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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE tD/stG.COMMENTS OWNER BUILDER t'ELC R TION
<br />t h.rby dfilrm undcr l* llry nl !,crjury that I an crc"ur tro rtr G,ltxcbN I-iccn{ b* for rhc folnrBi.S rcr$n (Scc.7o3l.5
<br />susincs snd Profc$i(,n Gnjc): Any Cir, or Cou.ry shhh r.quim n Fnnit ro s.(ruci, alrcr, improve, dcmlish or tFt any
<br />nocrua. pri nr iis ir\orn r, dl$ rcqnt.srhc lprli.rnr lor such tEmil ro lilca sigmd srarcmnr rtd hcorshc i\ li..n*d punu.ni
<br />Io rnc rrcrhn,ns of rhc Conr.!.roar l-iccn\ed tjs (ChlPr* 9, Conn n.ing wnh Scclion 7uD ol Divnin 3 ol lhc Burint( nnd
<br />holcsion\ Cod.) or r hnr lh.rsh.l.rcnDr lheBton lhchrsislorrhcrlhscdcrcmprn,n AnyviolurionofSdiln?0ll.5byrny
<br />amlicsnr ior.Frmn subj(h rhc aptlicanl to acivilpcntrllyol nor nxncrhin nv. hundr.ddollars($5uJ)
<br />_1. o*f,crorih.,flrpcdy,f rycnploy.csw,thwrlcsrsrhctvncconDcnsarion,willdolheorkr rhc{mhi.oL
<br />ir.dcd orotltrcd iir lrlc (SL\.7014, Busincsr ond tlorcsion\ C.do'lhc Conkrb \ Li.cisc llw do.\ tror.oply ro unoqncr ol
<br />thc pblfn! wtxr brilds or i'rqn)v.s rhcd)n.:tril qh. d(s skh wnrk hnnsclfor hers!l'.r rhnugh his or hcr o*n c,nlloy..s.
<br />Forid.d rhnr {r[ i'npnnornrs trr nor inrcft|d orofir'.\ltur uL ll] k,scvcr. rhc burldrS or iDprovc.E n s *irhin onc ]rr
<br />of conlrhrion. lhc OqRr Bnildcr *ill h!rc rhc hurdc! ol nnivins lhli hc or shc did fr, huild M i'rtro\t rhc fmFny lot rhe lurFE ol
<br />._1.!sowncrolrhcpmp.ny.lnrcxclusivclycomnicriig$irhlic.n\cdconta.iJFro..nsd.rrh.pojcd(S(?Ol-4-Businc\s
<br />rnl hofr\sbn Cod.: Th. Conkr.ror's Liccnsc Lsq de. nol q'rlylo mowncr olnropcny wh(, builds.r nnprovcs lhcrcon.
<br />and *ho conlr!.h lo! such rn'Jccri *irh a G,nrmcron, li.os.d tur\urtrr io th. conlrocrols Licctrs ljw)
<br />-l
<br />rmercmpr undcr Sccr
<br />rlo-BxEBlitrl)utrNttrrrlN
<br />l]}:!.:I,rLBAIlON
<br />I hcrchy.ilt uIlcrt.rrlry.l I).r]u!yon..f rhc ftnLrvi',g ccLrrri('n\
<br />-lhavcandwillnuinriinoCcniftarcotConscnrtuScltlnsur.ntrworkcN
<br />conl,.nslion. $ lmvidcd lor bySNtioo 3?00 oflhc
<br />tiborCodc. forlhc0.rfoirrErccollhcwolk lorwhicfi lhcl)(n.i i\ n\!cd
<br />rfi hav. ahd w l n,i.rain qo,kc^ .onrr.ngrion insum .c. os nqutcd by Saliotr 37(]O ol lh. blnr Corlc, ror rh. psror.Ua or
<br />rhc worl aorwhi.hrhh p.rnir ir iss.d. My wortc( .onD.ns.tion i.surame carier ard F,lic, nrftbtr rc:
<br />Lc)
<br />l'lJlo';'+'lzt? bq o\
<br />">-'l-ta
<br />l.cnlfyrhrr nr r[c lrrlnnnrNc or rhc work lor *hich rhi\ t^-.nil i\ ]\\ucd- I \hrll nor c.lIuy rry lcnotr ir uny mrtrner
<br />$ !\ro tt.om suhj.crh rhc w{ cri.o.,Fnsdn,n h$ \ ol cdilni,ria. ,trJ r!ruc rhr irI should hcconr $bjcd brhc
<br />sorkcn compcnvri(,n pm!i\n,i\ DfS.dnm]T0Oofthc Lf,htr Cdl..l\hrll.li)nhsilh oDrly wilh lhs povnions
<br />IVARN|NC li,ilurc ro \c.u'. *{rkc6'comp.nsrri,rn drcmlc i\ u lrslul. a d shrll subl..r 0. cnDk)rcr lo dDintrlpcruhi.\ and
<br />.iil fincs up k,,,rc htrMrcd rhou\ai{l dolh^ {Sl(n.(xx)r. in rddirtrrr rhc .oq oi conDcn\rrion. drnu8cs !r l)n,vi{lcd f,n rh.
<br />SErion :10'76 ol rh€ btnr Gnjc. intcrc.r a.d in(fuy r
<br />o,r", €-24-l? too*oor.
<br />DEIIdMIION
<br />I hcrby,nn undcr pcndry olFrjury lh.r I am liccn*'d utrdc. pruvnnrn olChrprcr I (conmn.hg wih s(ti,n 7000) oIDi!hi()n l
<br />ol rh. Bu\ircs rnd Prof.ssionsC(!lc. drd my lic.trsc is intull ntrcc trfrlcftccr.
<br />1 , L75-
<br />u ., o '?1 '?2 ,C
<br />I hcmbt arrm und$ FMlryofpcriuryth.t llEc is aconnrucliotr lcndin8 oscnct lor rhc !.rfonuftc orrhc sork for rhichrhh Frmn h
<br />hsucdlsa :1097. Civ C)
<br />AITU(ANLI,IECIAAAIION
<br />I hcrctry {tltm utrtl.r Fulr, otrf,rjtrry oic or rh. rdk,*nr! dcrlarriors:
<br />Dcmolilion Pcflni'sAsbcios Nolificlrion Fcdcml Rcsuhlbnr(tnb40. l'rn6)
<br />-Rcqntcd
<br />l!rcr.l' Nolilicari,n
<br />I ccnifyrhrr rlEladcnJrclututi.Ds rcg&liDershti.\ rcnntrnlrc D.r ltnfliIahlc k) rhn pR)J.a1
<br />+r..n,,),r", r r,.".,-rr h s ltl)flnrritmrrxl !rrc rl,.r nt 1nnrntui, iscotrd.Ia8ra t' comrly sirh rllCirynnd Coonrt
<br />hcrcbynurhorizc rcprcsnr iv$ ollhn Ciryand Coonry b.nrcr upon rh.hri'rg k, huildnr8 con{rudn r
<br />$.tc mniioncd ro!.ny hr nrpccr
<br />,\t)t'liu l or '\xul Sirnilr'(
<br />Pemiree mm€ (Dn,r): )r'?'A ..p - Ni l.,"o.a's 1,.
<br />Set Backs
<br />Erection Pads
<br />Subf loor/Vent/l nsulation
<br />Roof Sheathino
<br />Shear Wall t.
<br />Framino 6/r/t /.,K/L
<br />lnsulation/Energy
<br />Drywall /,'/ zt lt{-"1&44)
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />I
<br />FINAL 7/zz/tl ,r*t ,/
<br />Certiticate of Occupancy Tl'
<br />Notes, Bemarks, Etc
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Flood Zone Certif .
<br />u,," >- - Z'l' 13
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