|
BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUI I-DER T'ELCA XATION
<br />I h.rcby afllnn uMcr |fnilly oipcrjMy lhrl I urcxcrpr,'rcmlhc G,nrr!.xr6 l-icci\. l.atr f(tr rh. frnlrwiDe rcnqnllscc ro.ll5
<br />trusircrs trrd ttolcssi(lr ('.dc) A y Ciry or Counry which rcqri'cs r t).nn{ ro .on\lrucr. rlrcr. improvc. de'tuli\h ( L-ptn 3.y
<br />dnicrrr, pridn, ir\ i\su'rc, aho i{trncs rhc dfllri tu suchlcnnilro ile i siSncd dar.mnr rhd It or shc is ll.cr\cd ,rnumt
<br />r,rrhc,K'vnion\ofrlrConrracrorsl-iccnscdtr*(Chant.r9.C.6ntncinSwrlhSccli.n?(x)0ofDivtio:l.frhcBtr\irrcsini
<br />PR)fcrsn,nsCodcrurrhnrh. orsh. isc\ctrrft rhcekom! rft t'r\is li)r rlf rllc8cd crcmrrjor Anyvio[rionolS..rk,n70]l 5byr y"
<br />.ppli.0trlrbrap.nnirsuhjcckrhcq,rrica ()r.irilPcnrlry.rnor,norcrh{niivchundrcddollarllS5([)
<br />l. ns owrcr nflhc I'ropcn!- or rly crrt'loyccs nirh wrscs as rhct solc coDp..\!ridr. willdo lhc w'rh exl ihc nnENrc n n.r
<br />idcndcd o!orler.d fffssl.(sr.7o.l.l, au\irrcs,trd Phf.lsnnrsCdc rhcConk n,-( Ijc.n$ l r+' dms nor lprl! tu ni owncr .f
<br />rhc F)rcny sl{J tDild\ or inpnncs rhcd . rlEho et \Eh tr otk hirsc lf or ho{lr or rhtuu8h his or hs own cnrl'!..s,
<br />pn,v id.d rhrr sr.h iNlrorcmnh m mr i dnlci or oltcEd fu slc til k s.vd, rh. buiunF or iD{n ovcnrnr is 6H wirhin .'t )tir
<br />.f.orylcrion- rtF Osncr Buildcr sillhtrh rhc b!,rlcn.f pn,vin8 rhd lr or sh. dil R)l trild nr inpn,t rhc rmPly hr rtE purrns ol
<br />l. r(osidof(hc |klrny. rmcx.lrli'Tlyco rr.ri"E *irh li.rn\dn contarhs h ..rN nrd rlE nr{rtecr lSrc 7(114.3uuc\(
<br />r ltrrisilC.dc lh. Conrrrcnn \ l-ic.n\c l- w(n)crnurn ,lyfu roNn.roipr.n rry *ho ht ilds u inrfotc\ rhcr con.
<br />rtrd *ho cotrtrd\nr{chnrojc.rsirhiConrrrn)nnliccnscdpu{,a n,rhcCoturcttr-sl-i.cn\cLrs)
<br />I amcx.mm undcr SccrFn .B &PC fu' thn r,'{
<br />D.r.: o*m.:
<br />1vl)nff8s:l:aut[lll-IlaN
<br />IIElLrtBAu9l!
<br />I hcrdry rftnrrndlr p.nalrr rfpc.jry nrc "l,hc nnL,uiD! d..hnridN:
<br />I hav. erlwill mri ainrCcnificdcolCoosenrhSclalnsurcftnwork.r(..mp.trshlion.as nrcvi{lcd tot hy Seriotr :l7U) of thc
<br />htx)r C{ic- fff rh. p(form,n.. or rhc wo.l lbr which lhc Niini n isskd
<br />I hrvcrtrd will nriflnir workcri conrcnstrri{in in\untrN. r\ rcqtrircd hySelii{ l7lx).irhc l-ihorCodc. f(tr rh. P.rLnhtNcof
<br />ihcworkrorwhichrii\tcrNirisis\udMyrorkcr'conrpctrrlrionnx!'rrccatricr kl ,rn icy nxrh(r rrc
<br />- S'r Art- fit,,tp
<br />,"r"t
<br />^",,n
<br />,4l g'$'24 -f .5/,lE
<br />-l..nilyrhxr
<br />inrhc|rrfonr...frhcworkLrrhi.hrhl\|rrnriri\t\uc{1.I.hrlltrorcrdoyrtry|{rnrirrfytrHtrcr
<br />\) r\n, hcc(N\uhrc.r rorhcw.rkcrs c.nrpcnsirnnr L rsoiCrli,ornir. ddqrccrh ilI\lnnrli t conf, sohF.t kirhc
<br />work(\'c.r,rn\nrionfnvi\irifroiSccri{nr.l7([).f(hcl.rtnrC(dc.l\hn!llilrhsirh.D,ny*irhrh)*nnrri\nnN
<br />WARNIN(;: liilurc lo \..nr sorkcri.otrrtttr\dn co\trilc i\ nlistl. in{l sl il ruhl..r I corplo}cr l{, cn i'rlr.Hkics md
<br />rn'l h,c\ up ro rnc huiJrcd rh! trrtrd ,lollrr\ (1llr{).(xx)) irr rLl(llriotr k)on ol conllf,ns.ri.n. dlnusc\ itr pr idcd ntrrhc
<br />s.!rtriL rr1160lrltr l.,l\r(.tlr irrr'.{.
<br />',1.
<br />"^,",v/,f rt,
<br />cr3 1827t
<br />rqls
<br />I hcrchv llfiro undcr FnrlryorncrjDry rhd thcE h a cofsrru.rion todirs rsckt rrtr Ih. pcrrbrmonce oirhc $nrk rar ehi.h Ihis ncnnil is
<br />n{r(rl 1S.. :r{)97. ( r\ ( )
<br />a.tPl,lcaNfpEclzlsafla!
<br />I lmby nfian u ndcr ncnllly ofpcrlxryonc.frhc loll.Rnrg dcclnrriotrs:
<br />D.nbl iotr Pcnnih.Ashcslos Noriliclrion Fcdcrul Rc$lart,i\ (Tirl.40. P 6r
<br />Rcqnircd Lcrrcr of Nolif'cdt,n
<br />-l
<br />ccnify rhrr rhc ltdral r.guhlnns ng8lin8 o\bcios rcmvnl orc nor lp i.nbl. tu thc PFl.cl
<br />I r.'r'lrrhxr I hr\('.r(l rhi\rhovc inlni,nrrtrir i!.o c.l Iitr.c l,icoDplt sirlr rllCiry!ndC.unry
<br />rdinrn.r\;id srrr. l-r* rlnr urktrizc rctrc{nhri\c\ ofrht Cn! and Counry to cntcr u|In r,f,
<br />rlrrc nrniioncd l()nont f(tr
<br />Apt,li$nl or \,renl SiIntrlur.
<br />T,-//i,toi
<br />,,,,";lt"ft?
<br />Set Backs ,Z S
<br />Forms/Steel/Holdowns k Eal Len *l
<br />Erection Pads
<br />Subf loor/VenVl nsulation
<br />Roof Sheathino
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />l\4ason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Floqd Zone Cenif
<br />slzs l/8 4/tE,fc)
<br />I
<br />FINAL '1146 -(,L/a4 /q)
<br />Certif icate ol Occupancy I
<br />Notes,, Remarks, Etc {
<br />\w aa,*o 'c 4ct
<br />e t
<br />UFER Ground
<br />SLAB Floor
<br />Brown Coal
<br />o,l-1 lq ,.{-/14'n (,tta,l, {4t Au,
<br />(t1
<br />I hcrcby,finnn.dcr IEMltyolDcriuryrnar I !n licn$d und.r pdvhnnr ofahoprcr 9 (com'rcncing eirh st.rioi TmOr olOivi\ion l
<br />or rlrc Bu\in.sr.nd Pronssirns Codc..nd my liccnsc h in fu ll r'or.. !d .rirt
<br />fT
|