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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE tD/stG.COMMENTS o\{N!:R IUILD!lR DIILCAR IION
<br />I hcrchy 0trirm uDdcr p.nilry ol rrjry lhd I am ci.mpt lnn rh. Coitr.Ion l-tcn{ hw ti, ih. nnL,slns rcnstr rsc(:mll 5
<br />trusircss rnd PFf.$ion Cnte): An, ciry or counry whkh rLrtuirc\ r ncnnir t, cotritu.r. rltct. iNl"ovc. dcnFlth or tPrir riy
<br />{tucrurc. prntr h irs isiurtrcc, dl\o rcquircs lhc {pdictrnr lq nch p.anii (, fiL a si!trcrl sr.lcnEnr rhar hcnr shc i\ licctricd PuN0nl
<br />lo lh. nr)vi\ioo\ o, tlE Contrctn s l-i.c.{d t.rw (Chiflcr 'r. Conrnrn.in8 *irh Sccri.n 7fiX) ol Oivisifl I nl rh. Ausn$c nd
<br />Pmfcsi,ri s C.dc ) or rh hcor \hc iscxcmpr lhcrcliomlnd rhcbr\is fd rhc rllcecd cx.trrPhon Aoyvi{,ldi.nolSc.lion703l5l,!rtry
<br />nttlr.nr r.r a pcrnit {rbjccls lhc rrrli.a ro d.irilP..rlrtor..r nxmrh.tr live hundcddollr\ lSSln)
<br />-1.
<br />as .urcr of rhc proFn y. or ny c lployes wth sdgcs r\ lhct v,lc compctrldnnr. s ill d. llE qort ud rhc nturru is nn
<br />intdGl or or.{d ntr $h ( Ss 70,14. Brsiocs lnd lrrlt$i{rx Co(lcr l'hc On r.doi s l,iccn\c lis do.s n.l nDnly h rn o$n . nl
<br />rhclnrFrry who huikh or nrl'Fvcs rh.Nn.,'d who docs such *)rk hinr{clfor h!'\clfor rhiough hh or hcr o!. c.rkty.s.
<br />nrorilcd ihrr uh i'nthtm.N m ('t imcnd.{ n oltircd ntrsrL lil${cv.r.rh.buildingorim0mvcrrnri\qrld*irhir.trclttr
<br />orc. 1l)Lri'n, ih. oMcr Buiils will hovc lhc hunlctr or ovii! rhJr hc or dt did nol h'ild or improvc rhd fl.lmy lor ltE NrFs of
<br />l.rsoutrcrolrhc|mpcny.n'n.xclu\ivcly.o.tacrnr!wirhli.cnscdconrn.rn6rodrnnfldtl'.pmj.rt(Scc 7(It. Bu\i s
<br />trtui ltolcshnCodc'rhcC.ntrnclolsl.iccnscl,nwd.c\nolrypllroanoNnooflno|.nyshohnild\ori'nforcsrhcrcon.
<br />ind qho onrrucrr for \uch projc.h wirh ! a n t,(o lf,cnscd rursuanlrorhcGnnrucktr'sL-i.cnse liw)
<br />-l
<br />uc(cnDl udcr Sar
<br />lV(lIlKl kS' (l()lll PI.,NSA'IION
<br />DECl,tIldLl9lt
<br />I hcrchyrlltrmtrMcr tEtrrlry.lpcrjurlom of rhc n)lIrq rtdcclirrrions:
<br />-lh!v.!dwillnEinrrirnccnl,i.
<br />cofCotrsctrlroScltlNurcior$ork.r'.on1P.ns{lion.rsrmvidcdftn$ySccrion:17fi)olth.
<br />tihor Codc- for rnc pclrornuN ofrhc sorl i.i *hi.h r,r ndnrir i( nsucd
<br />-l
<br />htrvcr. sill nriflri'r w.rk.n conrcns irnr innEncc. xs rc+tcd hy SL\r i(n l7(x) oi llr I rhor C.dc, iltr rhc Pcni)n.rmc of
<br />rh.(orlf(trwhi.hrhisrcnnirisissucdNlys.rkcr'coarpctr\rri,n,innrm.ccrflicra policvn!n,h.'dc
<br />-lccnilithll
<br />initu pcrfonro ccofrhct.rk lor !hi.h rhis prrmil ir i\sucd.I nrlln.r.trlroy rny ncrson irrny nr rr
<br />v, ^hhc()mc sobl.d turl[qorkcn coDrfctrlrri.nhl\or C0linrnir- tM ltgrccrld il Ishoukl hcco c\uhlcd lolhc
<br />rvorkc^ comFnsarion povNn,tr\ ol SLrli,r :l7U) of ln. Llhor (h{lt.l\hrll. forihwirh conrPly $irh rho{ rnrrnior\
<br />WARNIN(; I{ilurc lo scu.. \.rkd^ ..ir.trs lotr colcrilc is tnhulu!. ttJ rhrll suhjc.r rrr ctlrorr n, cri'ni'[l Fmhics rn,l
<br />.ivil fircs nt n) onc hun,lrr.l rhousiid doll.rs lSl{X).(Xx)), irr irllirion ro rlt co{ ofrc tl'.ts ridl ii'm8.s a\ l('vl'lcd I'n rhc
<br />S..lr[ ]l)76,'l rh.l.rlln (itr[. trr.'rn rrd rh .v \ r&\
<br />"",.,e{z/ tt
<br />Ilrrciyaflnar ndcr |ttulrt nl psrluy rl,{ IJnr
<br />,'l rhc llu\incs\ rnd ltofi\\i(rN Codc. r nryl
<br />f'o\i!o of Chil,rd !(.rnnf,rcn,g sirhSc.totr7(xN)).f Iliri\i{rn.1
<br />'"" slTf ta (ontrtcl,r
<br />! hcrcby rllirn unicr |tnrlryofndrjury rh rhcrcis i.nlcndirs!gc..tl,rrhctcfurnrn.col'rhcworkilt$hchrhntcrnir is
<br />A\u(|15r. rlDr Ctr (-)
<br />tnrd$ s Add(ss:
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<br />A.STUIAII"DECLAIAIII.}N
<br />I h.dry.nlm utrdcr pcMlry of pcrjuly one olrhc ftrk,wi.g d..lrruiions
<br />llcmlirion Pcrmik A\t nos Norific,ln[ Fcdcml Rc8ulnlions ('lillc40, Pun6)
<br />-Rcquircd
<br />L.rrd of N.rif$rion
<br />-l
<br />ccnilyrhtrrrhc ltdc'dlrclrlirion\ rcB ding Nh.nns rcnror.l arc nor npnlicftl. t) rhis lNlt r
<br />-l
<br />ccniryrhlr l hnv. r. d rhhlP,'li.ali,nr fl slirc lhnllhc trtx,vc inro' nniotr is corNt l rsre l. compll wirh allCiryand Counrt
<br />ordin,mcs rnd Srard,rws rcl.ring ro nuiuins con{rucrion. lBl hcrcby arrh(ri7r rcrrc\cnllliles oflhh Cirv nM C.unly ro cnrcr uPon rh.
<br />rlx*c rf,rli(nRl tron.rry n, i',sllc.rid trrtlc\
<br />Appliunl or Agcnl Sign.hrrc:(f.-5Br**..,"--!e'/"
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsulalion
<br />Roof Sheathino
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />Forms/Sleel/Holdowns
<br />Lic.nscChss:-
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