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BUILDING- INSPECTOR RECORD <br />DATE ID/SIG.OWNF]R AUILDiJR DET,CARATION <br />I hcr.by rfinD uMc! Fnalry or pdrjury th,r I dn cxcnrt,l inr rhc Cotu.ror' l-iccnsc Ii* ror rhc rdbwin8 !co$i (scc?0.115 <br />Irurincs llld Prolcsior C.d.): Any C y or C.!dy w[ict rrquft\ r lf,i'nir ro connDcr. rlrd. aryrovc. dcnx'li\h 'tr rcFn Jnv <br />dd.rurc. rri{,t, ir\ isudftc. ilso rcquirc\ rhclpflicr fd su.htcnnir lo ilc a signcd n{.,mnr rhd h.or \hc i\ liccn'rcd Pur\umr <br />lo rhc pnrisi,)n\ of rhc G)nrr.rols t,i.cn*d lj* (ChaPrcr 9. C. nncrcirg with S.crinr T[XX) oi Divkiot :l of rh' li"(i"'\{ }nd <br />Pr.fc{siotrsC.dc)or rhllhcorshc iscrcDpr rh.rclionrM rhc hlsis lir rhc lcg.d crcrnlrion Atryvioturbn.lScdionTo:ll5hyr t <br />apllicrnr lor aFloir \uh!.Brhc iltli..nrk,ocivilpenrhyofnornorcthMiivchndrcJdollds(S50(r) <br />-1, ^ osncr or rh. l)n)JEny. (n my cnfloyc.\ *irh sascs r\ rhcir $lc conlPc.\arn , qilido rhc worl lrl rlt nMrm t nor <br />i'nc'rlcd uroflarcJ lor $lc lsa 7044, Ausinc\s.id Prolcrrions Codc: l l[ C(nnrr.rtr s Liccrsc llw doc( ior rJtPlv b rn o$mr of <br />rhc pmpcny sh. hu ikls or inDNrcs rh.mn. r {k) do.\ \!.h uoft hnnrcll or h.$clf or rhouAh hir or hd oqn cDpl(,vc.s <br />prolnkd rhar \uch inlpr*rmnh d frn inNrdcd n olLrcd lhr srlc ll hoscvq. rhc $uildi'rg or inDnN,mnr is srlll wirhin onc Fs <br />of..nrpLtir rh. On.cr tsuiuer eillhrvc rtE burdcn ofrrovin8 rlEl hc or shc did tur t{ild or iD{]l)!c rhc Pmpcnv i.r rhc PUF){ of <br />l. r' uwtrc, ofrhc pr.t.dy. rncx.lu{vcly.o dlns rnh li.cD\cd conttrolsk'.on{fl'rrrlf, Inoicd (S.c ?ltrl.3!\i'tr\ <br />r ln'lisirC.dc1hcCorr(.tor'\Licrn\cl-$doc\norr[)]yn,rtroBn.r.lf'{,lcrrytrhohukl!ori'nltuvc\lhcrco'. <br />rid qho contrrcrr n)r \uch pnBcr\ trirhnCotrrNkS\rli.ctr...l!tr^u3dr ri rhc (inrn'critr \ l-irc \c lrw) <br />I ru.xctrrt, lfJcr S..iion .ll & l'( r(trrlrn r.ilrr <br />Doler oqner: <br />WORKFRs (:(T]\TPF{SATI(IN <br />I)F(II,\RAI'ION <br />I hcrchyrll'irDunicrpcfulryof ,crjuryomolrhclolb*ingdNl rarn,n\: <br />-l <br />hrrc anl Nill nrinrir a ctdilicarc .f (.otr*llo self ln\urc tu qorko i .ompen\rr ion. as flovidcd tor hv sL{rn ]?0oofrhc <br />tjbor Clodc, lnr rhc pslorndn c or lhc work for qhich rhc permi i\ nsucd <br />lhrvcridsill ii rirw.rkcFcotrlpci\nrbdi'i\uran.c.nsrcquncdhISc.hoi17(X)olrhclrborC.d.nrrh.!crlornrndcol <br />rh. sork tur whi.hthk |trnir is issucd My workc 'co rFnsirion i'xLrrnct carif rtrd Fnicy numhcr .: <br />[nict Nu rhcr: <br />-l <br />ccnilyl,ur in rhcporonnrrccol lhc wort lor whichrhis Pcdir ,r isnd. t shull nor cmrl(,ranyrcnon in snvn'lnNr <br />{, a b b...m suhjer ro rhc workcrr dnnp.trsdn l,*s oi Crlitunio. md r-srcc rh,t il l should becom \ubj.!l b ttE <br />{orkd( comp..salion [ovisions olSccrn,n ]700 ofrh. tjtsr codc.lshrll. fonhwnh.omtly *ilh lin'E pmlitiotrs. <br />1VARNINC Fnifurc ro ecud workcr co pcnsiion covengc i\ uilnwrul. d shull subicr rn cnrdorq ro rioinrlltnrhic\ rid <br />civil rincs up ro oac hlndsd rhon$tu dolhn lllOO.rDO. i! ldd nitr ro rhc cosl olconll.n{rion. drmaecs pnvnlM r(trrh' <br />Scclnnr 30?6 olrhc litrtr ord., imcrc( and rrlorrcy\ rcc\ <br />lrolrr Appli@nll <br />LICENT.EDIAXINASTOB <br />DECIJAAIION <br />I h.rrbyaffinnund.r pcnllryolt qury rhd I !d li$n*]utrdct Pmvni{in oaCh+r6 9 (.ommmin-! wirh S(rbn 7Ul0).ll)ivi\nrn l <br />oi rhe Bu\inc( Md Prorc$io.s Conc- md mylicsn{ is i'r rulll.rcco cilicr <br />-l i..fsc Nrn:hr <br />q)NEIts!JCII!]NIETiI,IING.&AINq <br />r\n'rrlrs.. 1l)r)7 ( iv ( r <br />L.idc.\ ddrcss <br />- <br />AIELIIANLIIECIABAIION <br />Ihcr.iyultt undcrpcnrlry.rlcUuryoNdl lhclhllowir!dcchruri.nrl <br />D.nkririon Pcrnils Asbcsror Ndrifi.nrion l;cdcr.l RcEullrionr(rnt 40. Pd6) <br />Rcquncd L.llcr of Norifi .nrI <br />-l.dil!rhar <br />rhc fcdcrtrl reguhtions rcCuding a\hcno\ rcmov.l d. nol amlicrhlc k, rhN frcjccr <br />l.difyrh.l lhovc rcld rni\ aDpli.arbn nM st.lclllll ihc!h)!c inrbnmrbn iscodccl lasterocoq)lywirhallCitvrndCot v <br />.rdnDEcs rRl Srilc Lnws rclarina ro bxilding consrdcliotr. aftl hc,cby sdhiizc rcprcscniarilcs ofrhn Ciry i.d Countvb cnrd u0oi rrt <br />rh.Lc nfl h.,nr't r"rrr! i.r ir.ncclior nJ F*.\ <br />;;;;;,;.;;;;;;;"ra E- ...2 z-.<- 7 0.,. o4/+/r { <br />,,.? <br />pemiree mne rprinr,:P 3A vn E-'tY't <br />Set Backs <br />Formsi Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/Venl/lnsulation <br />Roof Sheathin <br />Shear Wall <br />Fram in <br />lnsulalion/Ene I <br />D all a- <br />Ext./lnt. Lath <br />Brown Coat <br />lvlasonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />FINAL <br />Certiticate ol Occu n <br />Not S emarks Er^ <br />?,,(-, <br />/ <br />SITE.WORK COMMENTS