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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS O\YNER BTIILT'ER DFJt,CARATioN
<br />I hcr.hy rfllrm undcr ptnalry or !.rjury rhrr I nn.r.mFr rnrn rhc (i" r.ft^ Ltcn\c L.w for rhc f(,lbwin8 R,wr rs(I)ll5
<br />au\itrc\ .nd Profc$ion Codcl Any Cily or Coutrty *hich rcqnncs a pcrmil t, coi{rucr- rlrs. imlr.t1. dcnmhh or rcI'{t any ,
<br />nfl.lurc. prnn ro its issulncc- al$ rcqunc\ rhc udic$l lorsuch rEnnir h fik r riln.d {trrc rnr th h.or \hc n liccn\sl Pulunl
<br />ro rh. lorisids ol rlf, Contacr.fr LiccnRl Lrw (Chaf!.r 9, Conrnrc.ci.g wirh S.crion ?(fx) ot Diltion I ofrh. au<nr\s rnd
<br />ttof.sions (:odc) or rh.l lf,orshe hcxem lhcrcfnnandlhctn\niorrhcullcscdcxcrprion Anyvn,h'nrnorsc.lnfl70lr 5iy!try
<br />appli.trnr for opc.nrir snbjccrsrhc apllicrnr io ci!ill.nrlryofnor n,cihM 1iv. hudroddollrn (i500)
<br />_1. r\ osncr ol rhc F)Icny. ,n f,y c lnk,lc.\ Nnh srgc\ rs rhri' {,lc .otrlF..nld i(u. $ill do rhc s olk rM rhc shrl!rc i\ nor
<br />rhc pn,rcfly wl$ huilds.r inlPro\$ rhcmon- xtrd who docs such wnk hi'nrclfor hcrsclfor rhn)uFh his or hcr owfl ctrl'hycc\.
<br />Luso*nc'ofrlrcpmpcdt.rnrdclu\irclr.oikrcri'rg$irhlicc\cd.oiki.ti\bc.n{rucrrhcImjcd(Scc7rlr4,Bu\ms
<br />rRl thli\sh. ftdc: 'I hc Co rocttr s l,i.cnscl,r*des not nttlyh anosnrr o{pn,p.ny*ho huild\ or nnp(rc. rhc.con.
<br />and who conkrck tor snch tml..t qirh rConrdLd(n licc kd nuruanrt) rh. Conkrtr's Liccns L.wr.
<br />I x \r\.n,pr u.df SNrio
<br />IIAAK LEAIIItrNSAIION
<br />DECTABAIIAN
<br />I hc'chy llnhuftlcrpc xlryol,rjry.trc.f rhclollosir!dc.hr.rnN
<br />I hi{ rnd will rminr.ir n Ccnilictrrc ol Conscfr roSclf.!n{trc for wor[c6 conlnctrsrri,)n. !\ p$lidcd fi, bySccrion.]7(X)ofrlI
<br />L.hor (ixlc. Lrrhcprnornramc ol thc sorl fin shi.hthc tdnir is k cd.
<br />Ihlvcrndwillnui linsorkcBco rFn\riion innmm.. a\ rcquird bvScdn :l7lx) .f rlE tik, C.dc. lor lhc psftrnHN. or
<br />rl,. $t rt n{ $hih rhi\ F^rnir i\ i. rJ Mr tr' r^' s{,,tr rumncc.itrEr anl ,r.licy nunrMr arcV1-
<br />o,,.,.*"**. G!.trJ r^rC, l j4a?2..*n,..,
<br />l..nllyrhxri'rrhcncrt{xnrrn.ci'lrhcworlrforqhichrhisncrn,ir ^ i\ucd. l nrll tr.t ctr!rloy .ny |Er.n in rny hnNr
<br />\i n\r, h.oir suhic.r t)lhc w.rkcrc .orrDctrlrli'r IrN\.lCdlihrnin. M,lig'{ rhrr il Ishnll,l hcc. t tuhl..rrorhc
<br />\!ARNIN(: li l,m b s..f'c \ork.n rotrrrr,\ni,n, ..v..xgc i\ trilr\irl trtl\hrll{rhr.l ltr.nrpl{,
<br />iri o1. hrnr .11 ilrd \rrl r[n r'\ r\lr{i.irx)) nr rJrhr !) ' ro tr 1r
<br />*:, HltitTul g'*'*"''*
<br />I hcrchy amm u.dcr ncmllyoipcrjurr rhar I ro lien n orChrprd 9 r.otrnNftin8 \irh Scclion r(xxr)ofl)ilnion l
<br />of rhc Businc$ nd Pmlcsions Qdc, md nry liccnsc h in tull fore lnd cllccr
<br />_J6.1 ooqq Q4,
<br />,*ltaY 1l l!l!(^|u-rrn-
<br />c()NSTRUCT!()N LFltlltN(i A(iENCY
<br />I lf,rh!,fi1 nuM.rlInrlry.l,Mjuryrhrrrhocnac.nn.rionlcndin!r8ctrcyli)!rhcpcrl('nrNccorrh.sotklar\Ii.hlhi\Ilrntin
<br />is\kri lsc. .rll.)7. Civ C )
<br />AIIUqd$"UCIrIBAII0N
<br />I hcrhyn nmuDdcrI'cnalryof p.UUryoncol rh. f(,lk,ringdccl&rrnrN
<br />l)cnrniitlr Pcflnils Arhc{o\ Norifi.rri, licJcrrl RcAUhrio,\ (I irlt..1]). Pin6)
<br />It(tuirc.l l.crrcr of Norili.{n
<br />lj"n l] rhJr rl. hJ1.li.rrhrr n rEIr'1tr'F J\trr,\ nar \rl:.'. N r.'tt1'..'hh L rl'i.I'r.,|rcI
<br />4*,n, 'n*
<br />, r^. -"o un\ rnrrli, r{r.trrl{rrcrh. rhc.lr^cnrl.irndorrscotrccr Il8rLrrnmmprt* hrllt'ryrtrd(lru.(y
<br />orJ un.o\rin Srrro Ir{\rchri'rg !) hr
<br />in\. trrnri,nrcd fr)Nnr_ n, i'n|..ri,n,
<br />ne\cnhriv$ olrhk ciry aid c.unry ro cdn uFrrtr
<br />AoDliLrnl or lls€nl SiEnrh'rc
<br />P.miren m€(pnnr):
<br />ndr8.on\rtu.rn . n h.r
<br />q'
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing {/n ,/tr s w lrgtdt
<br />lnsulation/Energy
<br />Drywall
<br />N/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil.
<br />FINAL 6-1/-/' -//#z (M
<br />Certificate ol Occupancy
<br />Notes, Remarks , Etc
<br />Set Backs
<br />Ext./lnt. Lath
<br />Brown Coat
<br />r.\.\ -r
<br />tt
<br />t-+-
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