|
BUILDING- INSPECTOR RECORD
<br />SITE-WOBK DATE ID/SIG.COMMENTS OWNI'R BUII-DDR DI]I,CAR{TloN
<br />I hcrcby rfltr undcr pcnahy ot ntrjury rh l aD cxemfl nom rhc ti,nh.rolr l,iccnsc li, ,or rh. f(nhrir8 rcrYrr lsc.701l5
<br />llusi..sr lnd l\ofssn,n Codc) Any Cily or Cornr! Rhi.h rcqunc\ s lEn.ir h .on{tu r. 0hcr. inrProvc. dcnnrl,(h ttr rcnrt r)-
<br />{tu.rur.. prd b ns i\\u!mc.,l\. r.quncslh. rmlicrn b, such lcmrirt,lilc. siSncd slalcnrcnl rhrrh.orshc is liccnscd IUAUfiT'
<br />ro rhc provntN ofrh. contrrclofr Liansed li{ (chnfl.r 9. commcrcins qirh s.crion Tuxl of Divnion I orrh' Ilu\ints ur!
<br />Pn,L$n,n\ C6dc) or rhrrtr or sie h crcmfl rhcr.ft,mnnd th. b$is lor lhc lllcs.d.nnrflion Anyri,n,bnolScclionT{)ll5 hr triv'
<br />,tpli.,nrrora,rcanisuhjalsrhcrppli.r ki.ivilNtrilryolnolfrrcrhMivchundrcddollus($5ff)).
<br />Las osnc.olrherr)!cny.or ry cnPk)yccs *ith \rrs.s r\ lhcir {,h coil|{nsd bn. u ill do rhc solt ud lhc \rdlun i( n'r
<br />iorcndcd o.o,lcrcd ntr \rlc lsc.?(ll,l. Busincs and ttolt\.i{n'\ (ixlc lhcO'nrrrckn\Licchs.hwdocrnortrmlyrortrrwtrcrol
<br />rhc pmrrny Ehn huilG or irlll,ruvcs rhcron ord wh. der qEh u) hn!*lror hcrscltor rhnuah hi\ or h.r osn cmllovcc\.
<br />rdridc(lihar ru.[ irnpnrrcmnsm nor i'ncnk or offcrcd fdsrL ll hoscvcr. rhc tuildi'r8 or inPovcm is sold $irhin oqcdr
<br />ot.onpLrn{ rlE Ouncr Auitlcr sillhrlc rh. hur'lcn.fp(riu rl hc.!$cdid'xnSuil.lorin K)vc rhc nDdy irrh( Ptrqs{of
<br />.1.*,**,,'*r.*r,.d,r\!lu.trrry\n,rx!rtr'pwirhliccnscdconh.ttrsi.a)nirucrrl'dprt,l..r(scc.7(!r.r.Bu\in.\\
<br />I,il h"ti.'i,.C*1"'rhr('ontr.ror\LNctr.cIrtrJ,,c\trorllplyt, nowtrcror'!tr)ndywhobu,lasnrimlrra\rhctuon.
<br />rtrd who conrm.F for such pnrjcch lnh , c(lrh.tun s) li.ctrs.d puruMr t' rhcconrncl.is Liccns. Lw)
<br />;'"'wqil/.2 "-*.,
<br />I'IICIAIAIIAN
<br />I hcrcby rllirm u Ddcr n rltr ul ltrjry onc .l r hc li,ll.* inE dcc lrrrriun:
<br />I-.lLllB\c aftl trillnEn aiiJC.drllcirc.rCon.cdhsclrlnsurcr(rwortcn conlPcnsali{]n. rs ndvidci for hvSsrioi r70o orrlr
<br />Lrtx/C.1. lft rl'c prnhnrtrtrc.frltr No.k lhr (hich rlrc lcnn r i\ is\uc
<br />-l
<br />hrk rnd sillnuinrrirl qorkcr' comFn\ar i('n insurnncc. r! rcquitcd hySc.rion.lT(X)ofrhc lihqCodc. for rhc ,xnorninc. .i
<br />rhc work r(rwhichihi\ p.rnir is tnrcn. My*ukcri.. rrcis.rion imur0Ne catrid and Flic, numh.r arc
<br />P,ni(t Nu rhcr:-
<br />-l
<br />c.nily lhrr in rhcErr. nrkcolrh.$rrk,irshichrhi\ncnnil n is\ucd.l \hr!l ntr cnll,ov nnv l(r$n ii,nynr.nncr
<br />n, r! b h..oM \ubF.r to rh. !ltr(c^ .onltcn\arii)n hs{ ofC lilirnii. rnd tr8toc rhdl rfl slnnrld hccort sDbjc.l ro ihc
<br />*ork.n ro rr.n\.rn lnvi\ionsnfScdion.lT(Dofrhc Lil!,((xlc.l dull nflhRith.onrtly sit h rho{ Pr,li\nnN
<br />1IARNINC lilurc k, $.trrc workcr' cont|arslriotr covcftsc i\ !trli*ltl rni shrll su$]c.r I'r .nrdo]cr lo oininsl Fntlric\ nnd
<br />t' onc hutulrcd rhouvnd dollus (!l00.Un). in ddiri(lr h rhc co( ol ommns n'n. damucs nrovidcd f.r lnt
<br />Sc.rim:lo76olrh. L'lxi Cndc. inlcr.{ rtr{ldoriry \ l.rt
<br />6/zy'zotr
<br />NF(I ARATION
<br />I hcrcby rmrin undcr Fnrlry olpcrjury rhnl I an lienrd undcr Pnrvili.n ofChrPIcr', (connftftnr8 wirh Sctrbd ?(x)0) 'rDiuhion:l
<br />of rhc axsincs rnd Pdtsn,ns Codc. n d
<br />'y
<br />1tr..s is iI iull l.rcc md crr..r
<br />-l,iccn\c
<br />N!.rh.r:
<br />-
<br />CONS'IRUC'IIIJN I NNDINC CT'N(]Y
<br />Ihcrchyarfiirtruid.rFfilryoip.rjuryrhrrhcrcisr.ontu.ri(, lcrdirsrs.my lorrhcl).rformrrc orrhtwotk for whith(hi\ Jrnr i{
<br />isrucd lScc. lO9?.Ci!. C.).
<br />tfnJc.-c Nrmc
<br />-
<br />AE&TEANLI)ECIIBAIIO!
<br />I lrn$y rmnn und.r !.mlty oifcrjury oic orrh. lnlbwinS dcclarution\:
<br />Dcnnniri(,n Pcirnirs Asb.{o\ Nolificrrn,n FcdcElRrsul"rt,n (Tillc 40. Pana,r
<br />_Rcqlncd hncrof Nolific ion
<br />I.drrl.vIlrll lMIcdcrulrcsul ois rctdiliu rshcslos rcnrvrlrrc mr rflll.rhl.lo rhn nmFd
<br />V4 l.cnilyrhd I lhvc rcrdrlh q'nlic0rion unl darc rhdrh.rh)it rtrf{muli(nr iscorc.i I aEr..bconrPly{irhrllCIv.trd Coufrv
<br />0..\ d Srric Ln$s rcldill! r,6ull(lin!rnn,.rndI'crcb!.urhori7.r.t)'c\r r!r.\ol rhil(lr) rn,la,,uri)lt.nlcrnJ,.f rl{
<br />ak,vcnicnrionlpnpcdyturi'r\tx.rlotr
<br />,\Dpli.nnl or /lAenl Si8nnlrre
<br />< :Ztutl ^'.t/zt/z"S
<br />Set Backs
<br />Forms/Steel/Holdowns (,t8 =FLt vrt tadl
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq *tu/*tO--..
<br />Framino
<br />lnsulation/Enerqy
<br />Drywall l.L1,*t ;a,r*/
<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 />FINAL tl4ltq v /xuffil_z>)
<br />Certilicate ol Occupancy U\
<br />Notes, Remarks, Etc.
<br />Shear Wall
<br />v
<br />r-------T------
<br />T
|