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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS owNllR BtrlLllDR Drx-c^RAl loN
<br />I hcrcby rlltr undcr pcnalr, (,f P.rjury lhtr I inr cxcn,pr fro'n rh. Conlri.l,tr\ I-i.cnsc ttrw lir rhc l()lbwir8 ter{nt (Sc' 7011 5
<br />Ru\inc'. anl Pnn.s\nrn C(xlc) Any Ciry or Cornry *hi.lr rcqut \ r Ptflni kJ conslru.r. 3!r.r nn|}o$- dt xrlnh or rcJ|'ir my
<br />nru!1$.. fritrn, ii\ isurD.c.oho rcqutc\ rhcaJ,ph.rDr k, such pcnnirto lllc! stnc {rr.n.nr rhnlhcor \hc t riccn\cJ luAtrr r
<br />k, rhc pn,vis,otrs of lhc Contacrdrs Liccfql b$ (Chr|no 9. Commc^-.i',3 $irh Scdirnr 7G().f Divtion:l ofrltr Btrsincs 3trd
<br />Profcs\ion\ Codc) or rhar hc or shc hqcnu rltrcliunrrnd rhc ba\i\ f{trrhcnllc3cd crcnrrrhn Anyvnndnnrofsc'ti(r7l)'ll5hldtry
<br />irnlicrnr ru rItrnnr subiccl\ rhc nPrli.rtrrtorcivilP.Elryoriormorcrhln,1!rhundrLidolllN(stoo
<br />l. rs owncr .l rh. ,)mrcny. or m, cmlk,yccs *nh s{gcs as rhct $lc coml,cnsrlirn will do rhc soii $rl rhc sNm n nor
<br />inrc cd ororlcrcd itr slc l5$.70:14, ausinc$atrd l,ri'ltsionsCrdc thc O, rnckr't Li.cnsc l.trsdocsn.l!!DlrlornowDcror
<br />rM nn{cdy who hilds or i'nProrcs lhcrn. xnd who d,8 n'ch *ork hnn\.lfor hcNclfor rhr)ush his or hcr ow' cm0|)tcc\'
<br />tnvidcd rhar ru.h inDmvrtrrnt m mr iDlcnJcd ff ofitrul fu sL ll lo$cNr. rlt l'aiHin8 or inrrovctr.N is $H withir onc ,fu
<br />; d)nDlcrtnr rhc owmr Builler {ill h,v. rhc hudctr oi DDvins rhar h- or shc did fr hikl or imProvc tu pn,Fnv lor rhc purlb* of
<br />-1..wmrolrhcImpcny,arcx.lusivclyc.ntrcri'r!shliccnscdcontrcro^ki..n(rucrrh.pmlcrrlscc701-1.Busilr'$rlkl Pnntshn Cnlc: Thc conrxctr's t-i.cn\c Lau rlocs lor aPplt t, d.owncr ofF)P.nv who 6uilds or inrPtorc\ rhcrc'tr'
<br />and sh. conlrNlrturst.hrr.Ecr*irh r Conru.ttrl9 li.crr\cd Putsra.r tJrhc(onlrrctr's Liccnr Lus)
<br />lrnrt\c ,tr u iL.. Sc(ri,nr .ll &l'('nirhNr(r!tr|
<br />lrr
<br />IaEKIIBS:1;AMIENS rl()!
<br />DLCLIIAIIAN
<br />I lrcbvilli'nrrnd.r n nrlryol ttrjuryoncolihcnnk's rnccl{iii{nr\:
<br />lni *ill'minrr rCcrlilidrcol(inscrrrr S.llln\nc nn $orkcrr dDn.tr\dnnr. r( |]rovid.d turhvSc.lio.l7lX)ol rhc
<br />n Codc,li,rrhc pcrlonn i.cul lhc *n* fn*hichrhc Nnnir i\ i$ucd
<br />,.n\irioniNuruN..3srcqur.dbySccri,)n.l7(x).lrhcl?txtrCoilc.lirrrhc,f,rturnr.colc rn,l $1ll hrtr[nir rf rkc'r.o'
<br />La.Z:/ibt-
<br />l.cnifyrhnr n rhc ncrthnn n..ofrhc * 'k for *hichrhi\ Prnnir l\ i$trcd l nmll nor crnlkrrrnt |rr\{r ir xny trtrEr
<br />\r r!1. hcconf, {rhF.r ro rhc worker co'np.i\drnr h${ oi( rlinlr nr. itrd !8rcc rhrr 'fl (hotrlrt hccont {r[iLtr tu thc
<br />\rrkcri ..nT.n\rrnrtr .\'ri{nNofSc.rii iTlI)orrlrIxlxn(,xLr.I\hxl.hrh{ h.t lnt\irl!rho\(ll rrlion\
<br />$AllNlN(;: I; htr. h $.tr't tr.rk.'! (otrr|ln\xr rtrd nr,ril suhj.rr rtr cnrPlqtr rt dnniMll{nrlric\ rt
<br />!i,, 1,,n nlrliotrntrl,!,'lltr\ i\ll) i{rr "P' -..t,-e.* * r"",,t"r t"'t''q::;,.7:'')y':-:,:;
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<br />prd 9(coN,f,ming qirh S..rir)n 7((x)r.ll)ivls otr lI hrrhyrlllrnrrndcr Nnrhy.f t{rjury rh l mr li..n
<br />ol lhcl)$iR\\ri Pm,c*i,rr\ Cod., ml ry li.cn\c i. i'r luLl ln c nml ctlc.:l
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<br />I h.tohy afinm uflder pcnal(yorpcrjurylhal lh.rc n r $srtud;n hndins a8.mv tu rh. pcrrtnnrnc. olllr sork Lr shich rhis F-flnir is
<br />Lin,l.a\ Al,lE\\:
<br />APPLICANT DF(]LAlL{'I]ON
<br />I l.r$yrilimltr df pcDrllyo,I.rjuryoi.ol lhcfo1l.s'nrrdeclnrrri(trr
<br />Dcnrnirion P.nnirs \bcjos Nori6.rrid Fcdci l Rclu1!lionsI l irlc'10, Rrno)
<br />l1(at,rn.iL l.rrn1,'l N,iiln nion
<br />I rLnlly rhnr rhc tcdcftlEsuhrion\ rcainli'rg r\ltios on.hlrr. nor r!n rrhl. nr rhi\ f(!ccr
<br />l.. ilylhrr Ihrvc rc lrhnrt,n i\romrr I nflN b conuly $irh.llCilyrnJ C.u rI
<br />rcrc\c t,rnc\ol rhi\ Cirr-rtrd C.unryk).ircr tr|FrnEonlrmn.csrnd Sr tc Lrwr rchiirg
<br />rhrr rfii( rl |n)n n! nr rtr
<br />I'rntitrt n.nr lprinl): a--'
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathino 4 ltzll?2mora /4.
<br />Shear Wall
<br />Framino
<br />lnsulation/Enerqy
<br />Drywall
<br />Exl./lnl. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Ceftif
<br />FINAL //'tt/nr 6r/tr/k /o-
<br />Certificate ot Occupancy
<br />Notes, Remarks, Etc
<br />Set Backs
<br />isud(Sc. .1097. Civ. C )
<br />L. ,ld . \atrr
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