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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER iTIILDEII DFJI-CARATION
<br />I hcrcby alJifln undcr |*n lry oi pctiury rhrr l afl cxcn{'r ri.nr rhc conttfun Ltcn\. t]w lor lhc n,ll(t*tr( rcr\'n (scc 70:ll5
<br />lrNincss rRt Pn,fc\sui C.Je) Any Ciry ot C.utrr! *hrh t+nts i lf(nil n) .o {nrd. rllcr. intno\t. dcneli\h 'tr rcIr't rnv
<br />sru.trrc, pritrb ir! i$uu.c. trl$ rcquncs nr ll)plicJnr f{tr \u.h Nrnil l{r lilc I \igrrd sr cmc rhd! lEor sic i\ li'ctr*d Nrlid
<br />io lhc pa)!i\i,nN .f rlf, Conrmct, s l-i.ci\cd ljs (ChnDrcr 9. Co'nnrcNirrg wirh Scrri( 7tX)0 ol Dni\i(r 1 oi rhc Btr\i'r'\\ rrl
<br />I,rolir\i{'ns Cdilc)or rh0r heor\hc i\cxc\n lhcrclroDan,lrlt hasn foI Iltrrllcgcd.rcnlpli()n AnyuiohrionotSccrhnT0:ll 5hvrnv
<br />lprlicr rlnr |xrnrir suhiccr\ rhc qrtlicanlk'aci!ilPcnrxyolmltrDrcrhdfivchundrcdJollrs(S5(Jo)
<br />l. $ oqncr ol lhc prcFny. or my cnllloyccs wirh wdgcs is lhcir ok &'nP{nsd ion. w!]l do rh. worl od rh' (M@ k nor
<br />itrhfrlcd or otrercd roi $ic raN 7OJ4, ausin \s and Pmfcsioos Gdc: Thc Cintrcttr s t-i.cnsc lrw docs nor .|)nlv ro si osrrrol
<br />rhtrmFny slF hoil.l\ or nvn)vcs rhcren- ifrl *h' doc\ \x.h q hinrclforhcrscliorlhrorchhi\orhcrowndmtloyccs.
<br />Fovidcd rhar so.h i.rphEtrr.k rcrer idcndd oroflcE\llor s'lc lr. h.wcvcr. rhe hiklin! or invovcmnr is $ld wirhir'nc Fr
<br />;fcompLrion. rhe C)*mr Buikhr sillhard rhc tn,rdctr olPnvilr8 (hd hc or \h. (lil trol huild or i'nP(*t rhc pmPriy for rh! nuqnscof
<br />l.asowncrofrhcpopcny-anlctclusivclyconlrlcti',Slirhh.cnttlcontxdor\loc.n{rrucrrh.lniccrlSccT014Bu\incs
<br />rrd ll.lia.i (itrlc: ll[(i rtntr \ l-icctr{ Lrwdocs Dol rmly
<br />rnJ *lD .orrri.lslbr \u.h projc.r\ $nh rC.rkr.t{(\) lircn\c(l
<br />or prt)rnf trlb bu'r,ls or li
<br />I r cxcDJ! n .r S.rri,nraEr- f 18
<br />I h$cbyrltrnnu cr Fiahyof Erlnryonc ol rhc f(,11.*ih8ilcclnralion\:
<br />lhrvcand sillnuinl.in aCcnifi..rcofConscnt k, ScltlnruN |or worksi conf.trsilntrr. !\ Pi{ridL{ Iir brS<rir)n lTur'lrhc
<br />lrtu Oxlc. ntr r[c lcrhNuncc or rhc Bork l'or which rhc nennn k i$ucd
<br />I h,vc n.d willnraiorain workcra conrPcnsari,n, insrran.c N rcquncd byscrrnnr l?(xrotrhc lrborCodc. for rhc ,rrli mxmc or
<br />rh. sork lor which lhis ptnnn is issen My woricB c.mFnsulion iNur! .c c,ric. md Polic, iumbcr trc
<br />-l
<br />c.nify rhrr in lhc l)crlonmmcc of rl[ work Lr {hi.h rhi\ pcnnir 11i
<br />v, r\k,hc.om subF.l t,rh. v.ikcn .onlp.n\rrion hs\ of Crlilirnrix. i
<br />n llior. .y trny |rr(n, hnn)_ tr,rnnrr
<br />crh,i ill dnn'ld h.o r {'l'ic.rt,rlt
<br />\ork.s .,rnt'c .nrifn|mri\otr!,n S..ri,r r?lx)ol rh.I-rl[ C.llr.l lonhNir[.otrlPly siih rlh:c provni(nr
<br />WARNIN(I l ilr. n, s.uru Norkc^ .o rt)cr
<br />.n I lnt\ trD n, .fc [trn(lrJ rhru\nf(l du lr^
<br />S.lrtrnr l0r( ol llE l.rhtr(i c.olrrrraklxr('
<br />I hcrchv rllirm und.r Ixnrlr! of|[rjur, lhxr I rr lilttr{d lnri\ionol ChrDl$ 9(connr.r.ilrF qllh Sccri,nr 701X)r ol Divi\i,nr .1
<br />ol rl'r Btr\i,rcl\.trJ l,rolr\sio's Codc. Md n,J_ licctr\c n in frllnr.c rldllilr
<br />l-icen\.CL\\:-
<br />c(rNs-l Rll(l'l I()N I-DNI)INC A(i[:NCY
<br />I hcrchyrrrkf,ru cr l.Nlrtofncriur, rhrrrh.rc r i co.slru.r6n [nding i3utr(v l('r Ihc r^-n'nrNrc. olrhc qork tur rhich rhN Nnnir t
<br />i\{nal iscc :rr)i)?. ( ir C )
<br />l.cdcrs A{ldr.s
<br />-
<br />APPI ICANT DE(II AR{TION
<br />I tErciy ",linn
<br />undcr ncnnli, ol Friury onc orrhc tullosin8 d(lirrrn"'(
<br />ocrrnilian Pclnirs Ast {.s Noliiiori{'n Fcd.rrl RcBUlrlions llnh 40. Prn6}
<br />Rcquircd lxll.r ol N.rifi cnli(nr
<br />l.odily rhr( rhc l.(lcr)l rclthriinr\ rc hc{os rcft,rrlrrc n{ rt,fli.rh
<br />I.('rilyrh l hx\.rcrJ 1l,i5rt)tli.di{r ud cr lrg'.t r).oDnly qnh rll Cir) rf't (infly
<br />or (l rtr..L )rLlrir i.l$\,c.[r 'g I intr.l rhir Ciry md CoDtrl, ro cnicr uB,n {ht
<br />rll,r rnrtr c,lroE-n!_ lnr i
<br />applirH l or /\l.nl Sitnd
<br />A41 /,4 y
<br />5tf /9:,?
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath 1/,21:<3\€b
<br />Brown Coal L ilcAl*frint y*a-
<br />-Di+asunry *-fl-Xt tt \/il, 11*,>}\xIr
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Eneineer Final Report
<br />Flood Zone Certif
<br />FINAL t/1/2,,r1,o 2L?L/b 7
<br />certitica6Sad cupancy 7
<br />Notes,fiemarks, Etc
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