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BUILDING. INSPECTOR RECORD
<br />SITE.WORK ID/SIG.COMMENTS rlwNEn Brnr.Dr:R Dltl,(:AnaT!()N
<br />I hcrcby lrllrm unJcr pc.rlry ('r !.ijury thir I m cxc.rpl irom rhc Conkdo^ Licnsc L.w r'or thc loll,,wine rcisn (Scc.]lr]l5
<br />Bnrincss and Profissio Codc): Any Ciry or Cor.ry Nhich rcquirs d Frinii h conrrruci. alrcr, nnlmrc. icnFli\h or rPtrn rny
<br />stucrurc. priorro irs issuancc. rlro tquircs rhc iPpli.dnr for su.hFnnil tr filc. \i8nLt narcm lh hco! \h. i\ li.cn\.J PuGurn(
<br />t, lhc PmrisnnN or rhi c.trrrrctols Li.cnsed t $ lchsPrcr r. Co nnci.trrS wirh Sccrion ?fiD oI Divhi l ol lhc Busin'\\ and
<br />Prurcssn,ns Cod.) or rhnt lf,.rshc is *cnfl
<br />'h.rclionnnd
<br />nt b$n rorrhc !llc-cd crcm/n,n Anyviol.h.nolSccrirnTl).ll5hyrtry
<br />rpplicrtrr for a pcnnil rbjccr rh. attli.,trr to,civillcn.lryolnor mrc'hM fivc hutrdrcddollare lS5lr0)
<br />L r( owncr .l rhc troltny. or r.y cmplorce\ sirh waEcr x\ rhcl \n .onrn rrliur. *ill do rhc work md rtr sluru' I n 'r,
<br />inlcftled .r oflcEd ior qk (sd.7ul4. Rusinc\s r Profc$iorsCftlc: fnc(irntuckr'\LmnscLr$doc\noraPPllt)rtr.$rwof
<br />rh. pn,rcdy who bu,lds or nnpmvcs rhcF,n. und wh. (lircs surh *nk hinscllor hcmcla.r rntonsh hi\ u hti own cmfloyccl.
<br />povtl.d rhrr n,.h improrcnrnkm nor inrc'xldiorollcrcd fitrsrL ll h.*.tcr. rhcSoildingor irymv.ntd G elil wirhi",,nc )crr
<br />olco.rhli.r rlE Owmr Buitls willhat rtf bunlc.ofrrulin! rlulr h-.t shc dil n buikl or imPr.vc rhc pn,lEly for rhc Purpsc.l
<br />-l.Nowncrolrhctmpcny.dncrclusilcly.orrrdirswilhliccn{,lr.nrtucttrttuconnrudrh.PmJe.rlSc.rOU.Suiincsrmd ftrfcssi Cmlc Th.Contracttr \ l,i.cnsc t-(w (lir\ norafplyb rtrowncrol'0roi'crrywho hrild\o. nnProtcr rhcrcon.
<br />rnd who ro.rruh |or (rh r(&cr\ trirh r Contacron, li.cn*d pusurnrb rhcGhtncrn \ Liccnsc L!w)
<br />I rn,I.mJn uDLl.r S..ri,)
<br />Dolc: (hn€r
<br />w()RKERS-Conigr'NSAT()N
<br />IIICLI.8AU()N
<br />I hercby rlfii,nrnd.r pcmlly ol Frjury onc ofrhc tulhsins ncch'rri(,n\:
<br />-l
<br />havc lnd{il! mlinroii aCcnifi.{cofconscnrloSclf.lnsurc lor sorlc^ comP.nqrnrn. as Pn'vid.d fitr hysdriN r7(x)ofrhc
<br />L txtr Codc. for rhc pc.lormna olrhe {orl fr {hi.h rhc I)$:nI n hsucd.
<br />I h c ntrd will mrinra in $ork.6 ..mp.ns...n nNr.rcc. as rcqutcd b, scd n,r 17m ol thc lj&tr Codc nn rhc Nriotnmnce o{
<br />rhc qork l'or *hi.n rthFrmir it irsu.d. Mysorkcs ompctrsstnrn in\urri.c cMi.r .lld loli.y numhc, uc:
<br />N*,,|". {.o q. Ge7,32-
<br />l.cni!-rh ltrlhcrcrl()flutr.c{)rrhcsorkru\hichrhnpcnnli(k{rcn.Ilhillnorc{'n,ynr)y$roninrnynuncr
<br />so a\t,tr.onE \uhrccrh rhc wo ${..trrltns|lur li*s ol Cnlrt)irrir, rM r8r.. rllrn l should becom suhF.r brh(
<br />*orkc^.onlncn\rri{'nprcvi\$trsofSL\riotr:]l(X).lrhcl-rhtrCoJ..lnrll.f(trrh$irhc.mnlysirhtkt{prori\i)nr
<br />WARNIN(; Irilurc to s.urc workcr( .o'nP!n\rri{nr rovrrrF. i\ utrl0ntul. nnd \hrll .dbicr M ttrI,lotcr h .rini'tl ltmlri.\ I
<br />civil finc\ up ro.n. iutrdrci lhousand doll6 isl(xr,om
<br />Scct i.n 1076 o, rhc btrr Codc. inrc.c( End s ormt s ffts
<br />o",", - <-(,t(tr4 ,rpprt *
<br />PECId8AIIQN
<br />I hceb, {1fi,mlndcr pcMxy of Frjury lh.l I an liencd undcr pmvni{,n ol Chtl)ld 9 (lmmncins sirh scdi.n 7000) ofDivnion l
<br />or rh. susik$ .trd Pmtcsions Codc. and 6, 1i...{ h in rull foc and cfcct
<br />-B , 1..^.1".r"" . \.,o5<- 1.1
<br />o*", . -.-\,.S\r< co ncror )(l-€ <\ .-.E rr3A-\9 , llrtl44!ryq:
<br />COIIIBIJqIIONTEIDINCICENSI
<br />I hcrcbyamir.undcr penahy.r!.rjuryrh lhcrc is o onnruclhn hndins recfty ror lhc pslonMocc of rhc work aor trhich lhi! lc mir h
<br />tr{'.d rs.. togT ('iv C I
<br />td:;i;t::h. fcdcr.l rcgll.lions rcgudiry asbcslos renrclll ai. nor attlic$lclolhh Dojccr
<br />v.rcad rhn lpplicorionand srurc rh,r rhc ah.!. infomrion h conccl I orre ro omply wirn all C yDnd Counry
<br />tjws EUrinE ro6uildinacof,srnrrion. "J hcrcby r.r.\rnrrrnr\,'frh,\ (-ilr_ rkl(i,un1y k, cfr.r trBnr rlr
<br />I rnl)r 'mtrri(,rJ foFn) tu n\Fel
<br />\DDlirnnl or Arr t SilMlrrc "^," - y',cld
<br />1",-,',---",,,,,,aE vZ,t,+7/oA (Z,rTZr+.?a 25
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor 6 I I ti ,u.t(tf)?ln, - rq'l goout cn.te*.b
<br />Subf loor/Vent/lnsulation 5c4lc+
<br />Roof Sheathinq
<br />Shear Wall I t
<br />Framinq b r\c-,
<br />lnsulationi Enerqy >J&
<br />Drywall 6 ftrtu<6
<br />Ext./lnt. Lath
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certil.
<br />FINAL t\qn
<br />Certilicate ol Occupancy
<br />Notes, Remarks, Etc
<br />rO
<br />(_,
<br />DATE
<br />,b
<br />vb
<br />Brown Coal
<br />trt
<br />dnnu8cs ns novidcd f{tr rhc
<br />Lrtrdcr ' Addrc*
<br />AITUIANLDEIIAMIIIIN
<br />,lrrchyrfiirnrundcr I'anoll, oi rerjury onc orrh. r{,llowin8 deldrdions:
<br />Dcmnnion Pcflnits-Asbcstos Norificriion Fcdcrrl Rcgulatiotrs ( rillc 40. Pon6)
<br />Rcquncd txllerol nnifi carhn
<br />tt
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