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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE COMMENTS OWNER BT'IT-DI]N DELCARATION
<br />I hcrciy rfiinn undcr pcnllry ol rErju.y rhar Imcxcrtrio rhc ContacloF Liccne liw lnr rh. r(rlowing rc.sn (Scc70:ll5
<br />Bu\in.s nnil Prorc\\n,n Cnlc): Ant Cily or CDUnly which rcquircs n pcnnir tr cuiNfl.r. ,lrcr. inprovc. denmlhh or Eluir ary
<br />(tucrxrc, pritr ro s i\surn.c,0lr rcqun slhc lpplicrnl nx such pcrmii b nlc r sigrud qnhnur lhrl hcor shc n liccisd pr^na r
<br />ro lhr prcri\iotrs ol rb. Conrlctn\ l-iccnscd hw (Chryrn 9. ConmD.cing wirh Sedn,n 70OO .f Division I Df rhc Eusinc$ and
<br />Itotsri.d\Codc)orrh,r hcorshc h cxcnrl rhcrcfiom Md rhc l'r\n n, rhcrlL!.d.xctrrtrion AnyvidalionofS.clion70.ll5byant
<br />llpli.ad lora pcnnn subjNlslhc llpliclni ro rcivilpcnakydrtur nhtuihrtr nve hundtd dollar (S5m).
<br />l. as own rorrhc pn,Fdy..r mylnrpn,yes wilh tr (sc\ u\ tttrn v'k comt n\di.tr. willdo ltE qtrk r{ rnc dturm n ftn
<br />ifcndL{ orol]lrcd tu n'lc (S( ?Ol.t. Bdsi',cs.n tl ofcsi(nN C.dc t hc CoMa.tnr'\ Liccn{ Lrw docs not lpplr ro u owitr ol
<br />rh. tmlcdy wlx) hoikh or in{'m6 ti.Nn. md $hl dms \kh k)* hnnsclfor hcr*llor rhmulh his or hd osn cnDloyccs.
<br />plovidcd rhtrr such inlrl,Rtun! n fr, inrcndd or oftcd tur et. li k,*ocl ihc bxiuins or irfrovcm n wE sirhin om itr
<br />or.onlpr:ridr, rtE ovtrd Burllcr willhrvc lhc burdcn o, p ovins rllr hc .r sh. did trol buik or inPloE rhc !n]F.ny ror rtB purl)o$ o,,r4r'
<br />-l.
<br />rsowncrolrhc prolltny, an.xclusivclyc.Dtrr.ri,r! sirh li.cn{d conrrickns ro conntud rh. pnlccr {scc.7(}1,1. Du\incs
<br />rtrd PmtL\qi Codc:rhcConrr.crolsLiccnscLaudo.snorlpplyhdnotmtofp()Pcnywho6nildsorinptuvcsrhcrc.n.
<br />rnd uho onrGch ior slch !oF.G wirh r contrturtr r licen\L{ tur$anr t, lh. Conrrcr.i\ Liccnt tje )
<br />-lomcxemfl
<br />under S&rion-, B &PC lhrthhrca$n
<br />Dir. ()*mrl
<br />Ilt IlxI. Rs, ( t)l\lPFNsa ft()N
<br />Dlrct &l:uaN
<br />I huruby nfliro utrrlcr pcnrlly ol pdjry otrc of rlt lnlk,sir8 dLthfurnnr:
<br />I havcnnd sillnrinhin !CcnilicrrcofCon*nr (, scl( lr\uE or solkq i .omtEn\ar i{,n, * pn,vidL\t i, byS(rion:17(x)ofrhc
<br />Irft, Ct)dc.,n hc Frfoirn0nc. ol lhc snlk f{n *hich rhc Icrmir i\ istr.d.
<br />_lhrurndwill'roinrrinworkcrs.onD.nsariotrir\urrn.c.$rcquircdt'yS..rn)nl?(X)ofrhctnhorC.{lc.lorrhtpdfoimkcof
<br />rlrc work t,tr*hich rhi\ p.nnir i\ is{unl. Mywnr[cN'c.n{'cn{a,ioo in\urrncc. triot rr] Ixnicy truflrhcr re
<br />l'oii.y Numhcr:
<br />-Lxf
<br />trcs
<br />I .cniiy rh itr rhc Fr,birMncc {)r ih. No a.r shi.h rhis ltnnir is nsucn- I shall oor cnPlo, any t run in rtry numt
<br />n, s h bcmnE suhJcd ro rid workcis .onDc.qriotr lrw\ ofcrlir'oroir ond a8nc rhd irI *hould bccom subjcd n, rhc
<br />sork.risnnpcn{orionpn,vtn,i\ofscdn:17(Dolrhclltxrcodc.Ishnll.l]]dhsirh.a,mflyuirhrhotprJvtioN
<br />WARNING Friture t) Ru.c workcn'cnn{En\lrtrn covengc i\ onhstul. ind shall subjcd !fl cmpL,)tr ro dnrintrl Fn(lra\.nd
<br />cilil ri.c\ ut k,.m huMrcd ihousrnd doll0rs ($l0l).({)O). in lddiri(,n b rhc.osl.r conrr.ns ntn- dmugcs ds [ovid.d lhr thc
<br />S(ri(,:1076 olrhd ljhor Codc. inrcrc{ i.d rorrcy s fes
<br />u^,", sltt//t-
<br />I hcrchy tririrm u.dcr ncnalryofpcrjury rhd I am liansd x trPmvisionotChllrcr9(connrr.ineqilhScclionTOll(DorDivisn,nl
<br />of rh. Bu\ii.\srtrd PmlcsiorN Codc. d nrr liccn\c i\ h full tur.. ud clIcd.
<br />3 tt?
<br />a"",.".,,,.X
<br />IANIIf,IJCIION'INIUNC.AIiEIII
<br />I hcrby nfllflnxndcr pcnallyofn.riury rhtrr rhm n r.ondfl.rrn [ndirA iScncy lj]r rhc PcrtunrNcc.frlrc wotk lhr which rhis pcrmir is
<br />iss!.d (S.c .1U)7, Civ. C.)
<br />ATTLIIITNLIIEIIABAIIO!
<br />I hcdy amm und.r peinlr, olpcrtrry otrc ollhc rolk)+inE dcclminni\:
<br />Drnrolnnnr Pcnnirs Asb.{o\ Norili.ar.n F.dcrrl Rc8uhrion\ (lillc 40. Prd6)
<br />_Rcqui'cd Iirrcrof Norilt rbn
<br />l.difyrh rhc lcdcril rceuldions rgudin8 r\bc(o\ rflmvalarc nor llplltrabr] lo rhis ln+cr
<br />ordiMtrccs lnd Sur€ Las\ Elaring t, huildine .annrucriotr ud hcrch rrInr\c r]h!.\ ofrlris ( iry rnd Coufrr" t) cnrcr ljri rlt
<br />rh.t nrnrioncd F)lcdy rd inspcdnrn
<br />,\pplirnn( or.\Bual SiAnrl rt
<br />O at1 kr
<br />s/tt/t*
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf looriVenVl nsulation
<br />Roof Sheathinq q Lt rB <-,14A{d Jo*ra F,xt (t*r. h le *plt
<br />Shear Wall ^ Gar< *h. (.. $^.
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />N4asonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil
<br />FINAL J/.>8 <v
<br />Certif icate of Occupancy
<br />Notes, Remarks, Etc
<br />ID/SIG.
<br />/Y
<br />Fo rm s/Stee l/ H o ldown s
<br />Pool Fence
<br />/-/Z
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