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BUILDING- INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNER DT'ILDIlR DEI,CARATIoN
<br />I hcrciy lllirn und.r ,Enrlry of pcrjury rhrr l.'ncrcn,pr frorn ihr Cirnrr.nn{ l-i..n{c lr! liJ. rhc lollowin! rcaa.lscc 70lll5
<br />Bu\i',.\s r Pnnl\siur C(xlcr Any Cirl .r Counry wlrich rcqtr,re( . ltnnit b mrrslrucr- .lrcr- nnproE d.mli\h or Ep]n rny
<br />(ru.tuc. lrior b ils is$rtrcc. rho rcquncs rhc inllicur ior such ncnnir l{, nbr \igncd idcf.r rhd hc.' shc ii h..n\cd ttur{rrtr
<br />k, rh. pn,lisnrn\ oftlr Contactr-\ l-iQn\.d ln\r (Chrtr.r 9. Corn n.nrS sirh Sccti(nr ?00O of l)iviri{'n.l .l rhc tvu\incs rnd
<br />npDli.rnrforr DUmlr sulrcclslhc rttnlicntrllo 0civill[nnllyoltror unc lhri ivc h!ndrcddollnrsl$5(Xr)
<br />-1.n\o$ncrolihcpmltny.{,nrvctrfkJy..sIiihqrlcsrsrhcnv,h.oltrrdion.Nilldorhcsorkandrltntuhrci\fti ctrdcrl oroffcrcdforslc(Se.r0,1-1.IlmincsitrdProlisi.nr(lnl.:rhcC{nnrr.ttrsl-i.ci*h*docstroriPf'lyro ro+t' o,
<br />rhc pn,Fdy *hD huild\or i'nflovc\rlrrcnr. lnd wl[ doc!{'.hxnk hi'nrlfor lu{ll or Ihn,ush h is or hcr .wn cmtloyccs.
<br />prur cl rhrr $ch in,pn)yrnrnr ,r. n.r i,n.frldl .' .lttNl tur qb ll. lrnvc\ c.. rha huikli',8 or impnxrmnr i\ {ild $ irhnr o t }ti,
<br />olcoDnldifl rlE OwEr luiHcr $illh$r rhc hdrdcnoln'o\ing rhd hr or sh. kl mrhuiLloi ifl{ro\ c rlrc F)pcny turhcpuqn{ol
<br />_l, so{rc.otrhcltropcny,rhcrclusir.ly.ukr.rinEwirhli..\.dconrrt{ oconslrucllhcpretccrlS(7().l-J.Bu\i'rc$
<br />d Pf,,lasr C dc ThcCotrlrlctM s Liccnsc L.wdoc{ ool0pplyio rDo*tr.rofpn,I. twhohuit(o.iinPt \3srhcrcon.
<br />rtr(l $ho .ontrrr lnr {ic[ t8,FC r\ trirl, r ('!r ,r.ro,1\rl'.. srtl t)r{r n krrhc(idri.roi\ I i..n\c lr\ )
<br />I nn cx.frrr und.i Sccrio
<br />,",.5{r/r6 '<in"AX4:el)!tL!N!.!r\
<br />I hrrrh!rllirnrfd$N xlryol l)c'iLtrJ otrcol rhrl('lnNr!(1c.1rnri'r\
<br />l;ttlltr ( {nlc. br rhc p.nnour. ol thc sork f(tr Nhich rhc ncdir is n{i.d
<br />I hrv.and \rillnr.in(rin sorkcra comNns.rion innrrrcc. r( rsluirci h] S(rion.l7(X)ofrhc l-ahorG)dc. L!rhc Pcrlbnnrmc of
<br />rhc sork nr*Ii.hthh pciinil is issu.d Myqorkctr (otrIrnqln,n iNunnccqtricr md lidli.y nonrb.r dc
<br />lccniryrhrr in rhc iFrfonmn.. or rhc !.rk tu whi(h rhn p.rnrit is nn'cn.l \hsllnor dtrtpk,yrny Pcron ir lnynunDcr
<br />so as h) bcconrc nrhrcd to lhc workcn clmpcnsarion l,s\ ofcrlir(tr ir, ritl "8r.c rhd ifl should tccom sll,JNr h, rtE
<br />norkcr\ coDlFcns.riun F)visbns ol'Sccrion ]7lx)olrhc l-fin Gxic.l \hrll. Lnhqirh..ndy wirh ihor t'ovi\n'ns
<br />WARNINGT Failui. tu snrc work s .oo{'.trstion .otrm8c t utrh+ful. d \hall \thicr ri .nrtl.)u ro arn rl Fnrlrt\ rn
<br />.i!il nn.\ ut boft hundrcd rhousand dolhn lsloo.(xjor. in addirnnr lo rhc cosr ofconp.trs,rnnr. dx'mecs.s pror cd forlhc
<br />Sr.rirnr 1016 !n rtu lnNi ( 'trlr Ur-a-gA!*.-tD,,",>l l[91 \C o.
<br />I hcrchy ulitnr undcr pctrrlry ot r.rjurt rhrr I a'.lienvd u|drr ftnr'ision .1 ChiDrcr 9 (connmrcing $irh Sc.rion TuDr ol Diri\nr:1
<br />or rhc Busircs,trd Pofc(\iorN(i)dc. lnd my li.cnsc n in tullri)a!rndctrccr
<br />IIJNEIIUEU!}NIENDTNIj-AGTIIqI
<br />I h.r.by {fir urdfi0.inlry.rI*juyrhairh.rci!..on(ruclion,cndinsascnc,iorrh.pclrormmc.rlhcwortintuhichlhisIErnriln
<br />h\ucd (s{ lrl97.ci! c.)
<br />APPI.!(]AN'' DECLARAT(TN
<br />I tErchy lnim uids Fnalr, ofl.rjuiy onc orrhc n,lhRins dc.lirnri,,.sl
<br />ocrmliiion Pcrmits Asbcslos Nolificali{'n FedcralRq!hli{rnl (I'irl.41). Pan6)
<br />Rcqutcd L.ilcr of Mlifi calion
<br />Afr,;1,
<br />:irlli::fi);f
<br />hclcdcrxlrcgularion\ ruedditr! arhr{osrcnnrrlrrc n r nlplic$lc io ll
<br />vc r. rhi\lptlicJri,r,{' darcrlxi rh.rhr. i'rf,tr.uridr i\ codccr I
<br />ljqs rchrin8 ro nuiLlinB con{rcrion. ! hcrebt ro'htri7. rctrcscnr,l
<br />nly wirh all cir, rnd c.unry
<br />'ny and Coxdy n,.rcr qx,nrl*
<br />e-"I1(p'..
<br />\c*.F<!>[ <]&l<<t
<br />s(t le
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />Subf loor/VenV ln s u lation
<br />Rool Sheathinq
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lr/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certif .
<br />A
<br />FINAL ///r/l az-w6 )
<br />Certif icate ot Occupancy 7 7- 7(t7
<br />Notes, Remarks, Etc.
<br />SITE.WORK
<br />UFER Ground
<br />SLAB Floor
<br />Shear Wall
<br />l-ic.nrc Ch* _Licens. Nnnt r
<br />Drh Co roclor:
<br />Lrnds s AddE$:
<br />-
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