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BUILDING. INSPECTOR RECORD
<br />SITE-WOBK DATE COMMENTS O1INER BUILOER DTX,CARAITON
<br />I hcrcby alitm unds ,cmhy .i pc.jury rhnr I d cxcrpr rron rhc Cbntraclon Liccnsc l-sw ror $c rolbwi.s rcaen (S(.?l):11.5
<br />Busine$ and Proic$ion Codc): An, Ciry or Coutriy ehidh equtcs ! I]c mir b conso.r, nlrcr. imFovc. &ncrish u Rprn ,ny
<br />(tudu.c, priu ro irs n\uaft., ah. rcquncs lhc .rplica for such pcrmir ro lil. u siBmd tutcm lhar l* or rhc i\ li.cisl pusu!tri
<br />k, lhc Fovisions of rhc Conrracrois Lic.n$d tjw {Chdtrd 9, aomnrncinS sith Scclion 7000 or oivision 3 ol lhc Uosin.a 3nd
<br />PDtssnrns Codc) or rhlr hcor\hc i\.r.nDr thcrclror nnd rh. basis ior rhcallcscdcxc'nPrt'n. ny viol{lionofSc.rion 7011.5 by otry
<br />rmlic$t ror a r.rfrir \xhjcr rh. .mlicanr ro a ciril penllr y oI nor nx,ru rhd nvc hundrcd dollnm (S5q))
<br />-l-
<br />o\ o*ncr ol rhc ptup.ny, or my c,nplorr.s wirh uaScs ns thct {,lc c.mlctrs.r iotr. Pill do thc Pork lnd rhc {mtue is mt
<br />imcndcri orofrcrcd li'r slc (Se.7044. Blsincslnd ltofc$n, C.d. 1'h. Conlru.lol s l,icen* hw docs not iDplv ro u owror .f
<br />rhc lrep.ny ek)t ildr or ir{mB{h.mn. ! t who &B {ch wll hinNelt or ltRlf or rimu8h his or tcr own .tnll.yccs,
<br />provdcdrhrt such impmumnk e rct inicidcn or offcEd ror eL. Il tx'*crcr rhc ttri[ing or in{r.$nr.r is sld eilhin.m ,tr
<br />ol compLrbn. U. own& Builds will harc thc hrncn ot []vins lhlt hc ot sh. did tror build or inDmvc lh. IbFdy lor lhc Nrlns o,
<br />L asow6orrh. pmpdy. !mcrclusivclyc.nlEclins sirh licc.scJ .o trtrdo6 roconsrtucl rhc Pdjc.r (s(. ?ol4, Au\inc$
<br />ond PmfL5sionCodc:'lhe Conrra.k,t Liccnsc Lrw doct not apFlylo m o{nc, orPftrFny rho builds or imProv.s rhcrc.n.
<br />und who codn h roi su.h rojcck *irh ! ConlEcront lice,scd nu^nnnl 'o
<br />lhc Co raclois Liccn$ taw)
<br />I rncxcndr undcr s(non .B &PC forrhLrclron
<br />Dat. Owner:
<br />uI}BtrEIN:.COMIENIAIITN
<br />DECIAIIIIIIN
<br />Ihcehtnlt nundcrlcnlllyoflc4uryomof rh.followirAdcclarations
<br />I h.v.nM w ill truirrdn ! Ccniiiclre oa Cotr{nr t, sclr ln\uB fd workc con{rnsario,, a\ piovidcdlorhySccrion:1700ofrhc
<br />likn Gnlc- ror rh: lcrrorntsn.c olrhc rork for *hich rhc |Ermir i\ i\\!cd.
<br />I hrvc nnd willmainlain wortc.i conpcrsartrn insuhn.c. ds rL'quircd hyScdnn!.1700or'hc hborCodc. li)! rh. lLlfoflMn col
<br />rkforwhththi. n€mr N $md M) qdlr(.ory)cnqlionin\uroncet'nh' &dPohc) nunbsEc
<br />. 5+^+? €-",21
<br />so30glS///-/- /y
<br />-l
<br />cniryltu inrhcpc ortuncc orthc *ur* rorwhichr[isp.rnri n irsucd. | $rll flor enuloy anr Pc6on in ddy nlmncr
<br />q, !\ x, tEcoft subjcd b rh. workc6 compctrs{rion hw\ olCtrlif.rni( Md t8rcc rhat ifl rhould t*.om subrccl to rhe
<br />*.*c(..np.n\ntn,npmvtiotrsofSccri,rlTl)0oIrhcLjhtrC(ic.lshall.fonh*irhcodtlywirhlho*lrovhions
<br />WARNTN(|: Fnihrc ro surc $orkeis o,npcnsrion covcn,gc is uDl,wful. rid dDll rubicr u enPlotr. ro oinrinal P.nallts md
<br />civil 6trc\ !p t' oic hundrcd rhou\!nd dollln (Sl(]O.(XX])con olco ,r.n\lrtn:. drnuScs !\ lmvidcJ
<br />t)rl!.lrlUrQr
<br />Ihcrc$yallr undcr pc"alry o l Flury rhd l 0m liansct uMer rorhion or ChnPtcr 9 (connNNins wirh Smri Tm{r) ol Divhiinr .l
<br />of rhc Busims 0 Profc$ion!Codc, and
<br />'hy
<br />liftn* is in lull lorcc ond cilccr
<br /><39 3(s265-
<br />7-t4-lV..",
<br />gINEIAlrCUotlllDrNliaoENcr
<br />lhcrcbynllimundc,pcmhyolicrjuryrharrhcrcis,con(octionlcndinsagcn.yrorrhcFnnune.trhc*orkforwhichrhhP.anili\
<br />hsu.d 1S...1097, Crv. C.)
<br />aPrulANrDEcl 8Auo!
<br />I ncrcby o,fm undcr petralry orrdjury onc olrh. rolowinS dccl,TolnnN:
<br />D.nrlnn'n Pcrnfi*Asbcsros Norilic!ri.n F.dcral Rcguldri.trs (Tirlc 40. Pan6)
<br />Rcquircd t ttciol'Noriicarhn
<br />-l
<br />ccniry rb,r rhc rcdcral rc8uhlions Esudins a$cdor Emlalm nor {Ptlic$lc lo rhi\ Poic.r
<br />I .c Ii lhar I ha4 rcad lhn E llic,iion 0fi1 iarc lhil thc ohovc intbtrution is comr' I {8re to comrly wirh tll ciry lNl Counrv
<br />odin.rccs and Sllre Llws elaring lo building .on(rucln,r. oi hcrcby trulhi ctuprcs.nrdncsottnhCirynndCoxnlylocnlcruPonthc
<br />rb.vc r.trrnd prelrny for *;, ?-t7-4;"Applirant or Agtnt Silnrlo
<br />cl?1a\2^
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Shealhing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./1n1. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL 1\ ?,0\r4 l.lamd' )
<br />Certilicate of Occupancv
<br />Notes, Remarks, Etc
<br />ID/SIG.
<br />Erection Pads
<br />Sc.rnnr :1076 ol rhc lrbr (inlc. inlcrc{rnd
<br />7-/7 - /J.
<br />@- -
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