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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE COMMENTS olvlif R ul' .t)uR Irt:t-(-aR^T(rN
<br />I hcr.6y allrn u cr pcnahy (n Frtury lhal I !m ctcryi fn)n rhc Conr.arhc' Liccnt Law n)t rh. nru.winS !t'$n (S'c 7011 5
<br />Britrc( .rf,t P!ncs()n C(il.): Any Ciry or Counry whrh rcquter a ltrmt r) .ondrucr' rlr( rmpnrvc. JcmoLsh nr rnat v
<br />nruduE. pfrrr) s lsurruc. alq' (qutrc\ tlE lpPli.ad nr\u!lr Fan( r) filc r n!n.d n{r.nFnr rhrr h.or sh.6 i"n{d N6u'nt
<br />h lhc Frv$i()n\ o, rlr Conlr..(tri l-i(n{J tjw (Chrflcr 9. ConmcnrrP * [ S&ion ](xlo .t Divislrn I 'f rhc llu ncss r'l
<br />Pn,,csn,n\Codc)orlhlihcorshcr.rcmPrlhcrcironrnJrhehr\nt.rrhcallcgcJ.rcmJ'hon.Anvvirll trrnotSc.rirDT0ll5bvrtrv
<br />dlpl'canr n)r rpcm \uhjccis rhc anpliunr b rLiv,lNtrilryot Nr morc rhrn t]!c hundrcllJollrs (5500).
<br />l.is own.i.lrhcpNfny.orhy.n{'loyccswrlhwaSc\a\Ihc,rnn comPcn\lrtrrl qdldo ilr work a rh.ntutNi\nn
<br />hrcfticJ.!.lltrcJIi,rqk(SLt?O{,Buqn.$rnJPn,lcrnonsColc:-lhcG,ntrcl'trslncnktrsJ€inolapPlvbd'wncr'l
<br />ihc pnI.ny wh' tnnLlc .r impn,vcs rlxfr,n. d who d,f,s \u.h *ork himlclr or h.r\clI oi rhnN3h hr or hd own.nDhvccs.
<br />F)vrLd rhar {rh mpt,vcmnh m Bn dcn}cd d ollcrcd ntr sh lll ho*cvcr. rlr hu'Ilin! or infFrwmnr F {rll wirho nc }tn
<br />ol (oq,Liil)n, llE OwNr Eu le wJllurc rhc hurJcn.lnn'w! rlrJltrorshcJrl n idrLl o n!n,v. rh. PNPcnv I,(!r rlt NIlc tl
<br />l- aro*ncrotih. |)n)|.ny. rncrrldlv.lyLonrm.lin8 wirll li.cn\cJ (otrn.rrtr\n) Unnflcl lIE nn+ur (Scr 704-r. Aunn's
<br />dnl l\ncsr{r Cnlc:'l hc Conka.rtr s l.i.cnsc l-rw Jocr ior lnlly k' rn oqn.r.tPoll.nv whr) hu'ld\.r mfrMs rhfi'dtr.
<br />itrJ who .onkr(hlnrsu.hl]n+rr\q h rconti.tnl\) l'lcnscJ nu$u.nlk)rhc(i,nrr.ttr s t-(ctrr h*)
<br />lamcrcnpr u crS..lion-. U &Pc turrhsrcrv'n
<br />IAB(E8s:CQIIEENIAIIOX
<br />DECI.ASAIIAN
<br />I hcrdl,y rlrrm undc. rcnaliyorp.rjury Dnc rflhc ltllowins Jc.ld,rons:
<br />-l
<br />havc Dl will minllh a C.d ilirrc .t Conscd b S.l{ ln{rE tur worlcF' (ofrll.nelrnr. as Prcvrl.J tbt bv S(inr rTIx) ntlh'
<br />Iitxr CoJ.. tar rhc pcrlomn.c .I rhc htk 6r with rh. Fmil ir rsucd.
<br />I hlvc in,l s ill nuinrrin *olkcr' .omFnsarion nsratuc. ar rcquircJ bv Sculir .1700 of rhc tihor C{ e fffrhcl.rf'muncol
<br />rhc w rk hrwh'chrha P.rm si\sk\l MY a. mrcn\.ron 'nsufun(. camc! ml Jx,li(y nnmhcr {.1
<br />_Eknrcs:
<br />-I.cnrlyrhrlrihc
<br />pcrtuinrnccol thc sork tur w[Khrhtr Frm tr F\ucJ.l rhrll nol cmnk'y ,nv Pcr*'n in anv m'nncr
<br />v) a\blRohc nrhr..rr' rhc*)drn $ ipcn\ri'n laws ol Cd'tunM, .trJ !!rc. rhxr rll \ktrrld t&onE \uhi.rn)th.
<br />workc^ rohn ns,rk r pniri\i,,ns or S.cr (rn l7lx) Ilh.l,rhrColc.I(hrll lnnh*irhcomllv *rrhrln,s Pn'v$('ns.
<br />wARNNG farlur. h rcurc $orkcr'.on{i.nsrr('n ovcr.gc i( unhwlul mJ {h!U suhr.r rr $lnk)vcr lo diminalP.Mlrrs lnd
<br />S(r(,n 1076 ol lhc Lah,C(ilc, d .rc{ !trd!tumy
<br />DECI ARATION
<br />I hcEt y alrirm undcr pcn.lry o, pcrjury rhal I m lEcnEal unJct pn,vto. uiChlpret 9 (omm.ch8 *irh Sdx'n 7u[) ol D*trn'n ]
<br />I rhe Busircs rnJ Prutasions Co'jc, u nylLcns is nlull li)Ec dil.flcd
<br />104 076 z
<br />P/fr/14
<br />CONSTRUCTION T FNDIN(; AGENCY
<br />I hcrchy rfitrm un'lcr FmhyofPcrJury lhar rhcrc i\ a ($n{Ndi)n b ing rscncy nx lhc P.rnrrutuc of lhc wort ntr wtuch rhn p'rmir n
<br />tucJ(s.r roe7.Civ C ).
<br />I c.nrryrhd rh.tiJc$lrcsular('n\ rcFrJh* rsh.n*rcmoulrc nor iPPlicthl. n' rhtrF)F.r
<br />I (cdilyrlMr I luve nr'l rhildnpltrrr.tr dll n!r
<br />ordfm(( i , srarc l,rws rcbbn8 n) burllrry cond
<br />r. triinnL(trn' L\.on.(r I rErc. k,..n v w I xll ( rry ]n'l (nunrr_
<br />hcrchyiurho .rqJ,c!.nL rvcvn rhL\t'rvrtrJ(.nunryktcnrcrtr|r{trlr
<br />'lrnr nunrfrJ |i]t).'1! l!,
<br />lpplicFnl or ,\xtnt siEn.
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVlnsulalion
<br />Rool Sheathino
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />lt/11,/t T Ft,fi-t 'cLr
<br />Handicap Req I
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Cenil
<br />I ,{",lxl244 tA/rr,ga #d
<br />Certificate ol Occupancy
<br />Notes, Remarks, Etc
<br />ID/SIG.
<br />T-Bar
<br />FINAL '",, "////a7/4
<br />APPLICANT I'ECLARATION
<br />I lrtusy allim u nJ.r nenllty ol pcrjuty orc or rhc nnk)wms 'l..lddDnsl
<br />De,Bniion PemiB- \bc\tos Norficar('h FcJ.rtl Rc3ullri(,ns (l'r1..r{) P.n6)
<br />_RcquiddL crotMniliurin
<br />^,, Jl/ /q/q
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