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BUILDING- INSPECTOR RECOBD
<br />ID/SIG COMMENTSDATE
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SublloorVent/l nsulation
<br />Rool Sheathinq
<br />s\ 6sFraminq llrftq 1//ol<
<br />lnsulation/Eneroy
<br />Drywall 7(ra(e SA<f
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputv Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />7/r<{ //s sr)6FINAL
<br />Certif icate ot Occupancy
<br />Notes, Remarks, Etc
<br />a
<br />O14NER BUII-DER DELCARATIoN
<br />I hcrcby ,ifirn undcr Nnahy or D.rjury rhrr I an cxcnPr fnnn lhc A,ntddNr Liccosc lrw ror rhc folk'wil8 'cas'n
<br />(Scc Toll 5
<br />Bnsincsl nl l'rof.$n Codc) Any Cir, or Coutrl, which rcquR\ tr lt nir t, .\,.nfl.r. dllcr- invrolc, dcmli\h 'r rr'Jn Mv
<br />nndu.c. prxtr kr [\ issuanc.. aho rcquircslhc aPPlicsnr tur su.h ltnnirh l]lc t \igncd st3tcnEnr rh,r tEorshc k liccn{d lDnulnr
<br />ro rhc pn'vi\ionl ofrlE conrmrrois l-i..nscd tjs (chanrcr 9, co'nnEncira wirh sc.ri.. 7t{x) ot Divisio. I oi th' Btr\inNs r
<br />Pfl'rcsn, Codc)orlhlll& n\lr is crcmpr lhccfn,mnnd rhc bdn{ nn rhu !ll.s.d .rcmtri,n AnyviolarionofsccrionT0'll 5hvrdy
<br />atpli.di n, rptrmii sohj.rrs lhc apllicrnr ro r.ivilPcndlryol'nornxtr hnn fivc hundrcd dollrn($5OO)
<br />-1,
<br />r\ owncr ol lhc lmpcny. ,tr nry cmtloyccs *irh $xAN rs rh& qnc conlxn*{iur. s ill do rh. Nort and rh' (dur! i\ noi
<br />inrcnact or"r'rca t" *lc ri<.7I!,{. Brsimss,nd Pturc$ions Codc: Th. cbnrrackn \ Li.cnsc ti$ dodr nor amlv ro 3n ownd ol
<br />rhc pR,tcdy *h) ttrikls.r in{,rors rh.n$n. and sho dos \tch wik hnn\cll or h.i\clf.r rhough his dr hcr own cm!!orcc\.
<br />Drn,t",t rttur.r.t n\mvcmnr{mftn inrcndcd d oitrcd t(r \alc ll. howcKi rhc buildin8 ot inrmrcftnr is$ld wirhinonc )ur
<br />;rdnnflcr6n. rhc Owmr Builrd will havc rh. hrdcn or Pnvin-Q rhl hcorsh.did trol tn'ild or i'nnrovc the prrFdvforltu ruqx'* ot
<br />-l-
<br />0\owncrofrh. pruNrly. !ncrctusiv.lycotrtrrclinawirh liccn\.d.o tck$kJ..istrlclrhc pn'id.r (ss.70{4. Bu\i"c*
<br />rM PolcrsinrCodcrltuCont0clor'sLiccnscLxwd.c\trol!l)rlyl{'d.wn.roinnPc,whobuildsornnprovcslncrcoi'
<br />rnd *ho conrDrrs lr n'ch !reJccrs with r conrad{,( s) liren\cd Nr$unr t' rht c.nkldn r Licdic. La9
<br />lii.\. nt) , rl,, S(!r(,r
<br />\!()RK ERS', C( ll\l PllNS,1l I{ rN
<br />DI'EL8AIIgN
<br />I h.rchy rlfirnrnd$ |Enrlry ol tf,rjury otrc oirltr t,lk,$iLE dt.ll'rrirnrs:
<br />-!hnlcmlwilln$n'lai[trccnillc.lcolcon\cnlhsllflnsu.clil$or[crs.on{'cnsJlin.Npmvidedlj'hyscclion]7(x)oIlhcL!h.r Codc. rdrh. Frlornunccotrhc sork ror $hich rhc P.nnir i! i$uil
<br />I hnvc itrd willnraiorrii workcrs conrp.nsari(r insur.ncc. !\ rcqoncd hvSc(lion.l7fi)ofihc tihor Codc.lbr rhc |r.'r"'ninl l
<br />rhc $rk li)r whkh rhi\ Pcflnir is hsuai My workc^ comFnsarion nsorun.c clrhI ,nd nolicv numher dc
<br />!cth'0,,2.[ lra]c',tr t F,rt-;;.shlr- AauL cL
<br />-lcunilyrhrri'irhcNtli)nnalccofrhcworklorwIc[rhi\lrcr
<br />rir hi\su.J.Intlltrr
<br />(, .\r. hcc m suhjrcr t,rhc workcn comptn\ ri{nl ltrwsol Crlilirnrir trd a3ru.11 il
<br />,lcnrd.y ntry fcN)n nanr nrtrtr.r
<br />eorkcr coDpcn\rii{nr pmvisiotrs!l SNrnnr :17(n.f I hc LrtxtrCo,lc.l \hrll li)nhwirlr
<br />WAllNtN(; Iislu'r n) {.urc \orkr( ..nUicD\rli,r, co\.'xlc ^ utrlNvli'1. rnn {htccr xn c'npk,j_cr l,'.ri' i'ix Nrrlric\ xntl
<br />.ivll lnrcs uI h oic htrn,Icd lh'u\a d d.llas (Sl(xr.(rx)r. i', lJ[i r\rri,,r, dn ur8cs rs pnr .d hr rh.
<br />:::l]Eff'd H_
<br />hr|n.r 9rco nrtm]ng \irh Sc.ri(,n ?(xxrroll)nN!(r.lI h.tuhy rllirm tr rl$ nrnilryol |r.riury rhrr I dtrt lr.o{d trn,l.r ln,ri\trtri,
<br />ol thr llrN r!\if,ll"fLsrrl CoLl(. J\l nir- li.cr. ^ n 1tr11T,,.. rR!.lrr.r
<br />10Zb
<br />Bvtlle
<br />boz16 ,.,,,,,",,,, /_'Tt G r, (/<4"G,luat\x
<br />c()NsTRll(r'l-l()\ I llNDlNl; a(lItNct
<br />issucd (Sr. 1097. Civ. C )
<br />l-ctricrs AdJrrs
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<br />aPPLlC,\N',t l)l (ll Al{,\lloN
<br />I lm{ryrttrnuftl.r r--. rlry.l t--riurl ond otrhr t{rl{trvir,3,lcchrrr(rt\
<br />Dcrn)liri(nr Pcflni( Asbc(o\ Norificrrion FcddrilRcrtrhriqr flirlc lo. Pr ()
<br />Rrqtrirc(l l.rrqof N.rill.niiur
<br />I.driltrhd rhc r!(trxl rclr18on\ r+xrilinS \htno\ rc nn.'l r |, t,Jilr\rl,. ri rh\ |x,rL(
<br />X :r' lr,i'ir.,',1: r',;-l'Jiri;,,Ji iJili
<br />',1,,\. (' r ,fl.,l rn,trn! rtr trrt,- r{rnur
<br />ntrrrri!r n.on$r I rlrccr,icomplt$[hrll( ir] rnd ( rnrl
<br />rdlrriz.'.Ilrcsc rtrilc\.l rhhCrtrtrdCounryn,cdrcrul! rrlr.
<br />^ppliuu,r
<br />or
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<br />sianx(ure x,\ JVaVl ?^-
<br />,,,,",, 111f t6
<br />SITE.WORK
<br />Shear Wall
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