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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs 4,,.'lt'Il,AV/"
<br />Erection Pads './
<br />UFER Ground
<br />Subf loor/Vent/l nsulation '.fa/4tRoof Sheathin 1ryl /8 L l
<br />-
<br />y'--/'-tShear Wall
<br />Framin u/zz.
<br />4 ril o)lru.(w)(
<br />lnt. LathX I ;i)EfsJq-.
<br />own Coat L
<br />Pool Fence
<br />T-Bar
<br />En ineer Final Re ort
<br />Flood Zone Certil
<br />FINAL t t
<br />Certiricate of Occupancy I UI,I
<br />Notes, Remarks Etc.
<br />ln l-e-
<br />a
<br />I
<br />\flr I .t)tl{IIoN
<br />ri.
<br />l,rolr$i{!F(od.) nr rhrr
<br />rn|]ll..dr ntr x J{nn[ suh
<br />hcorshc hcxcnpr rhcrcfromud rhc hr\i\ for rhc .lcFcd crc,nlnbn. Any viohtnrorsccrhn 70]t.5 hy nyjkh rhc rpflicr k, a civir t)cnatryofnoi nxtu rhln rivc hundrcd dolus (S5(x))
<br />,frhc p.trdy.or nrycrrrplolR\ *irh*rFc\r\ rhet nnc.oDrtr \xri()n.$iIrl.rhcrqkrMrh.nto.rrtr.is[{i cndGl orotiircd for \rtc (sa.7(}l4, Brsimss.trd pmlcrsion( Qxjc:1.18 conlracrtr\ t_i.cnq tj$do$nor apdyk, owncr.r
<br />rhc nmt ny wtu builds or irwn,vcs rhcE{tr. dtrd who d(s {rh qo hnnsctforhcrrclorrhroulhr,t.".t",u*,"-pr,,"*.
<br />lrovidcd rhrr nrh impn,vc,rnrs arc nor i' ciddl o' .flc*t anr qh. It rnqcvs. rhc huit,titrs ". i",t .",rnMr i, ",h ;irh; -. ]"*ofn,npLriotr. rhc Osn.r Buiklq willhan rtu hrdcnortuvinsrhi! hr.rshrJid mi $oitd o; lnnrrhcpmld,roritrnurlnrtrr
<br />I. r\ o*Nrot rrrc r)Nny. rrrcxctusivcty conrr0diDg wirh tun\cd.onrrcrff r. cotr{nr.r rh. rx,jrct (Scc. 7(!r4. Brjncslxl hDri\lim codc -rhc (tnhcl.i s t-iccnsc r_aw dms nor irrr ty ro rn nr nc, or !(pr y "r," t,,tia, ", i,,p"*". rr.,o..rn.l who ..nrrc(nn ru.h pn!.ccwirh,(i,nrracni, ticcn"cdpu6u0[ ro rhc (i,;kacrtr.\ Li..nsc bw)
<br />I ,i/',b Z*-
<br />DFCI dTATI(IN
<br />I h.rcby rrfihlndcr pc.lhy or Frjlry onc ofrh. rottdwins dRtmlions:
<br />_I haw and *ill mn ain a C..rifEarc or cbnsnr ro Scta,tnsurc ror workcr' comp.trsrion. as rrDvidcd for by Set ion l70o or rhcLllD Cod., fo. rh. p.rLturcc or thc work for shich rhc pdnir is hsled
<br />_lhawd.dwillm.n ainwork.( mopcnsslion iNUBnce_ as rcquncd bysc.rioi j?00 oftnc bb.r Codc. torthc pcrfo,nunc. of
<br />lne work ror whicnlnk pcmn is hsucd My workcB' m,{rnsdiotr insurancc .arifi drd Fticy numhcr d.:
<br />ilyrhrr inthc pcrforntr .c ofrhcwork for qhi.hrhi\Frmir is islu.d.I \hrtl nor cmployntrvp.r\on h.n, lMncr
<br />v' a\ lo hcd,ft suhjcd to Ihc workcrjoh,'.ns(i.n la*s olC.tihrnia. and aarcc lhd ift shrld trcoru suhiar ro thcsn,tcr c,trntl.1. r,nfl,^tri.\..\Nr'.trr7rnirrl-ct,ih{ridc.t\t,J t,,nhtrirhomntl urrrrr,"*r,",n-*
<br />WARNINC: Failurc k) ycurc workc( .ofiFnsdion ovcrlC. i( unldsrtrt. and d$lt \uhj.cr an cnll,torrr b crininat pc*,tra\ andcilil lincs up n) onc hundrcd rhou$nn dollm igl(x)-(x)0). in iddirion ro rhc co{ ofcoil|xNd n. damg.s xs providcd nn rhc
<br />I)t.t( L,\RA llON
<br />Ihcrc6ynlln u cr Fhlr, ol pcrjury rhlr Ionr li(n$J unnd pn\ nion of Cturrs 9 (.onnktuinS *irh Scdion 7{XX))ol Dili\ion.!
<br />.f rhc susin.sdnd Prn'csions Codc.,nd nrr licctrs n ii rulllor.c rd clfcct.
<br />Cotrlr..lor
<br />IONSIIIJSIIOA.LENIIINCIIiTN.CI
<br />I hcNby lirm uddcr rcnslry ofFrjrry rhlr rhcrc n a.onstrucrion Lnding alcncy fix rh. Frlolmme ol rhc work for $hich this tErnrir ir
<br />h\ucd (Scc..1097. Civ C.r.
<br />ATTLICANL.DEIIdf,{IION
<br />I llrhydl'tr urdcr |[tr{lly olp.rjury o.c oflhc blhwin! dccltr'arions
<br />Ocmolirion PcirriFAsh.stor Noria.diion F.ddtrl R.SuLrnnN flilt l0- P!nC)
<br />-Requncd
<br />krler oi MtiaKarbn
<br />I.('rilyrhrrrh. tud.rrlrquhrn)r\ RSfdin! r\h.{.s rUn.vrl rrc for rnrll.lb]l r. rh s pn+ct
<br />Forms/Steeli Holdowns
<br />SLAB Floor
<br />lnsu lation/E ne rqy
<br />Prywall
<br />Masonry
<br />Handicap Req.
<br />Deputy Final Report
<br />tln62k/,->9)
<br />n
<br />7
<br />llndcis Addr$sr _
<br />CirY
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