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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.
<br />Set Backs
<br />LL 1 ,ID w*s
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathino
<br />Shear Wall
<br />Framing l FA4ryq
<br />lnsulation/Enerqy II ***4 ')
<br />Drywall 6MB4
<br />IExt./lnt. Lath '/,1 W*kt
<br />Brown Coat ;r***7
<br />Ivlasonry I
<br />Pool Fence bkawT-Bar I lr
<br />Handicap Beq.I ltal ?\ \rM?'l D
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />IT I
<br />FINAL I \)
<br />Certificate ot Occupancy
<br />Notes, Remarks, Elc
<br />-+
<br />OWNF,R AUILDEI' DELCARATION
<br />I hcr.hy 3ltrm r&l.r fnrilry or N4ury rhdt I .m .rcmpr lion lh. 6nrra.i8 l,i.cn{ liw lar rhc n,},wins has,n 1sc(.?0r1.5
<br />Bunn.sr a Pnrlisk r Crlc) Any Crry o! Counry whirh Eqdms a lrm n, .oiirucr. ,lrc.. ,mpovc. d.m.lin' { r.Iun rny
<br />iturrur.r(trt, (s r\uancc, il$ aquft\ thc,pdi.dnl tur $.h Frmr n) ilc r ssncd ndch-nr rh,r h. or shc t lilcl*J Pu(urnt
<br />t' rh. l'nvisons of lhc Contr.l,tr s Li.cn{cJ Liw (Chrprcr 9, Conmcn.,nE * h S(rin TUJO ol Divistnr 3 of lhe Busincss unn
<br />hrisri,,n\ OrLJ or rhar lf, or shc i\ cxcnfl ihcEkon dJ rh. bans ntr rhc ,llcScd crcmptiur. Atry vi,'kri,,n ol Sn-'tir 701 I 5 hy rny
<br />rmlk. ntr a rimir $hjc.h rhc annliranr b rcivilrcnrlryoan.r 'norc rhatr fivc huMr&rd lllrrlS5lI))
<br />-1.
<br />a\ ovi.r ot rh. ptutEd y, or my cmployes wilh pares as thcir snc ohp.nsrrxn,, hll Jo rh. wnk arl rhc nBlm is nol
<br />,nr.nJcd or olrcrcd tor elc (SN 1144. Busnc$ in'l tuni$r)ns C,rlcr Thc C.nkac(tr s L'cc.$ L.v lEs not 4'I'ly lo an owrcr ol
<br />rlx F)pcny rho Soil& or inrrn'E rhcr.)n. ail who dtr sa.h w)rk hinsclfor hcrrllor rhrorgh his or hcr own cnnl,)y.ci
<br />pn,vdcl rhlr su.h inPl)hmnn m nn inrcBl.al ff oficftJ toi qh. Il, hdEvq, rlr t{ .1m3 ot mlmrtmnr k $U etrhro onc rc{
<br />olmhtlrru rhco*ncr Bu kr q l hrE th. nordor ol'p.ovins thal hc or sh. Jri ntr bu&l or hltorc tic !nT$y ntr lh. OqDs ol
<br />_1. rsowncrofihc I,rl,IEny, dncrrlulv.lyroitirhne wnh liccrsc.l conlra.l,s i,.on$rd th. pn,rcr (S.c.7044. Buv.$!
<br />anJ ftrlssr Codc: Ihc Conkrl(tr s l.kcnsc l-aw docs not lpnly b rn o*ncr ol prcr{dy qli, burlds or mttuvcs lhcrcon.
<br />and who onrE.r! tur su(h no,c.r\ w h{Cin ra(t,( n hcnscd Nrtuatrl lo r hc Cir ra(tn \ I-i..n\c L*)
<br />I incxcmpt unrlcr Sccln,
<br />]r()a6E&::-(!l-tI!${II0}DD!LI-8{M!
<br />I h.'.hy rlltrn,un,l.r prtrrlry!, tururr_otu.t rl[ l,nl!)win! nc(l{rrk,N:
<br />_lhrvc ri!ill mainram rC.n'1,(dr.otCohr h ScMnstr. n{ *orkcs .onrFn\rtron. ar p.ovrlcJ lor by Sccrrn:11)0.lrh.
<br />Lilrtr CoJc.Ii'r rhc pcrfornuNc.frhc vtr[ Inr*h(hrhr p.rn n isuc']
<br />I hivc rnJ *rll mr i' r i', *orkcrr (oml(nsrr nn nntrfunec. r\ r.!trrBl hy Scll Dn 1100 .l lhc l.!hor O)'lc, ntr rk Pcnnrrotuc ol
<br />rhc *oll (tr thrh rhN !('nn r A '\uul My$DrkcA (,rt*tr\rl.tr n{n r.clrrrr rnJ Frlry Nmhar rc
<br />ilrav
<br />' (-)f 2t)2
<br />I (nrly rhrt m lhc pcrlolauncc,,irh. *ork tu whi.h rhi\ F'n,ir n $\u.J. I thallndr cn{n'y.Iry !.ron irr atry mrn.cr
<br />v) 6 t' h.d)m \uhFd t, rhc sork.is .dm0.nsdtotr laws ofCald,nnr. Md 4rcc rhJ iil sh,ulrl h(.n* \uhF_r brhc
<br />woi(.^ ro.1Fn\dton lnrvsk'N or S(rr lTLuollhc L,l'in Ciic,I shrll, li,nh*nh$drly w hrh,st'r)!i!.trs.
<br />WAnNIN(;: F ltrrc !! rcuc workcri !.mp.nsdrir..vcritc i\ un[*ful anJ \hall rubj.d r cmPl,)ycr h nlturllFnilras 4tu1
<br />(,v,1 UN ul] !'.nc l ndrcd rh trsrtrJ d.lli (:ll(](r,(xxrl. n alJi()n t' rhc .on cor{Ens{tun. dM[3cs is !n)vi'lc'l li)r lhc
<br />S.(rri' rrrTa.l rlr Lrhtr (,{1., n .r.i rrlrn.nf,y \ li.\
<br />o
<br />DECBAAIIAN
<br />I hchby atlnm unJ.r !.mlry or !.rjury rhar I ffi liccnsl unncr lnrvi\irn ol Charrcr 9 lconftnr rE silh ScclNtr 71xr()) ol Divisn'n I
<br />ot rhc Burims ! Pnrlcsri'ns C(xlc, erl my li.cnsc is in tull rbrc ,il ctlcd.
<br />l(otD
<br />CONSTRUCTION I FNDING A(;ENCY
<br />I hcrcbyNflt urklcr pcnllry ol ncrjury lhrr rlrrc h u connodi'n lc.Jin! rg.nry frr tb. Frtalrufrc oi lhc work ltr *hich rhi\ Fmn is
<br />^su.d rs.c :1097. C,v C.)
<br />API'L!CANT DECLARATIoT
<br />I h.r6y diiim und$ pcnilryotpcryury onc oflh. $lhwing .lcrl&rn,ns:
<br />Dcmnirion Pcrm lAsttstos Nohlicahon F.dfal R+nldrnnN (T lc40, P.rl6)
<br />_Rcqun.d k(.' of Nottuarirr
<br />l.cnily,har rhc rc'lcralrcg krions (*gddr! ash.sorrcnDvalarc mr.nDl(uhlcro rhnpn,F_r.
<br />ffi,-rr,nr,n,'",-a 'n^rnd'lartrtnd {r.rh rhc rh)v. irli)rnDlion is corcd I asN h coDply wrrh all Ciry rnJ Counry
<br />'fttrirr(\ atui srJrc L,*\ rcblrn8 ro hurLlm8. ndruL!"n.olherchy,urlxtru.rcrtrcrnrar'!.sorrhhCny, Counly ro cnld u,ih lh.
<br />ih,v. nrtrri,)n.'l Jln,tr'ry,(tr irisN.r.n Nr l} 'sc\-z '72
<br />lngt
<br />l
<br />COMMENTS
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />.\\",,t i\41
<br />ll.
<br />I lr.\rl
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