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BUILDING. INSPECTOR RECOBD
<br />SITE-WORK DATE ID/SIG.COMMENTS ()1{NER OT'T,I'ER DELCARATION
<br />I hcdhy r,Iinn undcr,trnrlry ofFrjury rl l trn .xc lnr f(nn rhc c('nra.l.F l,tcnsc t-nw ln ihc lillowing ro{nr ( ss.70.1,.5
<br />Burincss and Prolt\sion C{xlc) Any Ciry or Coutrty which rcqutc\ a Pcrnrir xr ..trntu.r, altr. improvc, dcn.lhh ot rcl]lir onv
<br />{tu.rurc. prirro irs hsurtrcc..l$ rcquircs rhc inplicanr lor\uch pcrnir h ilc r siEmd n cmnr rhai h..r nr k liccn*d Plrulnr .
<br />ro lhc lnovhiotrs ollhe C.rr.r.M s t-i.cnrd tnw (Ch{rcr 9. ConrntncnrE wirh Sc.rion ?00(r ol Divlnro :1 of rlr Burtrcs\ rnd
<br />Prrlcsionr Codc) or thrr horshc iscrcmpl rlrrcirom$J lhcl'!{i\ ftn rh.rllt8L'dcxcmplion Anrri.lrrionofscclirn?o315l'v ny'
<br />rytli.r.r ror d pcrmr subjccs lhc irplicrnr ro srlvilncnrhyori.r rorclhntrlirchundreddolld\(S5t ).
<br />-l-
<br />r\ os cr .r r hc pbncd y. or nry cntdo)es $irh ua8es ar rhcn i,b ..nwtrsdiof. will do ih. w.rk ind rhc amluc is fti
<br />rrcndd o. oficrcd lbr {L ( Sr.- 7014. Businc* nnd Pr.fc$nxr Cdc Thc Conkrtr'( Licctr€ ta! docs nor lpIly tu m owncr ot
<br />rhc pDp.ny who h{ilds.r hD()vcs thercn. iod *ho der sch trolk hihsclfor lrc6cllor rhrclgt hi\ or hcr ostr cnrlloycci
<br />pturidcd rhrr \uch irproE.rnhmR ini.idcd oroiTcd ntr !'L ll h)*cvcrrll hikling or nl9r*tnrnr r $kl*ilhina'f, ltr
<br />.f..'npldi,,n. rhc Owrcr Bnildcr *illhaf rhc tudctr oapn,viry rhar hc or sll did n.l hild or i'nnot rhc lbFiy for rhc puqrt ol
<br />l,trrcxcnrfl undc!Scclio
<br />"","sbsu3 Di ,rL \2-
<br />]III.BKEtsSIOII]T'IIAIIIJ!DtlL -SllllllN
<br />I h.r.hyilltnrufdcr p.nrlryolr)criur!ok.lrhctulkNnsdr.ltiri, \
<br />Ihdlrdxlqilltrui ai.nCcniararc.fcon{nrbS.l tr{rc fn uorkcn conFn.dion, N F,vidcdli,rbySc.ri(r.l?(X)ofrhc
<br />hhor Gdq r(, rh. Nrlonn ccoilhcworkf which rhc p.nri' i\ i\s'r{
<br />I hrvc rnd ! ill nrn rin worl(c( ..trrtrtrs,iotr iNUaNc. $ rcquircd ht Sccrbn :1700 of rhc t-rhor cldc. f(tr rhc n rlnnMncc ol
<br />rhc trort lor whichrhhp(rdir i\ n\&'l I{y sorkc^ con{En\lrt)n in{rdi...ane, ind P.licr_ numh.r rc
<br />Va.)
<br />-lc.niiyrhrr
<br />inrhc rrro.n r.colrhc work br s'hicIrl,is ncrhir i\ is\u.rl.l {hrlltrol cnrPl{ty rny P.rY,l nran! nrmner
<br />nJ is k, b.rorft su$iLri lorhc wort.n €mPctrs,rt,n ln*\.rcrlir.iflir. rdnarccrhrr ill\h.uld t .oN $rhiccr brhc
<br />sorkcrs .onr|{trsrl ior povisi.D\ oi Sc.rion :l7tx) of rhc l-rhn Cdc. I drll inlhqirh.u lry wirh rhot Pmvi\i{'n\
<br />WARNTN(;: Ftriltr. t, {cu( qorkc^ (rncn\nrion tovc.nsc ir rihstul. aM \h.11 rubicr an cnPk'y.r kr di,ninrl P.trrlric\ ud
<br />civil ,incs u! to oic hundrcd lhousind doll$ (Sl(x)-(XX)). h addiii( I' lhc co( olcotrlPcninrnrl. drnlBcs rs lnviic(lnY rh.
<br />S.cri(nr.1076 ofrhc utxtr Cdlc. ir crc{ rnd nlroflrcy l lcc\
<br />"""''61 /7- I P nrr,n ',
<br />I hctohyrfinnun'tcr pctrrllyoiJ,crju,yrhd Lm li.!i*{uidcr pmviri.nofchrprd9l.o nrrmirg wil h sccri,nr Tfixr) ol Dirhion :l
<br />of rh. Busi'rcs\ rtrd PrufesionsCodc. ud mylic.trsc i\ in full nn.c rkl.ficcr
<br />,",,"'6/ /*fk ."^.*.,t
<br />CONSIBUCIIONI,I}NDIM;ICIN!.I
<br />Ihcrchy itii,nundcr FnalrtorFrjutyln rhcEn!ron{tocri'.lcndire4cncy for rhc P.rroiimi.c olrh. sork tor *hichrh,\ Fnnn t
<br />lrsd rscc 30e7. Civ ( l
<br />txn,lci. Ad,Ics
<br />-
<br />AETLICANLD}:ILTEAII!]N
<br />I hdr]6y ammr undc! ncnalr, ofFrjrry onc.rrh. folbwinS dNlarations:
<br />Dc'nolili{,n P.rnnk.Asbcnos N.rincd ion Fcd$rlRceuldion! (Titlc 40. Pon6)
<br />Rcquncd Lcncr of M,riric"ri,n
<br />- tccn vrhJrrh hd^,xtrmud'nnsrclJdrneo\hrLo.'cnr Jlr" r.r trl]tlr.'h[ r'r\n nn,].,a-* '
<br />Ll! i.h'ry $r lh.rcrc rht rrrrlrrtr,nJtol{rrc rhr rhcabtc irlhrndn'n is cotu.r IaBr(roompl,wirhallC tlndCnuntv
<br />orihutucs Md sr.rc tiws rclarins ro $uildins co.{ru..on, drl h.rcbyaulh.rizc E,'rc{nr,rivcs oilhk Cir, and counrytu cnrs ulr)n lhc
<br />rh,v. mnriurtl pr)trdt ntr idltr.lr[ t)u'|n^c\
<br />Applic nl or,\xtnl Si,r lntu X
<br />LrO
<br />-,.,*/lslr{
<br />Set Backs
<br />Forms/Steel/Holdowns (1 tttl4,-(5t<, ,.L c,J u<vt vtcrt),
<br />Erection Pads I t l't\u /u'v
<br />UFER Ground
<br />SLAB Floor
<br />S u bf loor/Ve nUln su lat ion
<br />Rool Sheathinq q-14-tg ftc'z'z
<br />Shear Wall ,<1 )
<br />Framing ),vlvlr> Tv D\-n,
<br />lnsulation/Energy o ?,bt 'tL\\rx"". Ji 4)
<br />Drywall lrl 'het^afu<./ -,b)
<br />Ext./lnt. Lath xl ,l l^d)6>
<br />Brown Coat r)td.\-,Lhib):@)
<br />l\rlaso n ry 0v
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil.
<br />,$tt'c- fu.-4qem-1-tfrg 4c ai
<br />6za)al,J t**-o-rl ,a tnT \txun-d ,r9)-
<br />FINAL /,t t'ttl ',$p*d')
<br />certilicate of OccupancvT t- a- 1 Y
<br />Notes, Remarks, Etc
<br />I
<br />l'n rt
<br />T-Bar
<br />L Now.croirhc nmpcny. !fl.iclu\iv.ly..ftr.{iI! wirh h..nscdco r(bn k, .un{r.r rh. fm]ccl (Sa. 701'{ Bu\i,tc$
<br />rnd l}nlcsshnCodc:Thccontr.tofsLi.cnrcLrwdocsnoripplyb osncr of PreFny *ho hu ilds or inPiolts rhcreon.
<br />,nd who .onr..ls lo, such I'mJc.h NirhaConhctrh) li.cn\cd putruanr rolhcCdrzcrois Li.cn{ tjw)
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<br />la\t"
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