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BUILDING. INSPECTOR RECORD
<br />SITE.WORK ID/SIG.COMMENTS OWNERBUII-DER DDI,CARA IoN
<br />I hcrchy rffifln undcr pcndry of Flury rhrr I D cxehpr riom rhc Ct)ntr.ktrs Li.c.\c Las lor rhc lolloNin8 rcrvr (Sec 70ll5
<br />Iturirlcs rnd Pbrcsif Codc) Any Cily or cou0ry whi.h rcqun.( r Fnnir b con(nrct. .lls. inrDrorc- dctrx,li\h or rul{t !r,
<br />dto.iurc. prbr ro ils i$uancc. iho requtcs Ihc orDlicn n)r u.h pcnniri, nb tr \iamd dd.nrnr rh3r hcor rhc ( lrctr{d rr^u.ir
<br />h lhc lnlnions ol rh. Contriclor's Liccnscd trw (Chlprft 9. ComncmirA $irh Sccrion 7(X)0 .f Oivision .1 of rh. Bt\i',cs rnd
<br />Pn)fcs\ion\Codc)orrhd hcorshe is.xcnlprrhc.clromand rhc I'r\t Iff rh.nl]cg.dcrc'nprion n, vn,hrionolSccri.n 70lll.5 hyrny
<br />rttplrrtrr fd , pcmrir \uhr..rs rh. rypli.rnr r...i!,lpciahyofn.r mnd rhan livc hu rcd dollaB (5500).
<br />-1.
<br />!s owncr ofrhc trcFny. or flyenrtlolei wnh waScs,s rh.i vnc.unl,trtr\dtiotr. Lvilldo thc *orkand rhc ntuorc i\ n
<br />icndcd.rontred(.rqlclS(7041.Busims\andPmfc$ionsCoaqTheCofircror'rt.imn{li,d.crnornmlyrtanosnctor
<br />rhc pmpcny ub hdilds or iqnorcs rhc6r ard who de\ such *\nk hinNcllor h.rscllor rhDugh his or her own emrloyccs.
<br />pnrvidcd rhlt su.h inDm\ cmnrs m mr i cftLd n ofi.nn for sh I I h.w!vcr. rhc huiuir8 or impnwnEnr t $H sirhin nr Fr
<br />of compLrhn. rhc Owicr Blilddr vill hrlc ilr hlnjcn ol pmlin8 rill hc nr dr dil nn hnild or ir!r.\r ll1. pmrf,ny lor ltE purJ{c ol
<br />-l.
<br />rs.srcrofrhc nn,F-nt.3nrqclu\ivclyconlrirlir8rvilh liccnscrl .onr.rl,,6 t, con{tucr rhc Fmj r(s..70tl,l. Bu(i'(\\
<br />udfh,fcssi,iC.dc:lhcC.tr.nr\l-i..n\ct-x*doc\trorxt,rl!r,rirqncr,'fpi.trywhohuildsorimlrovcslhcrcon-
<br />rnd sho conrruch tor such rrqccr s wirh r Conrrdon 9 licctr{ nlrn'uN krrhcCorrrdois l-iccis Uw)
<br />-l
<br />an.x.mnl uRlci S(rion- B &PC.tbrrhkrc.$r
<br />Dot.: O*nerl
<br />]YOS6EBE.(:OUS,NIAII)N
<br />DECLIAd.II0!
<br />I hctuhy rfln u d.r NMlry of pcrjury oN ol rh. rolhw i'r! tl('hrnri,nr\
<br />I harra willmainrrin rCcnifi.aicofconscii h Sclf lnstrrc tr $ort.r{' .onptisnrDn. x\ piuvidcd foi hySccli.n3T(x)otlhc
<br />L&r Codc. forihe pcrformdnccofrh. sork for {hi.hrhc p.rn isn\ucJ
<br />I h0vcrnd qill rlnrnir sorkcrs contcn\rri, $tr .r. r\ rrqutcd hvSc.rnD lr(rool rhc Lilrt Coic.lor rl[ I[rron mcol
<br />'l'.tr,rlL"qh'(\rr.qrnnrrsr.nlcd\lvtr'rl\..!,rlI\.r.r'.'rhc,n., . Vl:.&.pr.,st ftlt^ .l^s.
<br />Orvv.ar Co t Al o+e.\.\\a.
<br />-l
<br />rcnilyrhxr i', rhcl].rlhrmmcolrhc *Irk lor whnh r[t lErmir is i\{icd.l \hsll nor .trlrk,y dny l,.^on ina y rn.trrcr
<br />i, rs(.lE onr sublc.l ro rh. sorkcr compcns otrlrwsofcnlifdnir.n. Urcc rhir ifl should t'cconrc suhFlornc
<br />s orkcn' oryctrsdion rorisions of Sar ion l7m .l rhc l-ohr (t)dc. I \ru!1. tunh* irh .omrly w irh rhoc prcvirn,n\
<br />\ryARNIN(;r Frilurc r. s.urc $ork is .o rp.Ndion.,^or8c is xrhwtul. ,nd shrll sub]-fl in cnllrloycr t] mn,inal Fiahics md
<br />U6f IIt l't${S;r"r'r;lir
<br />Ihcrcby!lltmuidcr pcn,lryotpcrjur,rhar I ur li.cnrdudcr nmvnion o t Chq,rd 9 (.onimn.ins wirh scdiotr Ttx l ofDivhion.l
<br />of lhc Businc$ rnd Pror'c$ioiN Codc. md mylicctr* i\ ir Inll hrccrtrdcllt.r.
<br />\oo1qqoa,
<br />(u,,rn(,,,r Y.W^'
<br />CANIAIJEIIONII]NDI!! (J,XCI
<br />Ihcruhyltnrnrlnder ncnrlryofFrluryrhar rhcrc i\!consrru.rioi k insaEcnc!rorrh.tlcrrormk.orrhcqorklorNhkhlhi\ricflnilh
<br />i\\ued (Scc 309?. civ C.r
<br />lrndcas Adrt.c\{r
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<br />APPITCANfDI.CIAAA:UO!
<br />lLnh) dftmundcr pcnally of pcrjUry onc oirnc nnhwir[ ncchrrri{,ns:
<br />Dcmolirior I,cirnir$AsiEnos Notil'l.rtion I'cdcr.lRce hriox ( lirlc 10. Pnn6l
<br />Rcqntcd l-cn.r.f Ndilt ioD
<br />-l
<br />ccnilylhd rhc fedcrol res,larions rcsa.dils Bshcslos rcnDvrl rrc nolxPlliclblc h rhir toic.r
<br />zf.cd iry rhd I har rcd rhk ,ppli.0t ur d s.r lx rhc fi,v. ifnrntuion iscoircd Ir8lerocomi'lyurrhullciry,nd(i'unrt
<br />,'rdnhkc\ rid Srrrc Lr$r rcldrin! b buiUnrE.otr{nrrtr. rid hcrcl{rurhorDc { r. tr.(t,lrl'*L ir\ rntlt[nr\ rL'r rlrDntrtrrl'c
<br />0tAY I? ',1'xhf\. trkrr , ir,l p',,Brrr_ inr n|{.r
<br />/1t,Dli(r 0r,\I.nlSitnalure fu?€
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Ve nVlnsu lat ion
<br />Roof Sheathing
<br />Framinq MEIT 6/zo/rF -,04.d.1 l/
<br />lnsulalion/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lVasonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL X>-{/7*ttr 9D ea
<br />Certilicat'e of Occu pancy
<br />Notes Remarks Etc.
<br />DATE
<br />Erection Pads
<br />Shear Wall
<br />Pool Fence
<br />Flood Zone Certif .
<br />ol c.n{.nsnrion. danEgcs r\ tmviJ.d fu rhc
<br />*"19 14
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