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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE IDlSIG COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation (z-) ,'
<br />Roof Sheathing 7.3 i't,\')Zz*P*<'
<br />Shear Wall
<br />Framinq fIT?PV 4tL77
<br />v;&^.1lnsulation/Enerqy ?5
<br />Drywall Jr
<br />Ext./lnt. Lath I t 7/92
<br />"*)'c-)Brown Coat -f.,
<br />n*t-?lVlasonry I '2r)
<br />Pool Fence r(Ut q
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Cra4lJ loltltl* 1
<br />"t)
<br />)at U \'\
<br />\/)*\^n VFINAL w)
<br />Certilicate ol Occupancy tr\1I
<br />Notes, Bemarks, Etc
<br />OWNIiR IIUII,DER DELCARA ION
<br />I hcrchy 0tfirm undcr I'cnrlry or pcrjury lhJl I !m cxcnrpr fmar lhc ConlmcroE l.icen* l-r* [q rhc tolLo*ing rcax,n 1s..70]l5
<br />Btrsinc\\ and P(,icsn'n C{xlc): Anf Ciry or Counry $hich r.!unc\ r permir r, ..i{ru.r. ,lrd. inuovc. dcnf,nish or rcl)it nny
<br />{ru.rur., ri.rh ns i\\urn.c.,l$ rcqun \ rh.,tdirnr ror\uchFmn tu filca sigtrerl s0r.mnt rhalncorshc n liccn"dd puuulnr
<br />ni lhc provirioos ol IIE ConrEcror\ Li.cne'i kw (Ch!|lcr 9. Conrmcncin8 $irh s..rnr 7m() .r Divi\n,n :l or th. Btrsincs ind
<br />Pn,fc$nrni(i c)orrhrr hcor\hc icxc U rh...h Jid rh.tEsi\ nr rh. dllcSdd cxcnrtrnnr. Anyliohrionofscdion?0.ll.5hy!!y
<br />qrrliconr,nr i!.nnir bjcchlhc olpliclDr ro ocivilDcn0xy.rnd mElhrn livc hu.drcddollar ($5ur)
<br />l. * own$ ol ihc lR,ridy. or ny cmibyccs *nhwdgc\a: rhctr y,lc.o rpcnsdn,r. lilldo rhc aoft orn lhc (Mrunis nor
<br />i cnrL:l or oflcrcd r(tr srlc (Sa.?(X.l. tlusimss and Pr.,tssions Qrlc: Thc Conrr$lois l,iccne us doc\ ior hrply ro rn ow.cr.i
<br />rh.ln,If,nt uho hildsor nnpmvc\th.sn, rnd wh() d{rs srch lorl hnn\clforh.^clforrhbuBhhr or hcr .trn cmployccs.
<br />poridcd rhor ruch nntmtcEnh uc rn idcndcn n o(cEd for $L ll. howcvd. lhc hlildiry or iq)Dwnrnr is sll wirhi" "trc ,trolcon[hri[ rlr Owftr Aui sqillhrvcrhchunlcnofpNvin!rhdhcorshcdi nor bui]d o, itn0.orc rhc Impcny for rhc l)Uqn{ol
<br />l.rsowncrolrhrrn)pcdy.rncrclu\ie.ly.ontrri',9$irhliccn\cdcunti.tn\ro.on{D.rrlrpnlccr(Scc7M.Buqru\s
<br />irxt hnL$i$ Codc Tl[Cotrtrcnn s I-iccnsc t-is docs rorrllDlyro ntr.strcr orrn,pcnysho huilds or nnnr.vc\ rh.rcoi.
<br />rnd rho codrrch tn su.h pnl.r( !irh r klr(n liccn{d pururnr hrhcC{,nrr.t,'s Lic.n* tjq)
<br />I Jmcrcnmr un.l.r S..rion R & PC i{,rhi\ rcr{ni
<br />I hcrcht rlTnnrndcr Irnrlryof |{r]lry(
<br />I hrv. arri will 'tuiir{in a Ccdifi.ar. of Consnr ro Sclf ln$ic litr workrs'.omr.ns ion, $ nnvided fn bySsrnnl7mofrhc
<br />litxn O c. nr rhc pcnormncc of rhc work for which rh. pcrnrir i\ irsucil
<br />Ihrvc .d will nh! .h workcrs' comNnsdiotr insmncc. rs rcqrncd hyScclionlT )olrhcl-ahorCodc.lnrrhcrcrf.imrtucof
<br />ihr q.rk fitrwhi.hrhi( p.nnir lt Gsucd MyworlcrL conrrcnsrrion insumncc caricr ui Fricy olnhcr rr
<br />Poli.yNumb.r:-
<br />I ccfliryrhd in rh. |).rr.rnrrccoflhc qtrt lnr whi.hihis l{flnir k h{ucd,l \h!ll nor cnrdoy lnrrrrv,n in rny uDncr
<br />nr as'o bc.o E rrh].ct lo thc worhcr Nmncn\lrn,n ltrwr olo,lifirni!. xftl asr.c rhrr irI shoxld hcoft suhjcd lo rhc
<br />{orkc6' omFnsart,n fmvhion\ ol Sc.ri.n ]700 ot rhc Lsh, Ark- I \h ll. r(ihwirh complt wirh rhoc pruvisi(,ns.
<br />WARNINC Fnibrc h r.rr. qork$(.omFn\n rovc.Jgc n utrldwful. nnd lhrll \ublt\r !n cnDlorcr r, aiDirulp.irlrics rid
<br />.ril rnr\ uf n).n. huftlrrd rhru\rdil dfllr^l(x),(xx)r. i'r ddirir h rho cosr oi.oq,ctrsarion- d!nu8$ ,s providcd for rhc4
<br />I her.hy xllnf,utrJdr nctrrhy.l pcriury I ar li.rtr{d nudor pn)r,\i(r.lChtrflcr 9 (.rnnNn.nre silh Scdhtr ?(lD) ol l)irni,n,.l
<br />ol rh. Busifcssr Pn'icssiorN Codc. Md nry liccnr is ir tull Inrcc rftcltccr
<br />CONiIf,!]SUQNIINDIAIj.ACENCI,
<br />I hcrcby alitm undcr Fnihy of pcrjur, lhar rhcrc t ! .o.sitocrhn kndin! q.n.y ror rh. ptrro,mncc ol rhc work tot which I hir pcrmit t
<br />irsucd Iscc.l0)7, Civ. c.)
<br />A}fLICANIDICLANAIII)(
<br />I hcrty dllmr xhd$ lcnrlry.fp.rjury otrc ofrhc rollosin8 d..l*rrions
<br />Dcnnlirn,n Pcrnrirl Ash.d.s Norifi.al,un IcdcralRCBUlari.ns (Tirlcilr), Pini)
<br />Rcqtrncd Lct.r.rNorf(_trri,rn
<br />fedsal rsularionr dsrdins *lxno\ r.,hvalarc .dr arpli.nblc Io rhls !rojc.l.
<br />dadrhisdmlic ionflrlsarcrh.ohcdbvci oamtionk.onccr.IoErceromnpl,qirhallCny.ndCounry
<br />l-x$\ rchlug ro huildnrsro {,r.ri(nr. d hcrcl,t El'rcscnrarircs ol rhi\ Ciry add Counryio.nrd u,mn rhc
<br />)p.ny lor inspccri()n t!rtxirc\
<br />al.s.),o,.2l'nta I
<br />llLlQTw
<br />Hhtdfioldn \
<br />Flood Zone Certif .
<br />ll74ta 'l
<br />l-i((f{ Nr rh.r
<br />t_
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