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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs N t- t.,"ilp q rQ /tild i6)
<br />Erection Pads Jl (:/
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Bool Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulationi Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lVlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />E ngineer Final Beport
<br />Flood Zone Certif .ffb5 av ,'D PvktEL 8',ahffi
<br />FINAL 4)K\
<br />Certif icate ol Occu pancy
<br />N oJes, Femarks, Etc
<br />'ZZA itn;r+n--
<br />OWNER BUtI,DER DUI-CARA'IION
<br />I hcrcby a0nnr undcr nc.0hy ol rcrtuiy thnt I an cxctrrlr fnnn thc Conr.ch$ Liccnr L.* ior lhc rbllowin8 lcDr (Scc 70:ll 5
<br />Businc\r trnd Pnrrc$ion Gdc) Any Cir, or Couniy which rcquirc\ ! Frmil t, on{ocr, rl'c', i'nri{,vc. lanolth '{ rctr Jny
<br />srrudurc. prior ro irs tsuamc. also mquncs rhc rlpli.anr ldr ru.h Fiinir k,lilc i siercd {arcnr rh0t h.or shc n liccn{d puror
<br />n,lh. pmvisi{n,\ ofrtr Cohrrcroas l-ic.nscd tlw (Cirprcr S. Connencing Nirh Sd.rim ?ofl) of Divisnrn I of rM Insincss.nd
<br />Pmfc$ions Codc) or th0r lr.rshc iscxrnlpr lh.eann nnd rh. basn l{tr rhcallc8cdcxc lptior. Atry violnlion ofscdionTO.]l 5 by atry
<br />applio lor a p.rflrit subjcch lhc arpli.0nr h acivilpcnrllyoin.t nrrcrhan fivc hun Exl dollors (S50o).
<br />l. $ owNrofrh. ln)Fdy. or trry.nDloy.c\ wnh wsgcl a\ rh.ir q,ld Lunpoerion. will do rh. ror* nlt rtE (Murc n nor
<br />inrcndcd oroficrcdfors(lc(Ss7O{r.0usinc$ondProlc$ionsCodc:ThcConnodoisl,Ecn\cl-rsdocsnorrrpl,t,anotrnnor
<br />rhc pmF-ny wh. hu,l,s or nq'.orc\ rhcNn- lNl who de\ su.h *t* hi'nscll or h.r\clf or rhmulh hi\ or hcr oqn c Plorcc\.
<br />fovid.d rhrr su.h i'nfmKtrrd. m nor inrcnlcd oroftmd {n srL ll lm*cEr. rh buik,iq or imfrovcnEnl is sold Firhin nnc )rr
<br />or.o'nphri,n. rhc Owm, Buiuq will hnk rhc hrd.n ot pr.vin-! rtur h. or shc dA d uiu.r inFmv. rh. lJ^,tf,iy tor rh. I]Uqrs ol
<br />I. Aosnsofrhcnn)pedt. nrcrlx\ivclycoikrcri.E $irh licco\ conracds k, conndcrrh. pn,icd (SLr.7(}14, Bd\i'c^
<br />lnd Prni\sir ci)dc: Thc contrickr's r-ic.trsc Llw docs tror.tply h rn owncr ol pn|xay sho huild\.r nnprorc\ rlEcoi.
<br />nnd who onrruch nn \uch rR,jcca wirh r Conrrucro( \ ) liccnscd puru rorh.Contd.ttr s t-i..nr tiw)
<br />I rtr,rxc,pr un,turS.critr
<br />Ir,lr trsnrr:
<br />IIaALli8[.LaUIlXlir!-Il0I
<br />tri!:LAtr ro!
<br />IhorrhlJllnntrtrJ.rn.trr11t.r rir) oD. ol rtu tulosi',! d{lxnri,nx:
<br />lhrle urn*illnanrruin !CcnilKarcorCoos.nr h Selflnslrc for worlcF dnnpcn\ i,n.I pnrvidcd rorbyscclion 3700olrhc
<br />I ibor Codc. l'or lhc pcrlornnrrcc of lhc work lor shich thc I'dmir n hnrcd.
<br />rhc $ork fu*hich rhi\tcrnrir ir ir\ucd Mrworkc^ conrtrn\ari()n nrsurricc.rricr d lx)li.y ntrnh.ru.
<br />c*x. STf,r€ rt'sO
<br />pax,r.," *,,1-3JSZ.8L -t/3
<br />civil lnu up n, onc hu rcd rhrarnd dolla^ (Sl(x r(xx)r ir rddiri, t, rhc rnn of.on f.nsarn,n. dd'tuecs 0s rovidcd ln.
<br />'hc,,I l)htr (ini.. .,c! r rl lirf,r'
<br />/,,s
<br />DECI.ABAIION
<br />I hcEhy rlitn undq pcMlty of pcijury rhar I anr liccnen ufldcr pmvisio. olCh.rrq 9(commncin8 *irh sccrion Tulo).rDivi\ion l
<br />ol rhc Busincsslnd Prdf.$ions Codc. lnd,nyli.cnk k in full f.njlld .lIcct.
<br />1t6 A--(ao')e a,P"
<br />I hcrcbydliraxnd.rFndllyorp€ijurylhd rho. is $niltu.rion knding agcncy lor lh. FctroflMcc oflhc *olk fu which rhh pcn, n
<br />h{cd (Sec 109?. Ci! C).
<br />AP&ISNLDTII.ASAIIIIN
<br />I lEnhr umm uod.r rcndxy ofFrjury dnc.rrhc roll.wins dccldrdions:
<br />Dcmlirion Permils Asbcsros Noli6carion FcdcalRcsulalions (Tnb 40. Pan6)
<br />-R€q!ncd
<br />ktler of Norifi calioi
<br />I cdiry rhnr fic lcd..al rcgdrrions ngardin8 ,$csro$ rurmval nm nor tprltlbk h rhG proi!.
<br />-lccnifyrhal
<br />Ihuvcrcodrhnry icarion and srardh rh€ ahovc inlbrm.r ion h comcr. I agre ro ontly wirh rll Cty md G,unry
<br />o'(li'rn.rs r rlSl (,l:N\ rchrin! n, hriLili',9.urhorlTr rcprc\cnrnrivc\ ofrhk Cny riJ C.utrr, to cntcr u|xr rhc
<br />&,vc Drfliorcd UoFnylor in\
<br />Amlicnnl or Ag.nl SiAnrlu ,L lZL4*--
<br />zlt/tr
<br />Forms/Steel/Holdowrll Jc--z-t -
<br />UFER Ground
<br />lll ltt ll,l
<br />I ccdilirhrr in rh. pcrrornurc.ofrhr qork for shichrhk pcrni! is i\sucd.l \hrll nor cnrtk,rrnyl.son ir anynrmNr
<br />s, .sk' bc.o r \ubjc.i k,rhc wdikcn (rnp.Ndrion lrwsofcrlififfh, and a8ec rhd ill dFuld h-.oor ntbjccr lortr
<br />wnrkcr'.o rtf, \nrn lniv(io.sufSccrionlT00.frh. tjhtrC(xl.,l shill. fonh$irh.omply $irhrhoe pnvnn,nr
<br />WARNINC Frilurc ro scurc workcr' conrp.nsrltD orcrn8c is un istl, snJ \h ll \uhjrcr rn .'nfl(Dtr h ainrinnl |FDrlrics iDd
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