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BUILDING- INSPECTOR REGORD
<br />SITE.WORK DATE COMMENTS
<br />I. as own.r or rh. !ro,rny. or nry rnUlorcs wilh w..ecs $ rhcir vnc compc.slrion. $iU do lh work dd lh. stnrluc ! tr.r
<br />inr. cd or ottrcd Ihr vh (sN.?0.1,a. Busi'E!\ !trd Pmlt$i.n\ Codc: Thc Contacktr s Licnsc hq docs nor amly to an o*ncr of
<br />rhc pn,!.ny who build\ or inprcvcs rhcB)n. {phodds{.hw)d(hinscllorhcrullorlir'lghhhorh.rownc ttloyccr.
<br />pmlidcd rhar ruch iDtl)rcmnr s [n trcndcd or olfcren tu {h I f. hoscrr, rhc tnildin! or inlPmvcmir h eld wilhin one rnr
<br />olconnlcrio.. rhc owncr Buitlcr will harc rhc hudcn ofpr.vinA rhnl h. or shc did mr tuild or imr,olc rhc pmFnr ror rrr pqr$ or
<br />I. rso$acrofrhcIn,n ny, r'!cr.lurivcly.ontnclin8 with li.ctr*d conrr ns lo consrnrd lhc phj&i ( s.. 7ul-l. Buucs
<br />ml llNrillin Conc ThcG)nr ci, s Liccnr liw docs nor (rplrro rno*ncrolpn)nL y who hnilds.r inrprcvcs thctco!.
<br />r&l who conrracr\lif\urhttuirtswnh.Cbild.ronnlicci\cd!trrsuinrr,rhcCq rrcroisl-icenscli$)
<br />I rrcrc rl, un cr Scon
<br />Dol€: Orn€.
<br />lvoRl(ERs', C0 ltnaA',rtoN
<br />DA;LA.BAIII}N
<br />I hcr.byrffirnru dc. p.n,llyoiFrjrryorc ollhc iolk,$ins dcclfoliotrs:
<br />-thlrca
<br />*illmlnnr rCcnifi.rr.orcons.trrros.lrln\urcr.r$ork.tr'comFns0rion.nsprovidcdfo.bysdi.nlT0oolrh.
<br />Lihor Codc. for lhc pcrfornnncc ofinc wolt fo, which lhc psmir n h\!cd
<br />I hnv.and willm.inra w.rkcrr conlllcnsrlt insur.trcc. rs rcquircdhySccrion.l7ll).frhclnhorA c, lor Ihc Pcrlomrmc ol
<br />ih. qorl ror whichlhn,'cnnir is isucd. My sorkcG <nnpcnllrion insura'rccxdcr urll.ltcy unr$cr:u!:
<br />Pa5\ crq:r:
<br />lccnilyrhni inrhcpcrfomriccofrh.work f(tr trlrichrh*N nir N r{rcn. I sM ll tror ctrrnl,)y Ly tx^on i nht nrdDcr
<br />c,Nhlf,.orsubjc(rb(hc*orkc6'.onrcnsili,rhq\.ICalilortri!,3ningrurrhrrifI\hroklhltorcsuhtcrr.,hc
<br />s rkcn .o r|)ctr\{t iu lrivisio.\ .l Scdn,n l7rx) oi rlE Lrtrtr C (lc.l\lu]l tnh$irIco rDly sirh rhu{frovisi.n(
<br />WARNINC: I:rihtrc ro \c.urc trori.r\ .ofip.tr\rrtr,r co!.rr!c i( u lrwtul. .trd \hnrl suhic' rn cnrpl.js ro nin,inrl rf,n hi.\ rnd
<br />r' nN hrfLlrcn rhou\xkl,l.llr\ rllixrixx)).l, !lrh r, nk.,^rol.,1 nrlr.f\ori,n,. .la'!rgcs r\ pfl,vidrd fit rnc
<br />S..ri,n,.ll)76oIrlr l.xhtr Crrlc, i' crc! x d xni:slr:1|r J.ly^,.<- llq.n.
<br />/ u&claf,anoN
<br />I hcrchy ailrm undc! rcnollrofp€rjury rhar I om liccn*n undcr provhn,i orchrprcr 9 (snxrencin8 wnh Sdion ?flro) drDivhi.n l
<br />of thc Bxsincs.6d P$fcssi.nsCodr. Md rnylirctrs ir ir full forcc dcftc.r
<br />,t:31 ..i 1
<br />\,",,r<rr Cons{ree{ra-n
<br />A.TPIIIANI.I'ECI.ABTI]ON
<br />I liEby dim uiiLr ,.nrlry .f t)crjury .rrc ofrh. f.llow tBdelmrio6s:
<br />Dcnelirion Pernrirr Asbc{os Norificriion Fcd.r.lRcSrldn F (Tillc.(). Pan6)
<br />-Rcqutcd
<br />lf, llcr olNorifi cari,n
<br />I ccn,lirhrr rh. rcdcral rcCULrions rcBudi,rB rd*sos rcnNrllr,c nor ap|rli.ahlc t, rhis pn,tcr
<br />-l
<br />ccniiyrhd I n.rc rcnd rhtlprli.arionud drr. rh rhc trtx,t inrqtu n,n is.orccr l.SrelocofllPlyrir,rsllCnyn.dcou y
<br />.dirinccs rnd Sr{tc Llws rchr in8 I blildi',! con{todn'n. and h.Rhy rurhoriz. rctrcsctrrdncs oflhi\ Cny ud n,rtrr, h.nr$ uFn' Ilf,
<br />xbort trEorflrd ptulcdy for in
<br />4lDrlidnl or A,rnl Si,:nnt
<br />aSm Iovu.j
<br />:.,", q 5
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Rool Sheathinq
<br />Shear Wall
<br />Framinq
<br />ln su lation/E nergy
<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 />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL I i/S/s --t f 6tt ,/
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc
<br />ID/SIG.OWNER AU II,DER DET,CARATTON
<br />I hrrchy rmirn undrr p.mlry (,r pcrjury rlur I m cxc!ryr rrom rhc G)ntrcron l-iccnsc t,iw for lhe lollowiry rcNnr r s.! 701 1 5
<br />Bu(irrss ,M Prolc$nr Codc) Aoy Cily or 6unry which rcquics r lc.mir r,, conntu.r- dr.r, inpii,vc. dcnmlidr or tqui .,y'
<br />nru.turc. priorro ils issuancc- aho rcqutes rhc oppli.xnr Lr such pc..rir b fiL. silncd $arcnr r rhd hcor shc n liccn\c Pursuenr
<br />tr' rh. !rcvirx,n\ ol rhc Conracror's Liccn*d tiw (Ch!0rcr 9. Connncn.ins wirh Sccrion ?Orn oi Divhion I ofthc Ausincss dnd
<br />Pm,c$nnr Codc) or lh n!orshc i\ eicmpr lkrclroni s'rd rhctx,\is tur rhrullc!. cxcnrlrtr. Any vi.hlnrn of SErbn 70.11 5 by rny
<br />applicrnrlbr a pclnrir suhjcch rhc rrplica tu,.ivilp.mlryornor nncrhrtr fivc hundrcddolhm (S5uD
<br />)s/ rq
<br />calirBUerIQNrENlM-d!!;NcI
<br />I hcrchynflnmtrndcr pcn ryoiFrjuryrh3t rh.rc i\a con{rucrion lc in8 E.n.yf.rrhct[rlaanrn.collltworkf(tr$hirhrhi\Enniris
<br />r$ucdlsc. :1097. Civ C).
<br />t11,,1..'. \d rc
<br />tinCciq Addrcs
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