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SITE.WORK DATE ID/SIG.COMMENTS ()l!Nt,:R IIILI)I.:R I[:L( ,\RA t l()N
<br />I hcrcby rrfirn und$ n Mlry ol pcrjry lhrr I anr.xc'nfl ft'm rhc Conrrer.r' l-icen\. Lrw ror rhc lolhwin3 r.r$i (s& 7011.5
<br />ausincss md Pdc$ion C{xlc)r Aht Ciry or clrNy shi.h rcquircs n Ilc.Iir tr .oiNrucr. dtcr, imt'nrvc. dtn$li{h or rct]dir onv
<br />nfldurc. Drimro ir\ i\{tran.c. nls rcquncs rhc olpliclnl l'o! uch pe..rir ro fil. r si8ncd (nlemnl rhar ltor sh. is li.cn$d Pu,$rnr
<br />r. rhc lrolirions ol rhc Conrruclr\ l-iccnscd L,w (Ch.rrrd 9. Com rcncing wirh Sccrion 7fix) of Oivhio. ] uf rh. Bu\i'rc$ 3nd
<br />PnrlcsionsC.!c)orrhrr hcorrhc ".rcnDr rhcrclmrand rh. basi nrrh.allcecdcrcmPlion. Anrli.lrrionolScclionT0:ll5hvtriv
<br />lpplicani t a pcrn r rublNrsrhc amli.anl lo,civilpcnrhyofnor nMcrh.tr lilc hun&cd dollar (S5Ul)
<br />-1.
<br />rs .wncrolrhc ptuFny. or mycarployes wilh s!gc\ r\ thcn n,h co.rtcnrrion. *illno rhc *(rk md rhc sltrr@ G Rn
<br />inicnd.d oroficrcd fnr s.lc (Ss 70€. Btr\incs d k)fcssion. Cl{lc Th. Conkrcnr's t-ic$s tj* doc\ nor ryply b M owrr oi
<br />rhc pmpcny wto huilds or nrrbh\ ltrNn. fld who drrt such q* hnnsclr o' hchclf or rhrough hir or hct owtr c,qllovcc\-
<br />prcvidcdthnr such nnlrorcnr.rs arc nor inrcndd or.tilrR] tor uL ll h,wcvcr. rh. huiting or im!tu*ftnt is stl sirhinom Fr
<br />olc ,nlkrim. rh. Owncr Burlls will haE rhc tulcn of Protrg rhd hc or \ht dil mr rruild or inlmvc rhc r$ltnv lor rlrc IUrFrs o{
<br />-l-
<br />a! oNtrs ol ihc E.t y. ir cx.lusitly conlrri ina *irh lic.ns.d .otrln nr lr) con(tu.r I h. Pruicr lsr- 7{lr4 Bx{trcss
<br />r Pin(x\ionCodc:lhcCo.krcttr\LiccnscL1*doc!tror.ptlyr.anorncr.rptuNrl!whohuildsorimpovcsrh.rcon
<br />and *ho conrrcrs Id su.h lmtccrs uith s C.d nEion \) liccn\.d PUFU rlorh.Conr.acttr \ Liccnsc tiwl
<br />Ln cr.mpi und.. Ssriur-. B & P.C. lbr lhis rer$n
<br />]tABKD&r:(a IINSjJIQ
<br />IIEILABAIIO!
<br />I hcich! ainnr undcr lcnrllyotFrjoryonc.lrhc rdk,rng dc(ldrdri{r\
<br />-lhsvcddeill'tuinrdrnCcnificrlcolCon\cnrloS.ltrlNurcf.rworker'conrPcn$rn,n.aslrii,viicdl',)rt'yS*rion:l7U).llhcttrh.r Cndc.lor thc pcrformrdcc olrhc *o* lorwhichthc pc,nrir n ksu.d.
<br />lhrvcand wilt trri,rlrir work.rr.. rpcnsdidl nruhncc. rs rcquircd bySccti(,n.l7tX) olthc Lrtxtr Codc f.r rhc pcrlonnan.c of
<br />NI! \
<br />U U
<br />-l
<br />ccniry lhar in rhc pcrr.nmmc.rthc sork nr! *hich rhn f.lnir i\ i\suel. I shrll rol cmlloy diy lcrsotr in rnv mrnn.'
<br />$ N n, b...ft subjar lo rnc trorkcE .omp.nsarion l.M olCahf(flii- and Jgr. rhar irI should hccom {fijccr r. rtr
<br />work$l .o'npcnsrr ion pmlnion\ ol S(in)n 1700 uf rhc bhot C.dc. I $rll. lon hwirh c.nfly wit h ltFr Pn,risi, ts.
<br />WARNINCT [eillrc h surc rorkcrs .onDcnsali(). covemsc i! lnlrsrul. Md sholl suhF-' u cmployd rn rinrimlll.mhics ind
<br />civil lincs uI room hundr.d rhusafld dollar\ lsloo.lln), i'r addirt).rorhccod oI romp..sInnr. daftEcs a\ prrvid'rl r'r th'
<br />Scction 1076 ofrhc ltrhor c.d.. i c.c{.nd atrrmy s fa\
<br />D.te: Appli@tri:
<br />I ICENSED CONTRACTON
<br />IIES,ASAIIA!
<br />I hcrchy,lfirdu.d.rp.tr0llyofpcrjury lh{l Idnrli.cns.d undd lovi\ionof ChlPr(I(.$mmminS *irhSccrhn70 )'rl)ivhion:l
<br />ol thc Businc$ rnd PrnrcsnnN Cod.. arld nr, licensc n in full forcc Mi cflR_l
<br />b ,.
<br />6\Lhl10K
<br />(:ONS'I'IIIJ(I'I'IoN I FNDIN(; AGEN(:I
<br />I hctuby rfllrnultrjcr ncnrlly ol lcrjtry rhd rhcr. is r..n(ru.rioi lcnding rgcncy lir rhc $rlorNncc olthd work lor shich rhn llc nrir G
<br />is\u.d (Scc 109?. Civ C )
<br />artltc NIt-0Egl,lrB ua!
<br />I trRbttll]r uDdcr pcnrlly olpcljury onc ofrhd folk,wrn-( ilccltrrrFn{,
<br />t)c'noliri{ PcnniNAsb(slus Norificiri,rr l:cdcful R.!uldi{ff (Tirl..lo, PanO
<br />Iicq!i'cil l-(rrr,,,1 N,i li(ri,i,
<br />l..riryrhrrrrk ir\L rl,csrlr. \ rc! Lttrrei\trnn\,.nnrrr,.nor,r)tl.rh.rirlr\l)n)ll!i
<br />o'di'ur..( itrd SrnrcLdws rcl$ing ro
<br />atx,vc mnrioncd ptuF-ny for nl(pccri
<br />rion.srihcrchyaurhori/crcprc{nl ivclofrhtCirymdCoxntytocnlcrupotr
<br />AU icinl nr ,\Ee.l Si*nnl *,Glul?tlg
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Venl/l nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsu lation/Enerqy
<br />Drywall
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />Masonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL 7//t/k gr> €t
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />BUILDING. INSPECTOR RECORD
<br />Pool Fence
<br />t.r..,,1'. A,t\c\. _
<br />tt
<br />I
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