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BUILDING. INSPECTOH RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER DUtI,DI]R DELCARATION
<br />Ih.r.byafinundcrFnallyotpcrjrrrrhdlnd.x.mprriomrh.ConlrrcroNLiccoscLasfttrihcn)llosilStcuv'nls.c?0115
<br />Busnr$ !ft1 l,ro{csrnrn G'dc): Any City or Coudt which rcqutcs a lf,rnli o .onqfl.r. 0ltcr. i.r!r,vc. d. $lish or rc!0ir inv
<br />nrucbrc. rrnv ro nr issuancc. also rcquircs Uelpplicrnr tor suchpci,nir to file{ sisncd srarcnrcir rhd tEor she h licen\cd pursuanr
<br />rorhcprovi\ionrof.Cont..hlsLiccnsedtrw(Chlprcr9.Co'ntmirSrilhSc.lio.7(xx)ofDilisnrnIoilhelrdsinc$od
<br />PoLsnrnr cddcl or lh h.orshc hcxcqrr lhcrcfro'nrnd rh. blsn for th. trllc-scd cicmptio. Anyvn,ri(,nolSccrion70.115hyrny
<br />dtpli.n.r lor a p.xnir suhjsrs rhe lppli.unr k, rcivilp.nalryofmi mrcrh{n fivc blndr.d dollds (3500).
<br />-l.a!owncrorrhcpn'pcnr,o.nrycnDloyccswilh*!scr!\rh.tv,l..onl|Ens
<br />ior. sill do rhe work ukl thc slnErurc is nor
<br />n old.d or offc.cd for sle (Sa.7l}1,1, Busincs ,nd Prof.sti rs CrxL l hc Co.rructtr\ l-i..nt tiq des mr rprly b M owNr of
<br />rhe Inpcny shD hoilds.r irrmEs lhemn, o.d Nlp doc\ srh work hinNclfnr hcrrll.r rhmu8h his or hcr oun cnrPhy.cs.
<br />fl.vidcd rh.t such i,npmrm s d nor imcnd.d or offid r(r sE. li houvcr, rh. t i|i.g .r iry)orcrrcnr is r,ld wirhin onc vta
<br />of conD|rion- rlE Osn.r Buikhr will harc th. hrdcn ot [ovins rhar lE or \hr di] not build ot in{mw dt lsFiy f.t lhc ,)!tlns or
<br />l.rsoqnrofrhcnmpcny.s'ncrctu\ntly.ontr.rir!sIhlicctrscdcor[rctmro.n{rucrrhcDn,}ccr(src701-lBurnc\{rrl PmlL\si,n Cod.: Th. Cotrk.crois l-i.ctrsc li* doc\ nor apply h ntr otrns olntopcny $ho bnild\ or impn,vcs rhctuon.
<br />rnd who conan lsIor\uchlJxrjc.llw hrc.Nrndons) liccnsed Pu^urir k ih. cutrkr.ktr\ Licensc liw)
<br />I rmcx.mpr undcr Sccl a &PL li)rrhis'cxwl
<br />llatrf,E&r.lauPliNlii.r]oN
<br />DE(]I.ARATION
<br />I hcrchy rlfinn undcr Irnnlrrolpcrjuryonc olrhe li)llo*i',a dc.hrrrnns
<br />-l
<br />havc {ld *ill tuinrlin a C.dificalc of Consctrrlo Scltlnsurc tu*o c* $rqEnsnlion. ar povidcdforbyScction:l7(I}oirhe
<br />hb(, o)de. t{r rhc Frfoirmncc of rhc wod r.r which lhcprnrir i h$rd.
<br />ih. r.,k n)rqhichr[n rnn[ s i\{'cd Nly rri,nr nNtrrrr.c.rni.r !tulE,ll() nunbcr rc
<br />lccnllirhrr ir thc pcrtunroncc,)frhc sork lin *hi.hthir pc nil ir is\uctl. I\hrlltror cnr oy rny lrr(in in trny m Nr
<br />h .s b tironE sn6jcd t, rhc {o&us'..nDcntalion lotrs ot Crlilornir. ttrd,8N rhal ii I should hcotu srbi\r hlnc
<br />wor(cr! conlcnsrrn,n F'visn,ns ol'Sc.liotr:17(Dollnc bhn Codc.l\hill.,bnhwirh..n!ny *irh th)ic Uovhion\
<br />W RNINC: t ilurc ro {curc sorkcs .ontEnlMon i\ unlr*lul. antt rhrll sublcrr 3r cnlplorr t, diniml pcrokii rnd
<br />civil 6nc\ !p ro otrc hrodr.d thousa.d do r. in rddi(i,ii lo rhc .on ol cornp.tr\rridr, dr trtScs !r ,n)vi{l.d Inr rhc
<br />.-\
<br />IJIXISIIITQIIIIJIIOB
<br />Llllll,rlSarloN
<br />I hcrcbyamrm undcr rEn![yofF.jury rhlt I am liensn under pm,isio. orch|ptcr 9 (commmins *irh Scrion ?&0) ofDivi\ioo ]
<br />ol $c Bnsimrs .nd Prcfc$ions Cod.. {d ny li.cnr h in full fore en eficcr
<br />o
<br />".," f/<l/t9 ,
<br />IQNEIAI]SIIANIENDIIIj.{CENEI
<br />I hmby lrtrnr undcr pcnahyolpcrjory rhdr lh.r is u.otr{ruclion lcndir8 lsc cy li,r lrk ltrri,irnrmc.l lhc work lor which rht Ermir is
<br />irslcd (sr. -1097. civ. c.)
<br />AELTCANLDECLIBAIION
<br />I h.mhy.fllrn undcr !.nalty ofFrjury on. orrh.lallowine d.clanriotrs:
<br />Demoliri,,n Pcrmir$Asbc(os Norillcdbn ftddnl R.gxhrn,ns (Tirlc 40. Pfi 6l
<br />_Requird L.ncr of Norilicrlion
<br />l.cnilyrh rhclcdcrrlrcsuhrnN rc8ddirA ,sbc{os r.trFvrl arc nol3pPlic I h rhN tl(lccr
<br />i .nd (alc Ihal lhc fi'vc n,turnuri(,r is corer I lsB ro comply *nh ,ll Cn, and O nry
<br />.ftlirrncc\ rnd Srrr. I xss mLrir'8 huildinEconsrruclioo. lrn hcrchyaortxtri2c rcprcscnl ivcs oi rhi\ Cnt nlld Coutrly ro cnrct uBrn rlf
<br />ahrvr lmrlioncl Dmp.ny lor ins
<br />\T
<br />q)a)za
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf Ioor/Vent/l nsulation
<br />Roof Sheathino
<br />Shear Wall
<br />Framinq l0 *z-lK x"v+tl
<br />ln su lation/E ne rgy
<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 />Enqineer Final Report
<br />FINAL ld-?7"1K
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc.
<br />/A
<br />\/
<br />Flood Zone Ceftif .
<br />/^\
<br />4
<br />--
<br />-l
<br />cenilylhll I hak r.rd rhi!
<br />4---r---\.?-->,'
<br />z.--/)-r'.;
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