|
BUILDING. INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf looriVenUl nsulation
<br />Rool Sheathinq
<br />Shear Wall /'\
<br />Framing *tK Y-W1U
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />/,-\
<br />FINAL 'd-2s-[Y h"Wtc)
<br />Certificate ol Occupancy
<br />Notes, Remarks, Etc.
<br />OWNER AUILDET DELCAR{TION
<br />I h.rchy affim hdcr Fnnlry (,r Biury rhd I m cxcmpr ri.m rhc (i)nrradoF l-i.n\. ljw ror rhc followi!3 rca$o (5--'.70.11 t
<br />B$inc* and Pror.sion Codc) Any Cily or Counly whkh rcquncs !,E.rir b.otrdDcr, rlt.r, inlltrorc.4cn kh.r tptir rny
<br />{ru.ru6, prior b ns nsuon(c, ole rcquncs lhc a$li.{r for {.h pcr.rir b nh. siBrcd n cmnl rhar hcor shc is li..n*d Pusuan'
<br />lo rhc Folisions ofth. C.nracttr\ Li.cnsd Lrw lchiprcr 9, Comnrcncing $irh sc.rt,n ?fin oi oivision 3 of rhe B!sin.r\ and
<br />Pn,lcsiotrs c.d.) or rhrr h.orshc hcxcnDr rhcrcfronrann rhc h!\is lor rh..llcBcd cxcm rn AnyvidrliorofSc.rion?0ll5hy.try
<br />apnliconr ior a pc,mir rut'jccrsrhc applicanr k, a.i!ilpcn,lryornor hdrc rhan fivc hundrcd dollrn ($50o)
<br />I. as ow.cr orrhc Eotxny. or my cnlPloyccs wilh vrscs rs rhen y,b conD.nsariotr. silldo thc work lnd lhc \lMh h nor
<br />i c,rn{ oi oficrd for slc ( Ss ?044. Businc$ md ftofcssbn\ Codc Thc C.nta.k, s Liccnsc l,s des nor +rly l. nn owN. of
<br />rhcptuFny wlx, hnilds or in{mBrlrmn..ni who dms suh w{,* hinsclfor hcrcllor rhroush his or hcr owtr cmlLyc.s.
<br />pr.!id.d thor ruch in,Fovc'nnrs m mr inrcndcrl or oft'tl for *'L. lt k,ucvs, lhc hiHinB or inlpd. .nr t sh wirhin onc )tr
<br />ofooplcrion. th. Owflcr Bu tr sill havc rh. hordd of rxJvnB thd h. or shc dn N build or in{,rn!c rhe pn,Fly for rhc puq$s of
<br />-1.
<br />owNr ol rhc Pl,rcny, i r.klulnaly .ofta.hn8 q [h l].cn\cd conrrrcxn\ lo cotrdtucr rh |n.J..r (scc. ?0{r. au\ir't\\
<br />r i l\l,rrsiin C.dc: Thc conndr's Liccnsc Liwdocs not Ut'lyx, m owndr or ln)lfny trho hnildsor nnPn,lcs rl'.r.otr.
<br />rid who ..nnidsror such pm]ccts wirh!Conlmclodn liccr\u rtrrsu,ni orhcG)lltrrclttr s Liccnsc l.Jw)
<br />I r cxcrF cr Sccri{,-, B & l)C larrhnr.r{{r
<br />Itl)8trE&tigUt[ISAIllrN
<br />DI:CI,IIBAIIO!
<br />I hcrcny lrfirnundcr pcnrhy oa p.rjury on. or$c lollo*nrs dcclahrionsl
<br />I hr{ lnd sill roinrain rC.nin.rr.ofCon\c.r k,S.lr.lNUrc n,r \eor*cr1 . np.i\ rn)n.r' ptuvx}cd lotbySecrion l?lX)ofrhc
<br />Ltrbor codc.lhrrhc ncrinmun.cofrhc *ork ftr shi.hrhc !.nnir i\ slucd
<br />rh. s.rk fd whi.h rhhrcnnir is issudl. Myworkcr'co nctrsrr i',\uran.r cnn icr Jtulicy unrltrmc:
<br />I.cnrryrh.r inrhcFrlbirMtrc.oirhc*orkforwh I rhn p.nir i\ r\{rcd.I slul]norcmploJ_lnyntrq,n rtrymrtrr-r
<br />$ r\ tr) b.conE subFrl lo lhc sorkc^ .oqrcnsrrio.s.fculrtunir. rndr8rccriar il I shorld lr.om suhjccr torlrc
<br />workcN'co'n!.ns,rionpovntunr.lSecri.nlT00ofrhctrhtrCdlc.lshrll.lonhuilhsmplrwirh x,{Pmvisions.
<br />WARNIN(;: F lurc b krur. workcr(.onDcnsili{[ rord i\ unlx*lill. rrd sh ll n'hjc.I rrr onrnk)vcr t) di'nirnlJrnrlra\ xtr(l
<br />.ivil turcs xp ro otrc hum[cd rhousrnd no ddirl,ni h rlrc co{ oi.oDfctrs rnn,, dnnr!.r rs Provid.,l li)' rhc
<br />Z
<br />DECIJEAIIIN
<br />I h.rchyllltrn uxln p.nalry ol Frjury thit I am liccn{n undcr pmlhion orCh,prn 9{connf,ncifls *ilh SEii,n 70m) ofDivhion.l
<br />ot rhc Blsim$ and P,orc\\bn! codc. r myliccn* is inful nna and ciTrr -
<br />r-lc$sc ern(6,/
<br />D{,c, 7 2-7
<br />coNsrallJto tlilDlNc-dliEltc}
<br />Ihcrchyll'nrmundcrFfrhyortl.rjlryrhalthcreis!consrocrion[odi',Erscnyrorrhc|ErlbirM!.collhctrukr whi.hrhi\ Ddlnir i\
<br />issucd {S(. :1097. Civ C )
<br />APPI I(:ANT DECI AR,ITTON
<br />Lrnbynnnm urlcr penalry or pcrjury om.lrhc lull.wirE dcclmrliotrs:
<br />I)cnmlilion Pcr.rils'Ash.sros Noriic!rio F.dfalR.!ul i,)nr (Till. Llo. Pon6l
<br />Rcquncd trttcr ol Norifrarioi
<br />I c.nifyrhd rhc I.dorll rcenl{ridn\ rcglrdire a!hc(o\ rcB,vxlrrc nor atphcrDh k! rhl( |n!.cr.
<br />I.cnilyrh l halc rcd rh\ arrliarion dxl {nrc rh ( rhc h,v. inldnd iofl i corer I rsre t, conrdy wirh .ll City nnd c(,unry
<br />.,(li'rnr.\ ind Sric lr$\ rrLttr,S huildnrS .o.srucrn[ rnd hcrchy rurhoriz! rcprc{ rriv.s otrhi\ Ciry.nd Counryro cnrcr uF,n rhc
<br />lho\r nrnriotrcd prcFny tur in\** \r,)"r'
<br />1az _.-_ ',,
<br />SITE-WORK
<br />Flood Zone Cerlif .
<br />tr dcr'{ AddF-:
<br />-
<br />I
|