrofSccri(n.llmolrhctrlxnCodc.l{rall.fonhwirhm,nrlywirhlioslmvi\ions
<br />WARNTN(;I F ilur. tu $.orc Borkcr'conpcnsntn i .o\cr4c is unbwtul. and shnll suticl a'r cnrll()vcr ro di'ninll Pcnrlrics nd
<br />.ivil linc\ !p k, otu hutrdrcd rnouqtrd dollxr\ (rX)rxr)), I rnliri,nr k] nr.rn ol.',i.n Jr r,rc\ !\ pn,vidcd nn rhc
<br />^", Qglzee4.v)
<br />l2rlL!-Btlll,tt
<br />s anh Sccrion ?(x)0) ol'Divhion:lt hcrhv rilirm trNlcr Nnrlrr.l t).rjrry rhd I itrt un .r pn)viri(!r of Chrnrrr 9l.trntrtrcir
<br />ol rh. Brn csr d Px,L$i,,n\C.dr. nM nrr lrctr$ i\ in,nllnl
<br />sAutrfi
<br />I hcrchy rllnm undcr !.MXrofFrlury drri lcndinFnpcncy f{tr rhc l,rrioin{tul ofrhcNork for $hichrhi\ p.nnir n
<br />is\ucd (S...:1097.Cir. C )
<br />lrn,lcr's Nrnt:
<br />-
<br />lxndc''\ Addrc$'-
<br />AIU,IJANLDSCI.AMION
<br />l rrnhy rllirn undur p.Mlry or F j y nc otrhc lollowin! d..lnr0rnnN:
<br />Ix xnirbn Pcirnirs.AslEnos Norir'..rur rcdcmlR.Aulrri{n]\lTirlc'10. Pon6r
<br />Rcqunen l-drcr ol Norili.arid'
<br />tns EBddinA astEslos rcnFvrl uc nor {dicablc k,lhisIn,,c.r
<br />c tr dd s{rc rhat rhe !tx)!c i'rr.nndion is corccr I gre ro omply *ilh lll Ciry rn<l Counrv
<br />blildirB.onsrrdion. ud hc,cby axrhoriz rclrc€nrarilci 6rlhis Cilr.nd Counry ro cnrn ulrn lhc
<br />Pn)l[ny nr in\Nd on PUrExcs
<br />Plina e\os
<br />,^*.ae12=d)?
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Rool Sheathinq
<br />Shear Wall
<br />Framinq
<br />ln s u latio n/E ne roy
<br />Drywall
<br />Ext./lnt. Lath
<br />N4asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil
<br />,1 D
<br />_.--.>_ v -d4
<br />FINAL z'-72 izl1 I l,iuw
<br />Certificale of Occupancy :I
<br />Notes, Remarks, Etc
<br />Forms/Steel/Hoidowns
<br />Brown Coat
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