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BUILDING. INSPECTOR RECORD
<br />OWNER B1]ILDER DTJLCARAT!ON
<br />I hcrcby rfilr$ undci pmlty ol Frjury rhar I dD crcnu fo,n rhc C.nLract'n Liccns L!* for rhc f.ll.wine rc.sotr (Scc.roll.s
<br />Busircss Md Prolt$ion Cod.): Any Cily or County *hich Eqlircs r pcrnir ro consru.r. alrd. i Prcvc, demolish o! rPIt lny
<br />d crud, pri{trr. irs t\u,nr.,lq' rdluir.i rhc,ptltdnl,il \uch Frnit lo filcasiSncd sl0lcmnt lhlr hc or shc is liltn{rl ruruMr
<br />h rhc !,.ovnions oi thc Conhctols Licenrd Liw (Chaplcr 9- Conrm.tin! wirh s.crbn 70fi) or Divisiotr I ol lh. Busincs and
<br />Pmic$ions Codc) or rhlr hcorrhc iscr.'npr rhcrcfrod,nd rhe b,\h fttrrhc nlk8cd crcnprior Anyviol ionolsdrinT0:ll5by.nt
<br />fpli.nnr rorap.mn sxbjersrhc rpplicanrro,civillindhyofnornbr.rhotrlivchundrcddollBr(5500)
<br />-1.
<br />as owncrolthclropcny. ormycnrkrccs sirhwascsN rhcir soL Llip.n\urion. *ill do th. wdk lnd rhc srrrN n ft
<br />inr.ndcd or ollcrcd fttr sh {Sd 7041. BusirEss ,M Pmr.ssions Codc: Thc Conhclois Licen* ljw docr nor aitly b owncr ol
<br />Ihc pmpcny uho builds or ifllmvcs rhcm,- ad who dc ssh so hnnsclrorh.Mlrorrhmughhhothc.ownc,nl,kiyecs.
<br />!rcvidL'd rh{ su.h inpnftmnts e nor i cndcrl or oruEn for sh. li h*cver. rlE huiiling or iartmrcmrr is v,ld wirhin .N }ttr
<br />.f complerion- rhc Osnc. Bxikkr will haR rlf t dcn or pmlins rhnr l[ or sn di:l nor buiLl or impmrc rlc ImFny ft, rlr IDrFt or
<br />L rso*n rofthc pn,lcny. i,n.x.hriv.lycontdnS wirh lrcoscdco racror lo con(rucl lhc pr+cr {Sc. ?M4. Bu$n$s
<br />and lirlcsi,n G'de:'l hc Conkackx\ Lic.nsc Law docs nor apply b Mown$ ofDnrcny who huild{ o. impmvcs !itr..tr.
<br />ond lho cotrirrcls ior such rrrccls wirh rConr cr{n(s) li(cn\cdpu urnrhrhcQ r..ttr s Li.cnsc l.o*)
<br />I x cr.nrtr trrdcr Sdcii(l
<br />l)al( l)ener:
<br />W( IRK l-RS' (l()nIPI\SAI I( )^_
<br />DI:CLI-BAIIO!
<br />I hcr.nyxlllrruM.r p.nalry.f pcrjryonc.f rl[ folL()(n,! dcclnrxrn'n\:
<br />-l
<br />h.vc nlwillDunrrair0Ccnirtarcorco\cnrroscl Nddlbrworkcn.ompcnsion.0sB)vidcdlorl'ySecrn,i1700.rrhL
<br />hhor Codc. for lhc p..aomncc of lhc sort for which thc psn ir tsucd
<br />-lnlvc
<br />*illnui nirworkc^conr.nsrrionin\urancc.!sr.qtrtdbys..riofl:1700olrhcl-$otCodc.nrthcFrron'un.cor
<br />rhc wor[ li,rwhich rhis!.rmir is i\\dcd M,workcs conpcnsrrn,n inrurM.c.ricr ind P.li.ynun$cr!rc:
<br />lccnilirh[ i'] rh. Nifonrtrrcc ofrhcwork lor which rhi\ p(flniri\ isuc.l.I \hrllnor cmpl,,triy rrry nrrnyrd,rNr
<br />s !{ r. hcon* suhFcr lo rhc *orkcn.onpetr\Ditun hw!.fCrlilarnir. d 4rccth$ il I \lxiuld 6.(nnc shj.d hrhc
<br />$orker comp.n\lin)nImvtionso{Sccri()n-lTmofrhcl,'hrC',nlc.Ifirll.ln hrvilh .on,tly { irh rhl{ lnn ili,rN
<br />W RNINC I'{ilurc lo sccurc *or[c^ coDpctr\rrnn, cokng. is trnlrwlul. r n l suh]c.r rtr cnrploycr
<br />S.clnr 10?6olllr ltrrhtr
<br />o*"'3
<br />I hcrby arfim uid$ r.o.lry of p.riury lhnl I onr limn*]d undcr rrcrnion ofChaprcr s (cotmting wirh sccrion TtroorofDivisiotr l
<br />of Ihc 0usin€$ lnd Pmf€ssn,is Code. ail my licens. h in lill rdd .kl cffcc'
<br />t.
<br />CONSI&J.(:IIONIEIDINCACEN1;.I
<br />I hcicby alfirnruMcr lEndryol,'erjury rhor rh.rc is a .ondrucrb. lendins rs.ky ror rh. p.rrornrftc ofrhc lork tn *hich rhi\ FYnrir a
<br />i\\!cd (S.c. :1047, Civ. C )
<br />aPfusitNr.Dt;1;trtBAnltN
<br />I h61,y !fitm und$ p.trilly ofpcrjuryonc otrhe toln,wing dcclararn,ns:
<br />D.dolnioi P.rmirr-Arh.sos Notifi.alion I'cdcr.l Resulalhns (Inb 40. P!n6)
<br />R.qxn d btr.r of Norificdion
<br />-l
<br />ccnifyrhir Ihc fcdcnl rcsuhrn,nr rcgarJing aslEnos .ctrDval arc .r lPPlic$lc fu rhis l,orltl
<br />-l
<br />.cnily rhrr I hxvc r.dd ihnappli.arionNil sdcrhd rhcrh)vc innrnrtNn i\conccr lrgrabc.mplr*irhnllCiryrnd(i,unry
<br />6'
<br />b
<br />ordi'rn.cs rnd Sr rc lrs\ rulJringl. huiLlnr!.otriru.rtr . dftllrrchyrurhorlzc r.|I.
<br />rbovc mnlioncn Fopcny lor
<br />Applicanl.. Atetrl SiBtruluF:
<br />SITE-WORK DATE COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loorivenVl nsulation
<br />Rool Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lVasonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Ceftif
<br />,A
<br />FINAL il-"l-/A'x.tuttl
<br />Certificate ol Occu nc
<br />Notes, Remarks, Etc
<br />Pcmrirec nln€ l|,nnt):bl-@.Grq
<br />ID/SIG,
<br />Erection Pads
<br />Pool Fence
<br />civil 6trcs up to onc hundrcd tho!{!nd doll&r ($100.000). i. addirion k, rhc.os ofcoryrcnsrtion.
<br />I "\lr' . '\J.t"-
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