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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNEN BUILI}ER DELCARATIoN
<br />I lErchy atium uid., p.Mky or Fiury rh.t I !m .rcmpl fDm rhc (oniEcron l-itn{ tj! for l,E folh*h! rl-\ls...7o.ll 5
<br />Butinc$ dnd Pn,r.*ion Cod.) Any Cily or Counly which rcqln t ! Fmn ro (,n(dct. .h6. imptoE. &mlish or E|nn m,
<br />{mJurc. ritr tu irs irsuar.. llqr rcqlircs rh. ll,pltrnr for luch Fmir ro fik i ri8n<t (.lcftnr rhr lE or rlE ir lian*n puruor
<br />t' rlE Imvnant or !k ConrrM r l]enrn lru ((tuplcr 9. Collwrine $nh Sdi,n 7UI] of Dirtion ] 6f rtE BurE$.nd
<br />PFf.s.ioN Cod.) or rhlr lE tr rlE ir.r.nvr $.rtfnrm rrn rh. h.{\ fo, rtr .lLS.d .i.n+i,n A.t vi .riroas<.rir 70.111! hy r.!
<br />{tlkrnr ror r Frnn sbj(lr3 rlE it'rlic.nr ro r ciril pcMlr y o, fl m,E rh.. nv. hundt n dollst (l5m|
<br />-1.
<br />os nw*r ol rh. I,oltny, (tr my .mploF.s qith w.3cs as lh.ir $k otr{tnsrhn, riu do l* vrk !n d. $Erm n ft,
<br />inrolkd o. dfr.Ed rd qk (Se.?(l4a. Busimsi ud hnrcrshnr Co& Tlt ContEi r Lins L.* &F hr .pply lo u ow of
<br />lrE FIEiy *ln llilk G idlmB rtdd !n *h &s rh s{t him<lf or h.tEll or rhEugh hi. d ts.m.rploy6.
<br />,roviLd rhrr rkh iqrffir e d ir.rd.d r oltu fr qE ll llffi. rh. h.irii.r r iqmmn n 5A *thh m J@
<br />or mrvlrin tlE ()wffi BliU.r will Mr llE t!d.. of FovinS thd h. or ttE dil d hoiB .t inprDE ltE F{Ei, li, rlE Fqnr of
<br />-1,
<br />.r owH of rh. fmFnr. .m.rcluriv.ly conrrr.1 ins *irh licned coddc ro odnrl llE F,rd (S< 7044, Bu.im(
<br />rd Prd(<in Cd.: Th. C.nrxror'r Lkrn* trr drB mr rl'tly lu u or'rcr of,,DrEn y *rb br c. o. inlPm!.! rhdotr
<br />.'n *lh ddd. rd trh F,Fr rirh . Conrrrrdiit li.u-d N^M ro rll co r.dct Litr l,t)
<br />I imcrrnrtn trn,Ir S..ridr
<br />l).1. ()sm.
<br />nol.t ,.Es (',{rltPr\saTx)N
<br />tlEcla&ulQri
<br />Ihdchl rlrnnuRlrr r rhr nl ltqrtr).rcolth n)l[)*tr,gde'hrxrtrtr\
<br />thrvcaxtuilli,ui'nrinrC.nrlirc.lCo.rnr1,,Scllln\urclnrtrorkcr'.ortki\ i .!(roridcdin6ySdnln17(X)ofiic
<br />l,trn C{xic. ntr rh.rrdndEm.ofrh.rr* li, trhahrhc Fanrir i\ r\ud
<br />I h.E ad rrrl dinlrin wo dr comocnnrb. inrnr.ft., ft E{l!'r.d by Sciirn lm, oa rrE trhd Cod.. for llE Ftu or
<br />rlE wmt ror rhth lhr Fni n irci My rdkra 6n!E.era'n iN!6m 6il id Pliy nun E G
<br />l)rl.: Appllorl:
<br />LICENSi:D CONl'RACftIN
<br />IrEcttxarlll!
<br />I lErchy alfirn urhr Fulry of Frrry rhd I am lNn6l uri.r Forni.n ofChit'rd 9 rcommrin8 rirh Se-.!im 7fi1) I
<br />' 'r Divilion l
<br />ol rh. Bu.imr(.nl Prnf6s nr (i'd.. ad mt li(.nr n in tull fi{e an cflelr
<br />(()NiIBJJSIIONITJIiDIMICIIII
<br />I turchr_ xl ftr tndrr Fnrh y ot rrltry rhsr (htr. i\ r .on(rcri)n L {li',S rIcf y I't r hc |{rforrN. nl rh $.rk lhr *hi.h r ht lthnf N
<br />A?lusANLtattllAlx)!
<br />I H'y rrh, udLr Fnrhy ol Frlo.y om ol rlI folb*ing d<. hlr i,hr
<br />l).B)lirhn P.rmirt Alh.{oi Ndfi(.!irn f.d.r.lR.tulathn{ (lirk to. Pan6)
<br />_Rcquncd kncr of Notli.drnn
<br />I cd ily lh.r llE fcn rsl E$lrr i,nr rE{diu rshior rcB'vrl .t tr'l qT,lk.hk t, lhir lmi.ti
<br />_-l.cni!rhd I rE\ c Ead rhn .mlrdbn &n k rhrl
<br />'lE
<br />rtnrr
<br />ordiMN! rnd srsr. l,v4 EhrinS n' tlildin8 .onnnrlion. nn lEr
<br />$ovc mnlio..d rmpcny fttr i.rFr(k'n purtos$.
<br />inlotuhn 6 cold l.sr ro o'q,y wirh.I Cny.nd Counry
<br />:hy rutrriz EF!€nrrrilc! of tht cny xxl Counly to did l9on tlE
<br />lpoliLenl or ,\rrnr SiBMruB
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framino
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL
<br />Certificate ol Occupancy
<br />Notes, Rerharks, Etc
<br />t(-/l-
<br />.f c.b
<br />frt/// ? (. / ND at -o/L-
<br />-lccnify
<br />rhnr in rh. p.rformm..l tlE lork ntr *hah rhn p.rmil it irru.n. I rhrll n, cithy !n, F$n in any lmE
<br />r) !s ro b.str ruh,.rr rorh. $oltsi onl..rari('h laesorc.lii(rnin. lnd atr rhrr itl itnon h.om rubj.{l lo rlE
<br />s,*6 mn{rnathn pmvnirN ol SN! io. .17(x) nf rh. trt ClrL.l ilull. fonh$iih o,npl, sirh rll,. nmvnions
<br />WAnNINC: liiluE ro Gm krk6 smlEndir mrtn3. ir unLlful- 'nd irElr tlhFt s .rq'trFr lo qiniEl F xa: t n
<br />civil fircj un h .E lEdnd rh,!!.rn dolLrr (lllr.(Il)). in .dliri'n r. rlE .o{ nf.odgEn{bn. {nmSci .r Fovit d lor tlE
<br />S(li,n 1076 ol l,E l,ln GiL, n'@{ .d .ltocy r les
<br />irtucd lss $97. Ci C)
<br />l.nrLrs N.r
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