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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DEL('\RA'TION
<br />I hcrcby liirnr und.. Fnalry of Frjury lh l m cxcn{'r fmnr rtu Cotrt.cror' l,ie.* trw ror rhc ioll{'wirE rc,vrn (scc 70ll 5
<br />Businc$ lrn Pnnes\id1 codc): Any cily or counry,hi.h rcquncs 0 P.rmir ro .on{ru.r. uhd. iflProld. dcnDlish or EPair mv
<br />{ocrxn, trturo ns issun.cc- ako rcqunc h. rprli. t lor suchFrmn n' filca riSncd sl cmot rhlr h.or shc is licenscd IuFuMr
<br />lo rhc pmvisbns of rh. Conlracrois l-icen*d Llw lchnprci 9, Connrtrrcing wirh Sccrnrn 7UJ0 of Divirbn I ofrh. Ilusinc\s rnd
<br />Pmlc$iuNCodc) orrfiar hcorshc is.xcmpi rhcrcfonrondlhc busis fd rh. rllcscd cxcmlri{,n AnyviolariotrolSarirT0:ll5ht{ny
<br />appliunr lor r F..rir ixblc.u rhc llplicant ro ocililpcnnxyornol mrcihun fivc hundtddollds (Ssfi))
<br />-1,
<br />rs osNr or lhc proFny. or ycnrnl.r.ssirhw.ecs0sthcthlc.o.fcn\ n r. will do rhc wo.k urd rh. {nrlurc is ft,
<br />i . lcd ur oficrcJ lor $lc (Sa ?04.r. Busn$s and Pn,fc$ions C.de Thc Cdnrd.t" s Li.cnsc t { d,c\ .or amlv lo !n owncr or
<br />rhc pmF-ny wlar htrild\ or inlJlmB rlL]Nn- o.d who drs fl.h $ork hnnscll.. hcrelfor rhtuxgh his or h.r o*n c.Vl(,y.cs.
<br />Drovd.d lhor such i plolcmms m fr ir cndcd or oficBl hr slc ll h(,wcvcr rhc tdildinA.r inDrovd tm h dd wirhi'r om ,t
<br />of.o,nfuion. rlt Owncr BuiUcr will huvc rh. honlcn oi lroriry lhd hc or \hc did trDr hild or im0rolc ihc FmrElv li,r lhe puPsc of
<br />-l-
<br />0so*nsolrhdln,!.ny. {ncxclusilelyconlradinr sirh li.cnsdl co md,n\ r. c.rnru.l lhc Prolcd (Sc. ?044. Bu\i"c$
<br />PnnLssirn Codc Thc Contu i(tr \ Li.cn\c Law ducs tror.Pplylo !!.*i.t ofProFny who huilds oi in{rovcs lhcrcon.
<br />.nd who c.nrEkror\n h pojccrs qirh r Conradon, liccnscd Putsu.nl lo rh. G,ntudoa s Liccnsc La*)
<br />-l
<br />nexcmpr und( SNr a &PC forr[]srcr$,
<br />1I(TR KFRS' (:( INI PF'NSA'IION
<br />DI.CI.ANAUON
<br />I hdrhy !ll nn! ui,lcr l{ rlry of l!-lury onc ol rhc f{nb*ing Jdlmrions
<br />-l
<br />navc ard will tuinhin ! Ccni,icllc ol Con\cnr tu sclr Insurc lr wo c^ q,nPcnYrio . ts lmvidcd fot bv scctiotr:1700oirhc
<br />tibor Codc. for rhc Ffonon.c of thc *ork ln*hich lhc p.rnir i isucd.
<br />I hrvc rnd will nrnn rir sqk..r conllcn\ddl irr\urrncc. r\ r.quircd hy Sc( nn lT0O ol rhc litrtr Codc lorrhc P(!6rtun.cof
<br />rhc work fitr whi.h rlrir fnnil is isrud My workc$ .omp.trsrrion insurrn...daicr dt {Flicy nurh.r dc
<br />-l.cnify
<br />rhrr in rhc p.rfoflmncc oithc sork io. *hi.h rhi\ Frnit is irsuql- I rhrll nor cnlt'lov inv Pcrwn in rny nDnncr
<br />R, ,s b h.conm $biccl h rhc worlc* .on!n nsarion hrs ol Cllil'onir. a'kl a8rcc rhar if I should hcmru suhjcct lo
<br />'hcktrkcr{ comp.ns.rion prolisioniof S.ct.n lT0Ooithc tik,I \hnll. fonhsirhcohply snhrh\c fovisiotr\
<br />\\'ARNIN(;: tx'lur. n) {.0.. r.rkeri ..n'p.n\rrr, ',.\r .n crnpl,"tr k, fiminrlPcMllk\ rnd:q4 *
<br />ion, d,mecs as prolidcd lor rhc
<br />I h.tubyJlfi.nundcrDcnllryof p.rjrryrhar I inrliareldundcrpm!i\n,noi prcr 9 (drtomkin8 silh S.rlion 70oO) oioivision 3
<br />ot rhc Busncsslnd PmlcssionsCodc, dd my li.cn\c h i,r tull fttrcc Jxlc
<br />I hcEhylifir undcr Fnrlryofpcrluryrnd rhcrc is a
<br />issucd (Scc 3l)97- Cir C)
<br />kibdin8lsctr., turrhcrcfonnrnccofrhc {uk roi *hth rhh Pcrn r i\
<br />tJndn r Nar*:
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<br />APPI ICANTI}F(JI ARATIoN
<br />I hcEny ofiimr undcr penalry orFrjury orc ol lhc foll{,wins del,r.rions:
<br />D.turirn,n Pcrmih Asb.sros Norifl.{io. Fdc6l RcBuhl ions (Tirle l(). Pd6)
<br />Roquird lxricr of Norilicdft ,n
<br />_l.cnifyrl r rhclcdcrdlrcgulrlions rcluling rshciosrc hvalffc n l
<br />I ccnifyrhil I lNr rcldrti\ anpli.nriotr
<br />odm.n csrtrd Strtc Lnwsrchriru k,huildi
<br />corccr lasrRroL\nnplywirh0llCnyrMCdunty
<br />r&xc trf,n1i,)ncd f 'oItfl y I(tr irNpccli(nr
<br />,\ppliunrl orAHrnt Sittrnlu
<br />**"*"'i)'ffi,'.ai,-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Rool Slrcathino 'l-L1.to /zf/'zq
<br />Shear Wall
<br />Framing
<br />tnsntatidnlf nerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />I
<br />FINAL /ol*rf ->lMi n)
<br />Certilicate of Occu anc
<br />Notes, Remarks, Etc.
<br />UFER Ground
<br />Subf loor/Vent/l nsulalion
<br />n
<br />-T
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