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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BTIILDER DEI,CAR.t ION
<br />I her.h, allnrundcr If,nslry.t p.rjory rh.r Ioncx.mpr rr.'n rhc Gntrrr.hs Li..nsc tjw for rhc followila rcnen (Sec1r.]1.5
<br />Bu\iir.s\ atrd PrcLtsiotr Cdl.) Atry Ciry or Coutrly which rcqnircs n ,rnnir to con(rucl- llrcr imnrovc. dcmulish ,r RNn rny
<br />{ru.rurc. pri.rb ns ksuam., so rcquncslhc 0tplicnnt lor \urh Frn t h iilc n nrncd naremni rhd h.or $. i( lr.n{d lunumr
<br />b rhc Fovhions ol lhc Conrracrors l-i(n\cd Ii* lchaprcr a. comn'cn.'ng p h scrr'on 7(,00 nI Di.rion .1 or rn Bu\incs rd
<br />Pofcsn,ns C.dc)o.rha! hrorsh. i.r.nrr!r rh.r.Iro'n dlhcbasisn lhclllc8cdcxcnrpln'n.Anyrnnlrn,nofscrb.70:ll5bynnt
<br />Iprlicorri { p.nril subjcch lhc oppli.arl lo acivilpcn.lryoitrot morclhrn filc hutultoddolla ($501))
<br />L1. r\ owns .r rhc ro|Eny, or ry cnrplole\ wirh wrscs or rhcir slc compcn\diotr. sill do rh. qort rnd trE strulurc is ml
<br />inrendsl or oitrcd n, sllc lss ?0,13. Bu\ircsx and Pn,rcsions c{dc: Thc Conti.roi\ Liccnsc hw docs nol olply h rn o*Nr.l
<br />rhc fnrd, shl builds or imFrvcs rhtar. .Rl qk, dds smh rttrk hi'n\cll or hcrslf or rhmu8h h or h.r own cmtloyccs,
<br />t)ioriJcJ rharsuch i'npnEEntmftn inkrxhd orollirrl li,r slc lll ho*$rr. rh.bnildin!or i'qtu!.rEnt ir$klwirhinon. ytr
<br />oi conrlcrion. rhc Ow.cr t,uiucr sillhovc rhc budc! otnovi'rs rhJr hc or shc did nor iairl or in!rt'vc rh. pn,Nny rd lhc NrFr{ol
<br />'/r.,k ,,* n ,n"",.,,m.xcrusivc ry .onrl.ri',s wirh riccn*d..nk..bn b co.srn,cr rhc pR,jccr (ss.' 7{r44. Burim$
<br />.nl Pi!'iN\6. c.dcr ThcConrodo.s Liccnsc La$d..1nor.t'Ilyro !nosncr ol p(,p. ywlr)huildsoriflfrovcsrhcrcon.
<br />xnd Nho conr(t lnr such ptuj..h wirh . ftnt,.ttr(\) li.ci{d purunr lo lhc Corkr.lol( Liccn* liw)
<br />"lt?Jb4
<br />t)tt t, \tr \t r()\
<br />I h.rcbyrf,lnnu dn D.n ryof |rriuryotrcolrhcl(nbwinsdccktr{ri,nrs
<br />-lhovci
<br />* ill Nirlli. a CcniIElrc o, C.is nr scll lnsorc a,r torkcra .. nrr..sar ion, as p()vidcdf.rhysc.ri(,nl7morrh.
<br />Lahor Codc. aorthcrc oirnanccolrhc *ork for which lhc pcrmil is hsoc{l
<br />lhJvc aii *illtrnnnJn, sorkoi .oilNnsdiotr nsur.tr.c, as rclutcl hySccrion.lTO0ofrhc lrhorCodc. for rhc Nnnarrucc ol
<br />rhc *ork turshirhrht pcrnir i\ t\u.d Mysorkcrr co'n|)cnsrri(,n insunrcc cnricr rni Fnicynunrhcr ffc:
<br />-l
<br />ccnilyrl r ir rlt l)crlhrnnrc.ol rhe *ul I{r *hichrhis pcnn
<br />{) r\n,h.con{ruhF.rk,rhcworkc^ (nnnctrldn)ihs\ofcrlitur
<br />!orkcri co'nFnsarn,n!'ovisi{, sof Sr.ri(rlTlX)olrht LrhtrC(rl
<br />$AR\l\(, l-J' L'. [ "..un.q l.'i q.0'r...]. r''.,r! JlcI
<br />.ivil lnr( uf k, on hutrdrci lhousitrd dollars (rl(xr.lxx)r. ir id(
<br />Sc.rion 1076.1lhc trtr C,{e- i c,cd rndrrtnmy \ rcc\
<br />ir h nsucd,I rhrll.or cn{by.fyt'c6on in atry tutr.r
<br />rii. rnri rrrcc lh.r il'l should tE( r{hj.dbrh.
<br />c.l \hlll hnh$irhconrly wirhrlr,s pmvisi('n!.
<br />utrlu$ful. nnd \hrll subjd an cnltlloycr ro oimiNlpculrE\ and
<br />b rhc cnd of.o lln s ior. danuAcs !\ prolid.d for rhc
<br />qr"{-re
<br />I hcchy,fln rndd F.trullyofpcrjury rhal I !m licenEt undcr pnli\ion ofChllrr$ 9{.ommmnrE *ilh S€rion 7(xX,) olDivhi{,..1
<br />ol rhr Btrsinc\sand Pmf.\sionq Codu *n mv li..n\c i in full foRT dxi clltcr.
<br />g9IIBIIIIII}NIDNT.INI;ICENCI
<br />I hcrcby rlltmu cr pcnrh,ortrrjuryrhirrh.rch0 con(nRtn)n h iu,gcncyr'o!rhrr.nnrnu..orrhcworklorwhichlhi\psnriris
<br />ksucn (56. 3()97, Civ C ).
<br />kndclsNam:
<br />A.tlUEdtLDElIaIEAIlON
<br />lllrhy irimu cr Ftrrlry olncljury onc oirhc nnlovirg dccllDrn,ns
<br />D.nn,lirbn Pci,nh$Ash.stos Nolifi.rlion lJcdcr!l Rcsuhlnnr\ (lillc4l). Pdn6)
<br />Rcquircd Lcllcr ol Noiillmti,'n
<br />Set Backs A\"ig-m/
<br />Forms/Steel/Holdowns tL,/'tnltl-o,/
<br />Erection Pads
<br />4 niltv fuwvt-ll1,/
<br />SLAB Floor
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Ir/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL il-"-/1 .J/16-,@)
<br />Certificate of Occupancy
<br />NoJes,. Remarks, Etc
<br />\_
<br />td,v
<br />UFER Ground
<br />Sublloor/Venti I nsulation
<br />Brown Coat
<br />Li.cns c!os:-l.i.cosc Nun$..:
<br />-
<br />D8le ('onldior
<br />_l ccniryrhlrrhc ta'l.rdl r.G{ hr ionr mg.rding.sh. osr.nrv0lorc nolalplicahk lo$is!r+ci
<br />-l
<br />ccdiiyrhar lhavc rcld ttis oppliuiion od dbrcrhd rhc r,vc inlarnrdio. is cor.cl loaraloconply*ilhallCnyandcounry
<br />ordimmcsand Srarcti*. rcbnns h bu ildhe . nJatud!,n. )d h.rcby adhori- rc!.cscnhlilcs ollhi\ Cny Md Counryro cnlct ui'on thc
<br />,*di"" "",*J. /r'f;;;,il"I 211 **,il{'o/g
<br />P.mi,e.Mmc,prin,: ,@+q*y, t t
<br />I
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