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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE IDiSIG.OWNtrR BUII,DF:R DEI,CARATX)Ii
<br />I hcr.by atinn und$ ll...lrt or pcrjury (lr,! I un cxcnrr rmm
<br />'hc
<br />C.itn kri l-ic.tr{ Lr* htr rhc foln'*ir8 rq{r (Src ?trll.5
<br />Busnr$ md Prolcssiotr Codc) Ant Cil, or Coudy Nhich rcquncs a Fnril lo otr{ru.1. rlrcr. imDnrvc. dcmolirh or rB,n any
<br />srruclu.c. prhrlo ir\ hsuarcc. uls. rcquircs lhc npplicrnr f,tr suchf4rmir ro lll.a signcd nd.,tunr rhnr lror (hc h lien\cd Nnu rr
<br />ro lhc pmvnions orrtE Co.kr.ro.s Liccnscd tiw lChrprcr e. c.nnncmir8 wirh Scdion 7lil0 of Divnion .r or rh. Bu\inc$ rnd
<br />Pmfcssn,nsCodc)orrhrrheo.shct€rsnflrhcrcliomandrhcha\ttffihcall.gcdcrcnl'rion.AnyvnnmiotrofScdi('nl(1:ll5hynny
<br />{pnlicintlor.pcnnit\ubjl\lsrl[.pplicrnrtod.ivilDcnrlry.fnornrerhinfivchnnnrcdnollan(S5(x})
<br />-1.
<br />a1 o{trc.olrhcpn,rd!.{tr'ny.n[k,y.cswirhwares!\rhcir{,lcc.nrJtn\nri(fi.silld.rl*\olkandIh.stflExtrc nol
<br />i'ncfrlcJ or on.rcd tr srlc (S.r 70t4. Bu\ircs d ProLs\i,n,\Cotu lhcC.nrNntr-s t,i.ctr{ I-iwdes not inplyrii o*ncrol
<br />llrcprepcny whohurldsori pmvcs rh.rsn. 0.t who d($ {rh wo* h iNscll or hcr{ll or rhmugh hn or her owtr . mpk,!c.s,
<br />nii,ridcd rhrr \uch in,|,ov.nrnh rc nor inrcmlcd orollcBl ftn qlc ll ho\cv.r.rh.buiklingor ir{,ruhnrnr is sJtl wirhi ,nc)r.r
<br />I.a\owi.rorihcF)t.'ry.dn.r.tusnaly.onh.rir!wirhllccsdd.otrh.nnsnic.r(rudlhctn,icclrscc.7(!4-n!$trc\\
<br />trfr| IDli(otr Codc Ihc(hnrradois Licc.rc lrs d"e( nolrptlylo n.oln.roiroFnysho htrild\or inlrtrofcsrhcrc.n.
<br />rnil {ho contr( r(n such tnojNrs *ir h a Cotrt,cbn s r li..n\d pu.\urnr h rh. A)ntncttr \ Licc { tjv )
<br />D"'",5-/b'/8
<br />t!()LKt,:Rs (r()lIPIaNsAl l(rN
<br />DIIILII]AIA!
<br />I hcrchy rlln Lnrl.r D.nxlr!-oll).'|Urr or olrft ll,lo\in! Ll..lrrxri(fn:
<br />-lhrvcind*rllminrtrinaGnilic(colConsctrrbsclf.lr$urcfrs.rkccconrpcn{riotr.nsprovidcdfutyS(rnn,.l70oofrhetihn C.dc. f.r rhc |c onmrcc olrhc wolk lor whkh rhc p.nnir s is!trol
<br />I hrrcJnd $illmrinr3iir *orkcrr.onrpcnslrn,n in\urrncc. rs rcqnncd hySrc!i{'n.lTlDofrht trlhitr Cod.. ttrlhc Nnormrn.ctl
<br />lhc work ntrqhi.h rhis ncrnril is hud I{ytrorkc'r coflr|{n\r(ion ir{mncccrricr M p.licynu r$.r ar.
<br />I .cdify thrr rn rhc p.rfomrmcofrhc work for *hi.hrhis ff,nnii ( nsucd.I shall nor cniplo,any pcison insny rnncr
<br />$ 6 to bc.onrc suhJccr ro lhc $orten ompcnqlion lass orcalinmia. rnd irrcc lhar ifI (houl.l tftont srhF. o rh.
<br />*orkcN compcnsd b. l]()lkiotrs of Sccr io 3?00 ol r,r tilsr Codc. I shdll. Ionh*irh comply wirh rho{ piovh ions
<br />IVARNINC |rilrc n, {.ur. *orkcr(..n,F agc i\ unhwtuL ind shill rubr..r .n cntlo)rr to c minrl lEtroltts !M
<br />.'ril rinr\ ut k).n. htrn{lrcJ ihourxnd drlls^ (1lr[).u i'r rddirnni t' rhc c,,{ .l compcns rnnr. daftrles is n..\idcd for rhc
<br />-<-/o-/B
<br />ulEilrDloNl]tll]1)a
<br />uli!:laB rqt{
<br />I hcrcby ifirnr undcr pcnahyol Frjury rhal ! om licensn undcr pmvhion olCharlcr 9 (conEncins sirh sc.ri,n 7000) orDivisi.n l
<br />ol rh. Busircs Md Piofcsions Codc. drd ny ltcnsc is in fDIl lnre oJn cittct.
<br />laNsrruEl9lrlNDlliti-&{iliNtl
<br />L.trrlcr'r Addr.!\
<br />Iccdilirhrrrhc r.dcrrlrcsrhrn,i\ r.!rrtli'rg r\tf,(o\rr nrrlrr.turnftli.rhl.torhi\nmlccl
<br />I.cnifyrh.r I hnv. rcd rhhqDlicrriond srrc rh rhr rh,vc infnnrrion is corccl I lgra ro conrpl, *irh ,ll Cny nnd (1,urry
<br />.rdm.tr!c\ xn.l Srarc Lxs\ Eld'ns riu'ld,ns connf,rrFn. rnd hclchy lurhoriTc rcprcscnrdivcs orrhis Cn, a.d Counry t, cnrcr uronih
<br />-Ji,.".,*^* ,
<br />^,;,":;,i-^;,,"";.,.",rw-'-' 4'/.O ^15a4-/3'
<br />"" r* *-.ton ut l4
<br />Set Backs I I ra.
<br />Forms/Steel/Holdowns v\ h) \r"\J- q 1
<br />Erectron Pads
<br />SLAB Floor
<br />Sublloor/Vent/l nsu lation I rrl\ [\
<br />Roof Sheathing H 1V J\1 h4 I
<br />Shear Wall I t\l {
<br />Framino 1,A4 ll,
<br />lnsulation/Ene rgy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />i I I
<br />I n iilAlr\L.q r
<br />Certificate ol Occupancy I
<br />Note s, Remarks, Etc.
<br />COMMENTS
<br />UFER Ground
<br />bl
<br />Handicap Req.
<br />FINAL
<br />a.tfl.lrltfDlig.aaau0!
<br />I lrdryrfiinnu.dcr lcfihy oftcrjury nnc of rhc followin8 dalnnrions:
<br />Dcmoliriotr Pcnnirl^shcros Norin.rrion Fcd.ral R.8ul,ri.trs (Tillc (). Prn6)
<br />-Rcqutun
<br />Grtcr ol Noriliclrn
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