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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE rD/EfQ.COMMENTS OWNEI BUIT-DEN DELCARATION
<br />I hclchy aliirn xn'icr ,rn,lly ol pcrjury rh I am crcnu 6orn lhc G,.tack6 l-iu.n\e llw rdr rhc tullowins mnrn (ld ?01 1 .5
<br />llurin.\s antl Protcssi,,n cl,Je): Any cily r Coutrry shi.h r.qtrtr s I ltcmit lo ro.nd.t. dltcr. imFrv'. dcnrlish r EFr rv
<br />iru.rurc, nritr k, ils ir\oin c, al$ tcquircs rn. rplli.m fi, suchFmir b lllc, si! cd st.rcmnr that h..r sL s lic'n{d nmu'
<br />b lhc 0olisirN rr thc ConrEcrors L'.cnscd ti* {Cha sr 9. cdmmctuina w h S.crion ?UrO of Divi\n,. I ollhc Busincs
<br />'nd
<br />Pn,l.$'ons CoJc)orlhar h.orlhc ( cxcmJ'l rhcrclionand rh.h.rG lm lhc all.r.'l .rcn!'l ion Anvlid,rionolSe.li0n 7o.l l'5 bvanv
<br />applic.nltnr3pcrmirsxbj.clsrlrc it',rlic!nr h arivil PcnrltyornolnrE rhxn tlvc htrndrcd dollrs ($500)
<br />-1,
<br />i\ ovrcrofrhc Pl,rEny. or nry cnrdoyes wirh wiscs r{hctr $lc .onP.nrdri(,r' !'i[
<br />'.ld ltt work a,rt lh. (rudm \ ndr
<br />tri.nJ.d orofliml ntr eh aso.?044. Btr\n.slnd Plolisoos ct',1.:1h. Cirnr&nr'i l-iccn\c tjw docs nor arflv k, osn'rol
<br />rh. rn,lE y wlN hu 'ls or imF)vc< rh.B)n. aril wtki d,E ruch M'lk hinN.U or h.rcll nr rhDuai hi or hcr own cmlloyct\.
<br />pnvi'lcJ rhrr srch mrpovcngh m nor i cndcJ o,,|ltild tu' \dc lll lt *cv.i rhc huiLlin! or ini,*)vcmnr r $Li wirhin orc,c{
<br />;f. q'i:rbn. rh. owncr Bt cr$illhrtrlt brrdo o! Pn,vqs rlll lrorshcdd nr tnnlJ or nllrtvc rhc Pn'r'nv l'rr rh' NrF'!-or
<br />-1.
<br />asowncrofrlr pop.ny, r.r crclunvely.onrt,(rug wirh lir.nscn .o trr oct,F b Ldnsrrucr r& Iol.rt 1scc. TOi,t Businc(
<br />.d Eol$sinr Cddcr Thc Conrrauxn s Li..ns. Lrw dds trol rol'ly tJ $ own r oi plrFny wlo hu rlJs o, inotuvcs ihcrcon.
<br />uJ wlto.onr^.hlbr chl'lFcts w[h a G)nrEcknlr lidn*l Nrnar n' rk Cl)nk.(itr s Li.cn{ tlw)
<br />I r ,.\.'nrr!trrl.r Sc.rn'n .B &l'C Lrrhtrrcr\)n
<br />IVORK ER.S' COi\I PENSATIoN
<br />DECLARAT(}N
<br />I lrrrhynlitrmu rr p.nrky.lt'.tiu!yonc ofrh. nnbwiu d(lraritn\:
<br />-I
<br />h.v. and will nui ain a C(l itiatc of cl,nsnl !o S.lr_In{rc tbr worloB cofrFnsaxon !s rn,vdcd fttr hv Ssrion .'7uJ ol lhc
<br />Llhtr C.tlc. ror th. !.rfomM ol rbe woft for whih lhc Pcd ii irsucd.
<br />-I
<br />h,vc ad will mairrdin work$a comtcns,ri,n imurMcc, as rcqlircdbys.ction]7OOoIln llhorGic.lbr rh' l.rr'm'u or
<br />th. wort lin *hict rih l'.mn rs hsu.n. My work 6 con{Ensrriofl iniuan{ cdict lrl I[lil:v .uhh.r e:
<br />t ccnili rhxr r rlr p.rloflMncc o, rh. w.r k Ltr whrh lhis Pcrh isr\sucJ,l\[rllnor.nll]ll)v!trvPeronmrnv anD'r
<br />ni a\i,h\oN $ht.cr k, rh. so*.s' corqEostrron liti olcrl'Lflrir, dnJ agr.c rhxrrl I slurln hc.om {rhjccl rtlhc
<br />wo*.^ c.nDcn\ari,,I,R,vtruns.fScurion.lTtXlolrh.l-ahtrCrilc,llhrll.k)nhw h (onplv wirh rhosc nnrvisi(nr
<br />WARNIN(;: fliluc h ccurc wo .^ contEn\irion .ovc gc i\ rtrhwtul. o'l \hrll \ubicl dtr cmp[ry.' h dinsn pcmh's dnd
<br />.r'1 ltrr\ nI n) oN: hnDtirc't rhotr\rtrJ .ldlhr\ rSll[).rIxr
<br />S.crrI r0?6.1 rhc l'htr CtJc. ncrcn rrl ir!nNy \ 1.(\
<br />ot cnmpcnsrrt,n. Jrnug.s rs proviJ.d Lr thc
<br />cl^z5 - lq
<br />DECIABAIION
<br />I MNhy afithund$ pcn.lryolr--rjury rh,l I anr li.cns.d untler povisn,nofChlolo 9 (LonnrcNin8 wirh S&ri)n rLUO)orl)ivisbn l
<br />o1 rhc Burircss atrJ Pnna$ions Cirdc, ul hy liccnt 6 ir lull brc. d'r].l,acr
<br />q-75-tq
<br />CONSTRUC-IION LENDING ACNNCY
<br />, h.rh, dltnr und.r tcnrlryol lf,4uy lhar rh.rc a a.on{rucrn,n hnJi4 rts.ncv tu rlE Pcrnlrmncc o, rh. wotk ntr wlrh ihk Plrnrir t
<br />n\ucJlS.c. ltlr)7, (lv. C )
<br />IJtuic.r AJ,lr.*.
<br />APPLICANT OE(II ARATIoN
<br />I lEtrly lim undcr rnalty oi pcrjry oN ol rhc Inlbwins d.(ldrations:
<br />D.flrnnn)n Pd'n s shcnos Noril,cin,n hdctsl RcEUl ion\(r h {1). Parr6)
<br />Rcqunllt I.rr(rotMi luri(r
<br />-l..nrlylhJrrhc
<br />liJcfulrcSuhlk)n\ rcltr'ltrB (lrlos rcnrivrl rrc nor rltll'(xhlc n) r|i\ I]n)icr
<br />l..niryrhrr lhrv. r.rJ rhn iIpl'caro, mJ srlc rhr rhc rh
<br />onlrronrc\ J SIarc t-rNs r.hritr! L, huild !!.onnru.rion,
<br />I r!r.c r,coDnlywihrll( (yrnJ (i,unrt
<br />rlnnrcrcpr.\cnraivcsolllis(iry3ndCdu rylo.nrcrnF,nrrr
<br />rlnvc Nnloturl lln,trdy l( inrp..tron Nrlb{c(
<br />l"
<br />s-751?
<br />{0 -17" l"t \ilpQts 1 w[--
<br />Formsi Steel/Holdowns I U I
<br />Erection Pads
<br />UFER Ground I!'-A,1:l!/
<br />SLAB Floor
<br />Subf loor/VenVlnsulalion
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulationi Enerqy
<br />Drywall
<br />Ext.i lnl. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence / '2,*,2"{Dtal ,<]'
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />I
<br />FINAL 'bYaTa DV,LI,Pl,{ k(\
<br />Certilicate ol Occupancy
<br />Notes, Remarks, Etc
<br />Set Backs
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