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BUILDING- INSPECTOR RECORD
<br />SITE-WOBK DATE ID/SIG.COMMENTS O1VNOR BUII,DER DET,CARATON
<br />I h.rchy atfirn rndcr Fn,hy .r Frjury Ih,' L .xcnrpr ron rhc cofr.dors' Li.ctrc Low r'or rhc lhllowins rc!$o (s!r 70.11.5
<br />Btr\i.c\! rnd Prorcssn{ Codc): Any Cit, or Counry whkh rcquncs a pcnnil ro c.nsrrucr- allcr- ihpn,v.. dcmnish .r rcprir iny
<br />ntr,crurc. prktr ro iis nsurmc. llso rcquncs rhc.pt'lic0nt lor such,Ermir r{' filcu sisncd dxrcftn( rhd h.or sh. is liccnsd Purulnl
<br />ro rh. F,vi\n F.rrh. Conkr.rors Liccn!.d Lnw lchrfl.r 9. Comnrn in8 wirh Scctl'n ?000 oi Divi\n,n I .frhc Burincss rnd
<br />Profc$io.s Codc) or Ih,r rE or shc is excnrpl lhcrcfron lnd lhe hisn 6r lhc lllcscd cr.nfrn,n Any vnnnin,nofSccrionT03l.5 $y rny
<br />rpnlicaotnnrpcrnitsuhjcchrhcappli.rnrt,acivilI.nrlirornornx,crhrnivchundrcddolr,rs{S500)
<br />I. ,\ oemr of r hc nmpcny. or my cmployccs sirh *!-!.. n rhcir $lc onr|tnsd ion, aili do rhc wotk dkl rh. {duc i{ ml
<br />i' cndoi ororlcrcd lbr salc (Sft 7Or4. Bu\incs,nd Proacs\ion\ Codc Th.C( i,rkn s Licnsc Lnvdoc\nolu,plyt'rno*ncrof
<br />llErnilEny vh. hnildsor i'reons lh.mn. nnd *lm dcs su.h w.rl him\cll or hcnclfor ihouBh hh or h.r own.nployc.s.
<br />pmvidcd rh such inI,olcnEnh m nor inrcRlql or oncBl fi, {lc lli lxNcls. ilr huildin! or i'rqmvc'm is sold within nnc ,crr
<br />olcorylclion- rhcONncr Ruihcr willhlw rhc hurdcno{rmvirs r tf, or shc dir mt huild or i'Ip$rc rhc pmpcnr lor rlt pqb{ ot
<br />-l
<br />amcxemfl undcr sedn,n-,lJ &Pc l'orrhisrcn$n
<br />O{mr:
<br />!ar.[EBs]lo!!f]:!rAlloN
<br />DII(IIIAIION
<br />I hcrcby rr'lnnr undcr pcmlly ol p.rjury one.l rhe lollorvirs dc.lmrions
<br />-lhlvcamlsillnuilloinrCenificarcofConsnrt'scltlnsurcnl$orkc^.onrr.n\!rion,N
<br />pn,vidcd tur by Scdbn l?Ul oilhe
<br />ljtFrCodc. for lhc pcriorroncc ol lhc wo,k lor snth rhc Fnnil h issucd
<br />lhrvca rill mrinrain *ork.rs .onrr.n\rrid insurnn... rs rcquncd hr_S.cri,nr 37(xJollhc LrborCodc. tx rhc t rr.nn nl .r
<br />,r wort,ar whi.h rhisFnnir is is{rrl. IUy worko{ .onrNfstf kr iNuriEe crricrund policynumherr.
<br />Pi)licv Nu rEui-Expnos
<br />Icciryrh0tinrhcFrfonnrEcoirh.*orklitr*hi.hrhn,i.nniisnsuc.Irhrllnorcmploy,nyr.^otrirotrymnnnct
<br />so s lo b.cnnr {$jcd n,lhc wo,kc6 conFn\arim l!*sorclliturnir, nnd,8nc rhar if t sh.uld hccom $nj(l h rhc
<br />wortcr conrpcruion provnions ofSccrbn l?(Xl olrhr lf,txr Codc.I rhrll, n'nhqirh conlPl! wirh thoc Provnionr
<br />WARNING: Fnilurc ro {.urc Rorkcn' conD.ns0iiotr ovcm8c i\ utrlawful. nnd \hol! s!6jsl an cmplortr b cinind p..rhiN dnd
<br />.ivil fitrcs up b otrc hu&lrcd rh.usrnl dollis (Sl(xl.oool. in .ddilion ro lhc con or.onDcn{rion, dntugcs N Providcd lir thc
<br />ssrdr 30T6 of rhc trtu (hdc. inrcrc( md hmy l l
<br />51A/ t{L!4-
<br />I hcrchy altm uMcr lcnrhyolpcrjury lhd I aN li.cn{n pmvisi(n, ol Chafr.r9(.rnnncrcirX uirh S..li,n Tlxx))ol l)iv si,r.l
<br />ol rhc ausncss dnd Pofc$jonsC.Jc. rnd myliccnsc h ir tull hre xl.i[c.r
<br />T/zr h4
<br />I h.rch! rltflnriJ.r Ixn lryoftrrjr! rh r rhdc i\ n.o0N hndire ascn.y l'or rhc pcnnrmncc ofrh. sork for ahlch this lEnnir h
<br />iserd isc. ro,)? (iv (' I
<br />dITUCANI.DTS.AAAIION
<br />I hcrd,y a&nr undcr Fnahyofpcrjlry on. ofrhc tul]oNirg dNlmrn,i\l
<br />t)cnnnlrion Pcnnirs Asbcnos Norili.rrion fcdcnl Rrguhri{'i\ (Tirlc t0. P n6)
<br />-Rcquncd
<br />Lclct.l Norific i{,n
<br />l.cdnirhd rhc l.dcrrlrc8ulnriors rcsdding !\ncnos rcnNvrl rrc nor rlplicrhlc t, rhi' pn!..r
<br />-l.cnilyrhnrl
<br />htrcr.rd rhisrnfliclri,rtoddrrr thlrrltrrb\r i',,oflnrri('r i\ronc.r IrEKbcomnlywilhrllCiryandCounry
<br />or.liMncc\ lnd Srarc ln$s rclariry io huildins con\rflcrnn rnd hcrchy rurhtrirc r.prc\cihiivcs olrhis Cil, anl Counrtb ctrrcr trF,n rhc
<br />H:,:;fi:::"f,/LorL-i; a;dit",,r". I 2r /rr
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFEB Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Rool Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulationi Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil.
<br />FINAL gltTltY 'tt!w.,4lN
<br />Certiticate of Occupancy I_U1
<br />Notes, Remarks, Etc.
<br />Set Backs
<br />171)
<br />-1.
<br />$ osrc! ol rhc r.Ieny. rn $clu\iv.ly cofild inE Nirn licenrcd .onh.ro6 lo conslrucr rhc Eojccr (Scc 7OJ.l, Bu\incs
<br />rfrl hrrc\si,nCodc: ThcContd.r'. Li..nsc hwdu.\ no! rprlyk, atrowncr o, pfupcnywho huilds orimrruv.\ rhctcon.
<br />itrd who otrrr0ch fff Nch pmi.rs $ilh aConra.toritliccnscd pursuanr lorhrConr.lcrois t-iccnsc l-a*).
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