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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DEI-CARA'TIoN
<br />Ihcrchynin u.d$ ltnilly ol perjlry rhor I rcrc'nFi lmd rhc cotrtd.ktr\'Liccnsc Lns ior tltr,ollowi'rE ravr (scc70ri5
<br />Busnrcs .rn t\o{csion Cdcr AnyCirynrCou ry *hich icqunc\ a lirnii ro onstrud- llrer nl]I)r,rq dcnnish or rFn.tr}
<br />srrucrurc. l]'iorro irs isuaicc, trlso rcqrirs rh.,pplr.nr ror sx.hFnnillo ljlc! sisncd {rrdftnr rhi ltotshc is liccnscd lursrnr
<br />lo lhc pnrvniotrs .l rlE Contrlci(tr\ l,iccnscd liw lChaprcr 9. ConnncNirrs wirh Scclion ?OOO oi Divlion .r ot rhc Busirrcs trnd
<br />PDfcssi(,ns Codc) or rhdr h.or sh. ncrenu Ihcrcfnu.kl lhc hasis lhr rhc allcBcd crcml)lotr. Any vidrriotrolSccri,,nT0.ll 5 hy diy
<br />rtplic^ rb!.Nirnir subjcchlhc aprli.rnr t, acililpcnrhyornormo(rhM fivc hundre(ldolhr\lS5(D)
<br />I- r\ osnu or rh ptulErtt, or trry crnployccs wnh wrscs ns lhct s'lc corrftn\"rio., u illio rh. work drhc{eru ilnor
<br />mcnd.d or ofcr.d lir $lc ( S$ 7(}l,l- BusirBs and fnrbsnnN C(xlr ]'hc G,nr crois Licc.\e Law do.\ mr amly h rn osncr . f
<br />rhc pnrpcny *l,ohuil or inlFr*$ rttrsn. irl who d€{ {rh tr.r* hifls.ll or h.rsclf or rhiouth hi\ .r h.t osn c'nfl,ircc\.
<br />ptolid.d rlr(r such i prot!'Enr\ c not i' cft}cd oroftrcd f(tr srk lt lk,wcE . rh.6uildin! or nq'mvcftnr is stt *ilhi. o.c Fnr
<br />of.ompltli(n, rh.OwmrAuikld qillh.icthc hurdcnolpnivirg rhtrrhcorshcdit ru huru or imProrc rhc Pmpcrly for rh. r$F,* of
<br />I.dsosncrofrhcFrDcny.nnrcrclusiulycontr.li'rg*irhlic.n\&l.otrtr.krshcon{rucrrh.Prljccr(S..7(x-{,Bueic\(
<br />rnn htrt$i Codc lh. Cofirtr\ Li.ctrsc Liw do.s ml aftlylo oa*ncr ofnrcpcdy who buikl\ or improvcs rlrcrc.n.
<br />rnd who.oftncr(tirsu.hnrclcchwilh!G)nrrrcni\)liccnr.dNr\urtrrt,rh.Conkrcknsl-iccn\cliw)
<br />Lmcxcnr unds Sccr
<br />Dire O*n..
<br />\TORXFRS' C(INIPI'NSATION
<br />DECIAXAIION
<br />I hcrchyrllirmundcr pcnallyoipcrju.yo't.lrhcfolk,wirrgdclarrrionr:
<br />I hivc md will nmn rir r Ccn i&are oa G,nytrr !o sclfln{r. fd uor*cn .onlEnsali.n. ss nrorid.d for hy Sc.l io! l7(t oa rh.
<br />tih.r Ci)d., for rhc p.rfoanotrcc oflhc {ork lor shich lhc pcdit i\ irlucd.
<br />_lhrran.lwillnui'rinsork.s'.onip.trldiotrnNtrn"cc.rsrcquircdhrS.cri,n170)utrhebbor(ndc.t{rh.,.rfomm.cor
<br />rh. work tur shih rhn Frnnr is i\sucn. MyEorkcm .onr!.n\iio. inurancc ruri& and Fli':ynumbcr atc
<br />Policy Nunrbcr
<br />-Erpirts:
<br />Icc irtrhrr inrhc pcrrontuNcoflhc work nn *hi.hrhi\ pcnnir is h$nl. ! \hilln.r c$doytrny Frr,l in rtry nmncr
<br />$ rslo trlonE \uhFlrh ihc sork$ .oht.trsdon hw\.fctlinrli!. und 4rc. rh itl.lvJuldhe.onE\ui,J.d n'rh.
<br />workcn dnnpctrsar i(D pm!i\i(, \ of S..r i.n 1?{l() of rhc lilttr Codc. l \hill. fonhsirh .. ]nly wirh riot pDli\idr\
<br />WARNING rrilurc 10 Kurc workcn conrpc hic.r atr .n,/ry$ ro diminrl ri(nrllics md
<br />.'!Ll li (\ urr (r r r htr rLr.(l rh!,$ rl (l.llx'\cortf, \rrnri. dr hScs rs Ir,vi,l.rl r,r rlr
<br />sccrn,n 1076.fr,r Ldlt, (itr]c. ilr
<br />l)t:ct..rk,\ l t()N
<br />I hcBhy rrrirntndrr rmlry ol Frjury I nm liena-d under pflrli\tD orCh,lld 9 (qnnrmins wirh Sftrbn 7t[xjr ofDivni.n 3
<br />.i ihc ll$irc$ rnd Profcsi{,ns Codc, rxl nry lr.n\c r $ fulln*randcllcci
<br />\o\n
<br />Dee)6 lB -l-9
<br />I h.rcbyalni undcr Fnrlryor|[rjurylhal
<br />k$cd (S.c l()97-Civ c )
<br />n{n,.ri(r l.nlinS xgr .y l(tr rhc t'.'l,trnurt flrh. uuk n, \h'.h rl'i\ JUnril i\
<br />AITLICANfDEIIASA.IIAN
<br />Ihol6y imundcr p.nrlryotncrjury or olrhc followirB dcchrdi,tr,\:
<br />Dcnnlitio! Pcnnirs A\tf,{os Norili.ari.n F.dcral RcAUlnrionr llirlc 40. Pan6)
<br />Rcqutcd L!rrcr ol Norifrdi,ir
<br />ti.trs msardiry!\n (orrcftrvrlrto iot qrllicablc tolhis pnr.tl
<br />tunNion n coreci I agc ro.omplywnhrllCnyrnd Counry
<br />y rurhorizc EpBscnrdilcs ofrhis Cily ond Counryt, cnrd uts. rhc
<br />J€S P-cs-l:d*-,
<br />c6 -/8*rB
<br />Set Backs
<br />Erection Pads A'r-1,llg let- ;E
<br />I I
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lr/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />-...--\
<br />FINAL 1lV lr tl -ttti+a\ t$f &'g'/
<br />Certificate of Occupancy r I l l
<br />Notes, Bemarks, Elc
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />Flood Zone Certif .
<br />06 --\8-
<br />txrd.a. AJ,lrc''
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