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BUILDING. INSPECTOR RECORD
<br />DATE COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />Dnaulerrt<{q)FINAL bhrln t,
<br />Certificate of Occupancy aI T-l
<br />Notes, Remarks, Etc.
<br />OWNER BUII,OER DELCNT(ATION
<br />I hcrchy a,fuh und.r F.nixy ol Frjury rhar I d.!.ntt r$n rhc ConkachF' LK!n{ Llw tor lhc nnbwins EN)n (Ss.?011.5
<br />ansincs\ rll Pflna$irn Cqlc): Any ciry or (i'unry which rcquircs a p.mn ro .on(Ncl, ,lrci improvc. lcnolnh rr mn,n rnv
<br />nfldrc, prn)r h ns nsMnc., rho Rturcs lhc aflllol lbr iuch Fmt ro lik r si3re't dlcmnr th.l h. or shc is lictn{J Pusuanl
<br />h rl[ Irovisio oi rtE Conlractff\ l"iccnrcJ tiw (Chrprcr 9. ConmcNin8 wirh Selon ?U)0 ol Divison .1 oi lhc Brsin \s and
<br />Pnncs\srx Codc) .r rh.l hc or sh. L\.{cq)r rhct,i{mrndlhc harn ldrrhc allclc! crcmliion Any viobrn}nol Sctri,n 7011.5 bvanv
<br />aprlrca lnral.rnir sutj.ctsrhc dl)pliu,nr ft, rcivilr.nxlryol not mncrhan ivc hundrcddollcs (5500)
<br />!. $ owncr ol rhc nn'|xdy, or nry cmplorcs w h wrg.s ,s ih.n qnc .omtcn\lr i,)n. w'll do rlE work ad rhc {turm ir ftn
<br />irxcrlot orolicrcd ld srl. (sc-..?04,1.Ilusinc$ uJ Pdi*io.! Colc lh.Conkrcroasl-Nnseljwdo.snoranplvlr,!nowncrol
<br />rhctoFdy wh. hurlds or m\Tlvc! rh.RD. arxl whd dc( {'.h w)* him\.lf.r lrcr*ll.rrhnruSh hn or hcro*tr eq)lqts
<br />nn,v cJ ihrr n'ch inpn)!.mnh m mr un.pil.J or o .Rl ftr sih. lt. lr)w.vcr. rhc tntrU 'n! or inDr.\tm.r s 3,U w(tun onc vtr
<br />oluomptiion.rlf,t)wtr.rBrrlds willhrvc rhcnxrJcnofpn,v'ng rl lrorshcJiJ nor huild or inlp()vc rhc P,aFnv lilr rhc Puqx,* o,
<br />-
<br />l. r\ owrcr ol lhc nn,F:ny, rm c(lulvcly ont&tn3 wi h li(cn{,i rontr.br lo uon(turr rlt lojce! (Se. 70{4 Bu in'(
<br />,ki Frnc$nn O),lc: Thc conkr((tr s l,i.cnse tjw nocr nor alfly ro !n .*ncr of pn,fnv wlnr iuilJs or inniovcs rhcrcon.
<br />rn(l who conkxcrslu su.I lojc.h enh r contacnt(s) licctrscl pu^urnrtr' rh. Conr.ui{tr r l-iccnsc l-iw).
<br />_l anrr.npl undcr Scul
<br />WORKERS' CONIPENSATION
<br />PLCIAIAIION
<br />t hcr.hr !,lnr!n'lc. pcrahy otr.rjuryoN.trhc li,lh*i,rg J.{l*arions:
<br />-l
<br />hatr,rJ will mi umaCcnili.{cofConscnrtoScl[lnsurct,workcs'ompcn{rion.ar Ptuvi]cJ ti)rtvSccrion l7rxror16'
<br />ljl$r C,xlc, tor rhc p.rformdcc ol lhc woa tor whah rhc aenir h tstc'l
<br />I havc rnd *ill nrainhin workc( .onr.nsai ion insor3rcc, 'r rcqu,rcd hySctrion lT0Oolrhc L.t'o! Cod.. tdrrhc P.rlioucc 'frhc work tu whi.h lhh pcmir is rlucn. My w{*er' !1,ml.n\ar nn rurikc. icr a,{ piicv numt cr m:
<br />I ucdilyrhar r thc 0crl.rnuncc {, thc *oik tur whthrhis pcrnrit s is\ucJ,I shrll nor cnlphiy ,ny !trson rn uny frrnrcr
<br />n, N o b.coN nrhrcur ro rhc work.ri co,nP.fls n lawr.l Crl'lithi.. and aeEc rhar,ft \h,uld hc.ok- subjccr h rhc
<br />wo, kcrl . n{'tnsai io, pr'li\tunr of sccr kr .1?00 ol thc lihn cixlc, I rhrll. nnhw h .ohplv w h lh'{ povni,ns
<br />WARNINC: iailu. (' cuurc *orkc^' co'n!.nQlotr .overagc ,s unhwlirl ! shau ruh]ccr a,, cm!L))q b.riminrl lcnrlrlq .
<br />r'!il iln.r nt ro onc hunJEJ rhorsnd dolhrs (lllD.lx$). in ndd k r r) rh..on o, c.hrEnr.rtun. Jrro8cs r\ lDvidcd lor rhc
<br />Sccron J076ol rhc lrhnC, c, nrcrc(lnd allomy \ Ibcr
<br />ADolimnl:-
<br />ILCENSED-CONIBACIAS
<br />DECI ANATrcN
<br />t herby arlm und.r Fnrhyolpcrjxryrld I m lienEd un'ler Is)viln,n orchaptcr, (lr'mmtumg with Seclion 70()0) I Dlvttr)n l
<br />ol thc Businc$ and PntarsionsC,ic. urj nylicen{ i\ m tu n)r* an!clt ct
<br />!9!!ISIMON!EN!2M!!.E!II
<br />I h.rb] dtum urdcr llculryor Frjury rh.i rhcrc r a con(dcri,n Lndtrrf a3crcy n)r rhc p$tirmlncc olrhc wotk tut whih rhn Fn (
<br />r\sucJ (S.c. l{)r)7, C,r. C ).
<br />ATPLICANT DECLARATION
<br />I hcr.{'y afiim n!'lcr pemlry of t'.rjury oN ol rh. tulk,wihS delnrotions:
<br />D.nol t'n Pcrmirs-Asb.dos NoLicnr!{ I;cdcral Reguhrions tTnlc'(). Pin6)
<br />R.rtutcd lx(.r.f Mn i..r$n
<br />l.cn'Iyrhxr rh.lcd.rrlrcsuhrions rcEnrJins n\b.{!,s rcnr)ular. nor rlPlicihle h rhi\ F+cr
<br />I {nilyrh,r I lDvc rr rhN dtplicarion ,..:;a
<br />"T2""" "
<br />n)('mtly wirh rllCiry rtrJ Cotrnry
<br />RtnlN.s o'l Srrrd liwi r.l
<br />rlx'vc rktrrtnEd l]n n n! l'tr
<br />,\ppli.anl.rA{enl Sipn$t
<br />ii)
<br />SITE-WORK ID/SIG.
<br />Subf loor/VenVlnsulation
<br />-ErDi(.
<br />Lic.nsc Clls:-Li€nsc Numhe r:
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<br />l)atc-
<br />L1J...
<br />^J[t.\
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<br />fT
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