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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />l. ( ow.cr oi rhc tmlxrly. or nrv cnuorcs wiih Br8c\ 6 lhclr $lc c.nrpcnslrbn. sill o rh. *oA,tl Ihc {flcruE i\ tror
<br />intctucd or olltrcd rhr {lc l SE 70.t.l- Busincss md PmLs\n,n\ Cnlc Th. Conrm.ror's Lkcnsc ljw docs ior trprly r. nn o*ncr ol
<br />ihc nnrr.rry sb lrilds or nrg)()rcs rlrEnn- u *ho dc\ srh sorl l,itrsclf or h.rsclf o hDu8h hn or h.r osn cnPl{,rccs,
<br />trovidd ihar \uch impnN.nrnn rr ft, inttokd n oiTcR{ h ek. tl k,*cvcr. rhc tnrildin8 or irnprncrEnr ir $ki sirhin oN )tr
<br />dr.orlrhtbi. rhc oqNr Bui cr sill harc tlr budco of pmving rhd t* or \hc dn d tuiU or inp,ovc rhc ra,Fiy ror rh. puqb{ ol
<br />l. i\.!rcr.irh. nrr!.ny. rncrclu\ivclycontacrins $irh iiccn\cJ contnctff t, ..nnfld lhc t'n&crlSe T().13. tsu\i"rs
<br />J Pnrb$irnCddc The G,nra.tr\ l-ic.ns. tiw doc\ nor at,plyr) owncro,pmFnyLvhotuikhornnprovcrthcrcon.
<br />rtul sln.. ruch {hr \uch pmtccls wirh r O8rrrr(r(s) liccn\cl p!^ur n) rhc cofttr.hr \ t-i.ctrr t.rr )
<br />lumcxcrhDr und.r SNLon .B &PC lur thn r.,-n
<br />Drr.: oener:
<br />NORXERS, COAIPFNSA:I.!ON
<br />IIE!!AAA.r.&!
<br />I hcrcby.lltD trM.r |tmlly oi pcrJury onc ofuh.lollorir8 dsllrdions:
<br />I hrvc nnt willnritrfui'r dCc'rli.rrc ofCotr\ctrrt) Scll lNtrc nr {o'kcri .onlt).n\arion, nnividcd nt hySsrion 37(X)olrhc
<br />l.rhtr Lixlc, ftrrhc prrlonnrnccofrhcwork r(r shi.h rhcrcnnir ii i\{cd
<br />I hrE strd {ill n irhir workcrs conu{nslrion i',\uraE-'c- ar rcqtriBl bys.dtun:17{x)olrhc hborCodc.lorrbc F.r".n-.- "rlhc solk lbr *hichlthFrmir is i\rled My sorkcrr'c.mp.nstrrnrn nr\xrm.c.rnicr dFlicynumi,cr uc:
<br />_lonilyrhtrrinihcporbnnt'n.dofrhcworkntrtrhi.hrhrlcirnirrs6\ucd.I\hrllDolcDnk,yrtrypcroninr.ymrmr
<br />*, rst, h(.o'r {lhjcd ro rhc *or*c6 conDcnsrrion hw\ ol Crlii{mir. md :l8ftc rhd ial \rx)ukl B...oN {rhi.l h rhc
<br />*orkcn conrFnsdi.n lrI)vision\.fSccri(r.17lx) ofrhc Lhtr Codc.l\lull, tunhrirh conrtly *irh rh.r rnnisi{ntr
<br />$ARNIN(;: Frllur k, \o.u( lfrlr^ ro pc !r1(( $r.'3!r
<br />.niL ln,c! trf t, oN hufdrud rl'otr\xDd ollr'\ (\1rXr.(XX)) rtr
<br />$ urlawlnl. a shrLl $hjl:.r !n cnrpkitcr h dnri,ril lf,trrhi( r.d
<br />k, rfu c.\l ol'.onlltn\arnin. dinnr8c\ a\ tt,v cd ior rhc
<br />\..riLr .ll)76 ol rl,c I rhtr (n,lc.
<br />'
<br />nr'.q rnl rrktrnr!'\ kr\
<br />I h.r.hr ilft o undcr N ilrJ.l n.rj,try rl,d I n, li..trwl utr(1.,orChrprcr 9 (.ommncin8 wilh Sdion ?fir)rotDivision l
<br />of rhcArqifts\a l Pmf.$nrr Cod.. and.ryli..tr€ i\ i,r lallfo
<br />I hcrchy rfilrmutrdcr n(mlry olpcrjLtry lIrl rhcrc n r cotr{dciion
<br />((tr!lrs.. lrD? aiv a l
<br />n,li'rg dtcr.y frtr rhc p.ni urcc ol rl[work i(n sh'ch rhn tf,nni '\
<br />AITLIIANLI'&;IIBAIIAN
<br />l)xnbv ifinnurdcr nctrrlry ofpcriury.nc otrhc lolb*i'rs dcchtrrt,n\:
<br />Dc x,lirn Pcrmi( Ash.ros Nolili.urnrn licJcralRcBukri(N (lillc 40.1'ln6)
<br />Rcqunrd Lcrr.! olNurilk i,
<br />_! cc ifyrhrrrhc fclcral rcguhrn* rerd$B isbcst.s r.nr,vrl rrc nollPpli.ahlc h rhn pn,Fcr
<br />l.cniirrhirl havc rcid rhis 0mlic{l ion lln \ralcrhir rlritnve inr(,nhrn i\..n(r I .8i\ h comPly rvilh rll Ciry and Coon',
<br />oklirrmcr.nd St.rc Laws rchtin-s lol,uildinscotrnrudion. rrd h.rchr rllri,trcr.\c.lrlivc\oarhkCilyandCounryf,c trutin'rlf
<br />,*,,*r,. .**, *,*-r,* (oo** L
<br />Pcmritec Nnx lnrintl:
<br />logaZ->fL-l\
<br />Forms/Steeli Holdowns irb qbir ;.-J-u'--
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsu lation
<br />Rool Sheathino
<br />Shear Wall
<br />Framinq elvl;8.?.tq . B J,loGlvyfu
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lalh
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL 4ltr lot -1,-V +^, .- "'/-2>)
<br />Certiticate of Occu n
<br />Notes, Remarks, Etc
<br />OIVNER SUII,DFJR DELCARATION
<br />I h.(hy alfinn undc. p.hulry ort rjury rhar I.mcxcrpr rtumrhcCo rn toB Liccn\c Llw r'or rhc iollosi,rE Erv,n 1s..7011.5
<br />BurinNs aM Prolisi(,n Codc) Any Ciry or (hutrry whi.h rcquncs r Fnnil lo s'nnrucr. llrcr. impnv.. .Lmrish or Nl[n My
<br />{ .rurc. priorh irs issuaKc.oho rcquiEs lhc rlpli.nnt lhr strch Fmilro filc! \isncd \rnrcmnr rh{ h.ot\hc ir liccn\cd lurs!trr r
<br />io rfie nR,vnn,o\ of rtc Co.trcrtr \ Liccn*d Lxw lchaprcr 9. Co$mmir8 wirh Sccrion ?(m of Divhion I ot rhc Bu\inc\\ rid
<br />Piotcs\tun( Cod.).r rh hcorshc iscxcmfl rncEliofln lhcbrskInrth.nllcscdcrc'nprnnr Anrvii,hrn .rScdi.nT0:1l5hyany
<br />lpplicrnr ior !,)(rnirsuhj(ls rhc orlicdnrro rcivilprnalryolnor n,crh,nfivuhundicddolhtrs($500)
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