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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs p1g4r b.V.i4)
<br />Erection Pads A
<br />UFER Ground Itol4 \rAL\to-ty-ttr L.Wr,)l
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It4asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />//\
<br />FINAL l-zt-t1 kr/11[)
<br />Certificate ol Occupancy
<br />Notes, Remarks, Etc.r$-P'YaI
<br />(I
<br />O\INER BU ILDER DI'LCA R T!ON
<br />I h.r.h, afinr ! dcr prMlry of Frlury rhrr I.nrcxcmJ,r lio.n rhc Corlr3cros l-iccn* ljw nr rhe loln,sin8 rc!!,n lsc.70ll5
<br />Btrsi|cs\ rM Pronssim Co<lc) Aiy Ciry .r Counry which rcqunc\ r ncnnir k, .!tr{nl.-i. iltq. nnPovc, dd'nolrsh I rciJn ry
<br />{tu.rurc. prtn b i( i\suan.c. dlo rcquircs rh. dprli.rnr for \u.h ltirnir ro rile r rig rd ndctrrnr rhd hcor shc h liccnscd nursmr
<br />lo rhc provhi{nN ol rl{ Conrruci(r\ t-i.cn{d tis (chaplcr 9. conrmcrcins wilh sccrion 7q)0 or DivNbn 3 ofrh. Bu\incs atrd
<br />l'tr,ic$n,ns Codc)orrhlr h.orshc ncx.m rhcrcnonr lhchrsisrbrlhcull.scdcrmlrn.Anyviouionolsccri$70.ll5hyuny
<br />r,'plictr rrtr, |tnnir suhicckrrrc alplicnnt r{' rcivilpcnalryofNl mrcrhrn fiv.lrndrcd doll,s(S5m)
<br />-!.r\osncrnfthcln,pcdy.(,rNycrntn.rtcswfhwlScrcslhcirslccorlpcnslri,'n,willdorh.worka"drh.(urucisiorinrcndcd or orIcsd f.r s,lc (Ss ?0{l. Busircsr and Prolc$ions (:qlc:Ihc Cdnmcrois Licensc ljw doei nor arlly k,,n owncr ol
<br />rhc pmp.ny who huikts or nq'(rhs rhi6i. nnd who d6s \mh w)* hinrcllor hcrclaor rhoosh hi\.r h.t owncnPk'yccs.
<br />nn)vidcJ rh.r such inrriovcmms m mt i.rcndcd n oflarcd ior sulc ll. how$u, rhc boildint or inqmtmnl n so[l wirlrin onc )tr
<br />olcoflrrkrian. rl.! Owncr Build€r will hrw rh. hurd.n dfpruvir8 rhd hc or she iid dn hoil(l or in9tu\t rh. PmPdy for thc PUrF,co,
<br />L o*ncr ol thc pR,lrcny, dm.x.lunucly .ontdirB silh li.cns.d codrNtn (, .on{nrr rh. pmiccr (Sa 70i14, BunN$
<br />!.d Pn,f!\{n, Codc Thc Contac!(r's Li.cn\c Lrw dks nor lltly t, otr orNr ol pn)Fn y sho 6uild\ or nnfrclcs rlBcon-
<br />rtr qho contncrslorsuchnmFcr\*ilha Conrukis) licrn{d prr\udm lolhrCodraclois l,iccDsc l-rw)
<br />I J .rc'nDr undcr Sc.uon B & PC ru' rln" rc$nn
<br />Orftr:
<br />]rcBtr!&troutrNsaLt0N
<br />IIECLABAIIOX
<br />I h.rcby,fli'n und.r p.Mllyoinr.juryonc olrhc f{nL)wing Jcclxrrrios
<br />-lhrvt{dwillnEinr$inuCcnificrrcofC.iknrtuselr.lnsur.r.rworkcN'co
<br />rpcnsrrion, rs povidcdforbrScctnrl'7(l}olrhc
<br />ljtxr codc. ror lh. NrlornEneoflhc solt nn*hich rhc pc.n,ir i\ ilsx.d.
<br />-l
<br />hrvc and willruir rin workcis .o'nF.ns i.tr iNurdrc. as rcquirdhySccri(in.rToOorrh.hbor(ndc-li,rlhcP.rr.nMi.col
<br />rhc sork ti,r *hkh rhkIl.dir n nsD.d Myqorkctr cotrIxns0tiotr insunE-'c.aricr md poli.t Nn$.r uc
<br />PolicyNumbcr-Erltcs:
<br />I ccnilyrhrr i.rhc prrfonistr.collhcwork ld which lhn pcrnrir ir i\\ucd.I slrlltrot cnpl('yanyPc6on inn , iMtrcr
<br />$ N b h.com subj$l ro lhc wortes conDdnsliion hws or Crlir,,iir. rtrd .src. rh(r it I \houl(l tKo t suhr,i.r h
<br />'hc*orkcr' colnDcnsll ion provnions of Sc.rn,n l7m of lh. Lrhtr Codc. I shrll. lbnhwirh .onPl, v irh rln,s flovnnnr
<br />WARNINC lrJlur. ro surc worlcH .omnctrsrri.n covcrlgc is trrlrslirl. iid rhnll subjccr 0n $Uloy.r i) oinli'rl Fnilrics.d
<br />r rl ftrc\ ur n) o c lrtrntlr.d rh.ur Dd (1,'lh'\ lSlln).(xi)
<br />sorro .lr)76 of lhr lf,l\tr (idc. ir crcn rnn r oflr) \ l.c\
<br />). Llriiid ro rltr ..n ol nsrlion. dahrscs rs pfl,vidcd br rhc
<br />4=7*'€,
<br />I hcrcbytrrlirnrundcr F.mlryottxrjuryrhtrr Ir r liccnsLt unds !mvison of (rtrrun.i"r \ ihSc.rrrr rixxr)oll)r1trtrr, r
<br />I hq.hy xrfirm und.r Ftrrltyorp.rjurylhal rhcrc is ! con(ruclhn lctulin8 xs.n.y lar rM Ftdhrnun.c otrtu work rd w[ich lhn Fnnir i\
<br />hsucd rs{.3097,civ c ).
<br />APPLI(]AN-T DECLAI({TION
<br />llmh) !fiimundrr |xnrlry ur p$jury o'r orrhc r(rloeirs dcclffili(nF
<br />lnmlirnnr Pcflnir!Ashcft\ Noriiicrriotr Fc.lcral Rcguhrnnrs (rih 40. P 16)
<br />Rcquncd krtc! ol NolifEdion
<br />l..niryrhar thc lcdcralrc8ulurions rcElnliry !\h.nos rcnh! luc n.rll)flr$lc torhi\ nnFcr
<br />-lccniirrhiIhrvcrcdrhi\.mMrurd)dnrrcrh.rrhcilx,ve
<br />irb'f roo i\cotrc.r Ir!rccr.coNPr*irhrll(:irytrddCou ry
<br />onliunccs rnd Shrclj*r rcln'inghbuildirsconsdction. md hcrcb riu. tupr.s.nrtuilcs ol lhis City afld Coxnryt, crrcr u,r.tr rhc
<br />otn\c Ndn,ncd pmpcny lor in
<br />ADDli.nnl..,\,l(nl sigtrtrtun
<br />fi.rn""*,,.".,." ***{77e5!e '7
<br />^3 2$:/94
<br />I
<br />Forms/Steel/Holdowns
<br />Flood Zone Certif .
<br />oI rhc atrsircs rnd Pmfcssion\ Co{ic. ui my liccn\c i\ in fullfttr.c ralctecr
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