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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS ()WNtR IltJll,DER Dl:I,C RATION
<br />Ih.rchyalinmu cr pcnalry olpcrjury lh l I Ncxcn!, ln)n rhc Corlrcro^ Li..tr* Ldw t)r lhc hllowirg rcavr (Scc.70ll.5
<br />Bu\nrs nJ Pr.fc\sn,n Cnlc) Any Ciry or Counry whi.h rcqun.l r rcnnir b on{rucr, alrcr, nnpror, dcnn,lish nr ^F'ir rny
<br />(n,crurc, nrFrb [s issuai.c. rho !.quircs rh..pplar f{, surh jrnnir ti filc r \ig .d iar.,tu.r rhar h.orrhc N li.cnscd Iu^nrnr
<br />r) rh. I,tuv1\nnrr ol rh. Contrrcttr-\ Liccn\cd LiN (Chlprcr 9. Connrcncins iirh Sccrnu 700, ol Dientun .l o{ rhe Busincs rnd
<br />Proli$ionsCodc)orrhdrhcorshciscxcmrrrhcrcko r.d thc h*is r(r rhc dlcg.d .rcnfrion. Anyrn'hrnJ.ofSc.ri.n 70.115 byany
<br />rnrlicrnr lorr pcrnril subjcch lhc 0pplicn b0civilt nrlryoftur nnrcrhm ivc huidrcd dollds(s500)
<br />I.rsoPrcrorrh.p'oFnr.ornrycnfl.yrcssirhwEcsrsihcirv,lc.o,p.isdion.*illdorh.sorkUxlrh.{ turn
<br />i' cndcn oroltEd lor slc (S(.70,n.Itu(i.cs a.d P,orc$ioN codcr lhc Contu rol\ Liccnsc t,a* do.s nor lPplylo rn.wmr oi
<br />rhc nmJ.ny wln) hrilds or irNror.s rhctosn. Nd wlb duc\ {kh mlk hnn\clror hcnclf'tr rhhu8h ht or hcr owtr cndoyc.!-
<br />tn,vidcdrhd\uch inlpn*ti.nh,ftfrn inhnddi orofl.rcd fttr silc lr- ho*c!cr. rlrc hildi',! o. impmvEmm is$kl wirhi'roic y.r
<br />oi.onDbrion. rhc (Nmr Builds *i11hnrc lhc hunlcn of8)vnA rhd h. oi shc dii mr brild or iqtrorc thc tmFny lirr ltt N{ne oi
<br />l.rsowncroirhcpmpcny.rmcxclusilclyco.rrrdin3$irhlicctr{d.otrrfl.rorr.con\rrudrhcEolccr(Sc.7(rl.l.llunE$
<br />r tn'lL\safl()d.: ThcC.nkkktr s Lrcctr\. Lrsdoc\ ior rptly(, nioq crofrn,It y whr) huilJr ur inln'vcs rhcrcon.
<br />rnd sho conrrcrsrnsuch p(iccr\*irhrG,nrr!c'o(\) li.rtrrd nur$nd 'ortuContrick"\ l-i.cn\e ljw)
<br />I urcx.upr dndcrSedinr-. a & r.C. ntrr[i\ rcrnnr
<br />Osner
<br />roaxrBs:1:oufl:Nt rloNulicttralaN
<br />I hc,.hy affn,n unt.. pcn,lry.tnc,juryoDc otrhc to .!i,r3 datrrrrnnN
<br />I hrvc [xlsill mainiain rCcnificstcofConrcnr lo Scli lnsurclor $orlcr'.otrrpctr\3rion. as prcvidcd i,, hy SNr ion .]7 )ofihr
<br />I xhr a',.1c.li{ r\c ncrr.rmJnlc 4lr\c r.r[ Lr tr1(h rhc ]rri.r F '{.urJ
<br />\bn*..,u .,, *.*'-..rrc^ Nmnrn\artr,n ,n\LrJncc. rs requncd he scdbn rTrr) o,he rnbor cod.. '(r,h.
<br />pc orfrMcc o,
<br />l{h. {u'\ Lr (htrhrl ! IIc'trn '. -.ucd Vys,{l-r.rmn"nuron.}u'r+".ran ahlF,rrr rumh. u.
<br />CO
<br />il Co D
<br />-l
<br />ccnily rl r ir rhc Frf.nrun.cofrhc lork li,r shic[rhi\ prrn n is.ucd.l \hrll0or cn],l,,y tr,ry tEnon inrnynrlnncr
<br />$a\bhc{onf,\dhj..rr{,rhc*.rkc.rnn|xnldn,nhs\o,Crlilonir.rndrarcctharifIshouldlf,cd,tsrhrcrrhrhc
<br />workc'i dnn initDpnvhioisofS..rion:l7m.irhc l:tinc()dc.l shrll- lanhrirhcon,tly siihrho{l( vi\i,nr{
<br />WARNING F,iluc ro enrc sorkcN conr!.n\arion.ovcnsc n uihwrul. Md sh.ll nrhF.r M cnrlo)rr ro finri,ml pcnilti.\ rnd
<br />civrl lincs ut kr.m hundrcd rhouqnd dollnrr (Sl(x).fiX)r. in ddirn n) rh..o{ .l co rprn\.ridr. d.rm8c\.s trovidcd L! thc
<br />Scrr![ ]r)76 olrlr l-iltn (irl!.. nrn.q idd rro',f,!'\
<br />5/ zz/r a
<br />l)E!t tBArtoit
<br />I hcrcby,lfirnundcr pcnrlryol p.rjury rh3r I !m liccnK, undcr pmvtb. ol Chxlts 9(connrcncing wilh Sccri,n 7ql)) orDitisn,n l
<br />or l[c Ausincs rtrd Prcfcssior Codc. nxl nry licctr* is iD rull lar.cMdcl]tcr.
<br />f,o)33 /
<br />CO!SIBIJqIIQNII!DITg-&G!!!I
<br />Ihcrubyrlfi.nuidcrpenalryoflf,luryrh rhcrc hrcon{turrion L insigcncyfdrrhcpdfoi,ruD.cofrhcqorklorwhichlhisF.initi(
<br />i\\!.d (s.. 3(D7. civ c )
<br />lrnJc , NJr:'c'-
<br />-l
<br />ccnni r hd rh. rcdcirl rcluldions rcSrrding Nrn.\ l. sral rrc tror fflic$lc tr rhn pmlccr
<br />-l.cniiyrhrrlh$crc
<br />rhi\ipplic(n,n nrrcrhdrltfi)vci nrmirion ncorcr IrsreloconlnlrsirhrllCir! iJCounrt
<br />orlirnn.c\ ind Srnrc [r*srcldir8 robuildins con{n'cr]on. IhcrcbyrdMrncrrrcs.nhrivc\ofrhtCir,udC.unrtk,cnrcruF,nrh.
<br />rivc nrrrdrd pn)lrdt rd iNp.(nnr
<br />/\tpli.tr l or,\tunlSi,t rh'.t
<br />l'snrils nrnr r prinl ):u-$urtl,-s/zrlY
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Rool Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handic ap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL z t/tHt,(Abrfr /{t>'
<br />Certilicate ol Occu pancy "' 't
<br />Notes Remarks, Etc
<br />a-
<br />APILIIANfDI:CII&IIIA!
<br />I lrrt y lllim undcr pcnalry orpcrjuryonc orrhc n,lhtrios dcchrarions:
<br />l]tmnirior Pcflnir$AsliesosNoti,ication Fcdcftl Rc3uldi.n\(Tirlc40. P,n6)
<br />-Rcquncd
<br />Lcrlcr oi Nolifi .trlbn
<br />Flood Zone Certif .
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