|
BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE .COMIITENTS ()rNuR It !t,t)],R Dr:r,('AR,\Il(,N
<br />I hcr.hy rlfirnr undcr nctrllry,rf frlury rhd lm cicmpr liom rh. c(n ncnF l,i..n\. Lnw lor lhc folk,sing rcn$tr (S.t?r)ll5
<br />ItusiN$ and Pn,fcs\i, Cortc) Any Cirl or Cotnr, shirh r.quncs ! Frn,ir t, consrucl. .lrcr' tnIn)!t. dcnnlhh or rcprt rtry
<br />(ru urc. f,rior b ils issuancc, als, 'cqutcsric al]plicrnr ti)r nrh pcmi b ilc ! siSmd dlr.ftnt rhll hcor shc n liccn{d 0nrunnr
<br />ro rhc pnrvisnnrs ol llr Conh.r.fi Licctrscd hw (ChaPrcr 9. Connftn.ir8 qilh Sccrion 7OO0 .l Divisio! I ot rhe Bnjincss i$d
<br />Itolc$ionr Codc)orrhrrh.o!\hc h crcmPr rhcrclio'n d rhc bd\h larthc rlltgcd*cnlt)ridr AnvviolarionofSc.rionTlr'll5httrnf
<br />rpplictrrlarrpcnnrsuhj$lslheaprlicanrk,r.ivill)cnilryorxnnxmrhMfivchnndrcddolla,s($5(x,
<br />-1.
<br />r\ .sicr.lrh. pn,pcny. or my cnDlorcc\ snh wrgc( rs rhct $lc conPrn\ ri(,. willd. rlE work dl rh stnEruc s nor
<br />inrcMdd or off0rd irtr slc (S( 70{4, Bu{i'ic\s r Pn'tcsions Conc: Inc Cir rrcrtr'\ Li.cnsc Lrqdo.snorrlPlvt'an.qmrol
<br />thc pnpcdy rh' tn'ild\ or i'Jrrrovcs rhcqnr ud $ho des \u.h *o* hinNcll or hcr\clfoi ih!,!3h hk or hcr osn.nDlov.c\.
<br />! vid.rl rhdr ru.h i'nnmkmih :e frI inrcM n ollcm.l fttr $lc ll h.*crcr. rhc hildii! n' nnpn)v.mfr is $ld sithin nm tsr
<br />ofcompbln.rltO*ncrauiLlcrwil]ltuv.rtthurd..olnmir8thorhcorsh.dilnolltr'ildori'nPn,krhcnllolyfitrrltpuiFr{ol
<br />t.{\owncrolrhcIxD.ny,rncxclulivclyconiEringwiihlicdi\cdconr&ftnshconinrdrhcPolcct(soclu4.Bu\ind\
<br />rrl tbfssi)n Cddc fhc C.nrracloi s Liccn{ Las doc\ nor aPply h m ntrn.r of n()Ij.n y sho h ild\ or nnpflrv.! rhcrc tr.
<br />rtrd sho onrrich fd \uch pmrc.h *ilh r (llnhcr.(s I liccis.d tusurnllorhc C{,nrrct/ sLic.nsc lis)
<br />-l
<br />amcxcmDr lndcr Scdion-. B &PC rorlhirrcthn
<br />l).r.' o'ner:
<br />llolxFlls (llrtPENsalloN
<br />IJrcUAAIIIJN
<br />I hcrchyrlllrNu .lcr I[inlryol,'crluryoncolrh.fdl,)si'rg dc.ltdi,nF
<br />-l
<br />hlE a.d will minr0tu 0 Ccfliltrrc of C:t *nr h S.ll-lnsrc for workcrr t..r!.nsalion- !s povidcd f.r hvSccln'n 17(Yr'rIh'
<br />Itrh., Codc, nn rh. pdrorroh_c ollhc work ln whih rhe Fnnir is issuc{1.
<br />I hrvc rnd wrllnr.n rin sorkcrs...'nFns.rion insumncc. ns rcqrt.d hfSccrion.lT(nofrh.lnborCodc. ior rhc Por'nuk"l
<br />rhc work for whichthis pcnnir is issucd My sorkcs- comPcnsllion in\uramc.nEicr lDdP.li.y nxmbcrm
<br />l'.ni.r_ Ntr h!r:
<br />Icolililh01inlhc|Enn,'n.corrhcBorkrbrwhichlhi\plnnir is is$Bl.Ishxllior c'nflovrnvPcron lnx v matrNr
<br />s rbhcom subj.{r rorh. $orkcr(con[cnerion lns\olCrlifdnd and asL_c rhr ilr rbukl i-com ruhjccr ralh.
<br />$.ricA r. rtctr\rrtr pnvni.ns of S$rn,n lTO0olrhc tatxtrCdc.l \hll. f.n hBilI conrdy $irh rk,s. lruvisions
<br />WARNINC, Ftrilurc t, {.uE *otkc6 ..nlpcDsarior .o\cruc i\ utrl.*6'l ]nd shrll suhjcd rrr lPlovcr b di'nin{llc'ulrhs rtr
<br />.ivil lircs un ni otu hxndrcd rhou{rnd dollrr\ (S100.00O). trr rddililr h rh..oi .i.orrpcnvrio.. drmScs a\ |rrid'd r'r rh'
<br />Sccttnr.1076oirhc lihirC.rlc. inlcrc\r ald ! ormy \f.c\'
<br />Dnrrr Appllonl:
<br />LTE!!U2.qIUAA(rcB
<br />NF(ILARATION
<br />I hcmhy rftirnr undcr pcnxlry.l P.rjurr rhal I N licer*d uRlcr lrfl)ri{on ofCionrcr 9 i.o,nrmncirrg $irh Sc.rion TlXX)loll)ivi\n)n:l
<br />of rhc Busincssa Profes\ii,nc C.dc. mri nry liccne h in tullf{tr c.rd cl'isi.
<br />LiccnrcClas:-
<br />CONSI'RUC'I'IIIN I i'NDIN(; ACFNI:Y
<br />I hcrchy tmundcr pcnalrr.fpcrjurylhal lhcrc i\a.oi(ndi(, tndirEi3c0.tf{,rh-rdlnirn0n.c.frtu$orklor*hichrhisFrriri\
<br />is\uc{llS.. 1097. Ci\ C )
<br />l-cndcis Nrnr:
<br />-
<br />lrndri\ AdJ'c\s:
<br />APPLIC NT DF(]t AR4TloN
<br />llrnby limundcr pcnalry ofptrrury onc ollhc lollo*inB drclnraiionsl
<br />l)cnn)lirnrn P.nnils- dEios Norifirarion f.dcmlR.3trhlion\ (lirlc"l0. Prrl6)
<br />Rcqun. bdcrolNolil-rcrrin
<br />lccnif!rhnr rhc Ldcnl rcsulario r rcPinlifg .lbc(os r.'novrl rrc nnr dDnli hh b rhi\ rtuid
<br />I ccnilyrllnl I h!!c rcdrhi(.ltlicallona irrcrharrh. h)vc irlhrmtrlion i(c.nucr I raG roco'nplywilhnllCiryrtulCotrntv
<br />dinrh_cs;ndSrtrrc lnw!rl itrP io buiklins.ondfl.rnnr.nd h.rchy aulhornt r.,R.cnrarits ofrhk Cnv md Counrrro cnrcr ul)or rtE
<br />alsvc NntioNd ,ropcny aq in\pd.rn pu,aoscs
<br />,\ppliutrl or l,lt l SixNtur.
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Ve nt/ln s u lat ion
<br />Rool Sheathinq
<br />Shear Wall
<br />Framino
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />It4asonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil
<br />//zt/tf zW )
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc.
<br />ID/SIG.
<br />Forms/Steel/Holdowns
<br />T-Bar
<br />FINAL
|