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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE COMMENTS O1VNER BUILDER DELCARATION
<br />I hcrchy rittD undcr t'ctrrlly {,1 pcrjury lhd I rm cxcmpl trom lhc Conrrrcl$s l,iccfsc llw rd $c nrbwinS rcr\on (SNroll.s
<br />Itu(incs\ and Profc$ba Cdc): A.y Ciry or G,unry whi.h rcqrnc\ a prmr r. . nslncr, axcr, improvc. demlhh or rplt M,
<br />{flcrurc, prioi n) iis isurnc.. aho rotutcs th. rlflicm! f.r su.h Fnni lo fiha siSncd slarcmnl thal hcor shc n li..n$d tu uMr
<br />ro rhc nrorisions olrhc Conrract.rs l.iccn*d tjw (Chaprer 9, Connn.tuin! wirh scclion 7000 ol Divhion 3 ofrnc Buli.c\l8nd
<br />Pn)fcs\ionsCodc)orrhlrhcorsh.isc^cnptrhcr.rron,ndrhch,*i\trrhcrlhscdcxcnflion.AnyviolltionofSerbnT0ll5hyiny
<br />appli.rnr rdn p.flnir rubjrhrhc rtplicanr ro a.ivilpcndyornol Ntrcrhan livc hundrcddollaB(S5l$)
<br />-1.
<br />.s owncr of thc lnopcnr. (, n]y cnDlorlcs sirh $,se{ a\ rhcn v'h cdn[f, nshotr, will do lh. work rtrd rtr (ndu n mr
<br />inr.ndcd r of.rcd ntr vh (Sd.70,1.1. BusiNss nnd Pr.lcsions Codc ftc ConrEdor's l,tcn\e l r$ does nor alply ro ownnof
<br />rhc prcFny tr ho huilds or improves lllcrn. ntur who dms su.h *1)rt himsell or hcislror rhtuuEh hh or h.t own .mpbyec\.
<br />Dn'vidcd (hrr such inDntrcrEnts m mt i.rcnd.d or olfcErd fo. {k Il ki$cr.r. rhc ${ilding or irymvcmir is s,[, wiihin ic )rJr
<br />ol.onDbrn,n, rhr O*6.i auiUd willh.!c lhc hurdcn ofF$virB rh0r hc or shc did mr l[ild or iqrow rhe pmpsrt f(, rlt pu{R* ol
<br />I. .s olmr .l lhc lr{cd y. rD c\.lurivc ly contrr.rirg sirh li.cr{cd .onlrrkr\ b .onnfld rhc ,rt+cr I St. 7(}14. 8unrcss
<br />r PDli:ali(n Codc 'lhcConrrrcin s Lic.f\c Lr( d.r\ norrtplyt, riostrrr uftn,lf ywho builds.r inuovcs rhcr.on.
<br />! {t sho .o kr.r\turi,.hf6lc.ls*irhr(nmncr(\)li.ctr\cdfrsurrrk,lhcCo rickr's l-lccnsc l-r*).
<br />I n rctunrl, r cr Sc.ri
<br />(rPn€.
<br />uottr[&urollfENsAJtoN
<br />I]ECLAAAIPN
<br />, hcrchy rfln nr u dcr F,rh! olpcrjuryonc olrhc n)llowins dcclmliors
<br />I hav. drd will nrinrrin d Ccnifi.rtc ol Consctrr b Sclllnsurc for w.*cr' conpcnsarn,n, r\ F,vid.d fur bt Sc.ri,rn:170t) otthc
<br />lik)r Codc. forrhcpcnord8n..ofrhc sork for whi.hlhc Nr.rir ir is\u.d.
<br />lhrv. rnd willmii$rir w rkcra crnl'c$aliqr insurnNc. i\ rcquiNd6ySc.li{in]700ofrhclrhor(i c.idrhcpc immrccoI
<br />6r/ov T." )Htd,**" ")nlEns.rion
<br />in\urx*-ccarir rfrr,-rricv nu
<br />,fr,*f ,,x 006<10a4o
<br />-l
<br />cc llilhit ir lhc Dcnnrmrnccol'Itu w.rk tur whi.[ I nrir i\ is\ucd.l shrlln.r cnr/nyrnytcson innnyrrmlcr
<br />\) r\n,l(on{ $hi..rr)rhc trorl.'\ .. rt)ctrsir,l ind qrcc rhrr irl should b.com \uhj.!r r. itr
<br />s.rkrn .o :|rrxxri,nrfR,vnnns.lScdiotr :l7l[)ol hnh\ rh.onlf)lY I irh rho\c |xrrtr(n}
<br />rtrd \l ll {ihlccr rtr .fltlo)u r. .nnrinnl |ttr]lli\ nid
<br />ro rhr cosr olconltrtn\arn,n, da,Mgc\ as ttuvidcd fd rhc
<br />DIi( t_\R,\t l()N
<br />I hcrcht rlltr uMcr Nfillyoipcrlury rhrr lan of Chrpkr 9 i(unnrD(irt qilh SccriotrTrfi) ol [)ivi\n)n.r
<br />dnd PmrcsnonsCndc. aftl.ry licc.sc n tullrnrcc
<br />Kr
<br />zqtl l ?t1rc I
<br />(
<br />lh.rcbyrn.nundcrpcnalryofNrjurylh rh$.ildcotr{ru.rirkndingl8.rcyi(rrhcp.raornfuNcofrh.aorkftrshichrhi\Pcrmin
<br />i\s'. (Scc. l0rr7. Civ ( )
<br />-,,^,,',1.,",1,^;l""il';Yi\ .om.r. l .Sre ro con{ly
<br />rcprc{d nc oflhilCiry
<br />*Rcquncd l.llcr ol Noliicrrion
<br />P.6.A'-7-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Rool Sheathinq
<br />Shear Wall
<br />Framing '1.i8.r b ,l tfl*u,rQ )
<br />lnsu lation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath 4 fua.tt f1 7o-,) P&A lAh C DL,z'Le 2?.D^ -
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL g-'1- tr.J/etua " (vQ
<br />Certificate ol Occupancy
<br />Notes, Remarks, Etc
<br />ID/SIG.
<br />Erection Pads
<br />u t0
<br />txtrJ.r's 44drc$
<br />-
<br />AIII(;ANLI]EIIAAAIIUN
<br />I lEtrty aliim u ndcr ltn3lry o, tcrjury oi. ol rhc r(rbwnrt ddlarlri.n\:
<br />Dcmoliri{nr Pcnnilr Ashcslos Norincarion rci[al Rcguhrion\ llirlc {0. Pd6)
<br />Icrnilyihri rhc Irddrl
<br />-lccnlrrhd
<br />I h{vc rcad ihi\
<br />o:(li'irNr\ xnl Srrk Ixrlrhrn!t)
<br />>tnic mrrioncd pm!'.ny for
<br />^Dolirnnl
<br />or lI€nl SiImlu^.
<br />\-,,"".**,*,,,,h@rya
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