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BUILDING. INSPECTOR RECORD
<br />SITE.WOHK DATE ID/SIG.COMMENTS OWNAR BUII,DI'R DEI,CARAl-!ON
<br />I hdrchyrfir undci prnally of lrcrjry lhal I o cxcnrpr linrn rhd Co rNrors Lic.nsc Lrw lor rh. rolk,sing rcns,r {Scc.?0.115
<br />ausir.ss Md Pronssio C c): Ant Ciry or Couniy whih rcqun s . tEnni ro conrrrucr. slrq inlft,vc, dcndish ,tr rcr't rny
<br />iru.rurc. pritr k, ir\ t\urn... rl$ rcqurEs rhc qt'llicmr lor such licrnrir ro l]lc a\ignld nilcrknr rhd fuor shc is lien\cd !ur1ur.r
<br />ro ihc tolnions ol rhc aonrEcloi\ l.iccord bs lchrprcr 9. C. mcncing wilh Sccrinr 7Un .f Divsiotr I oI rhc Busincs 3nd
<br />Proics\i,)nsCodc)orrh lEor{hc iscxcrpt lhcrcr'rcrrtrd lhc b0i\ li)rrhc trlfg.d crcnunr Anyviohlionofsccrk T0rl.5bymy
<br />+pli.rnr rd r pciinir \uhlccG Ihc {'llicanr ro a .ivil p.nrlry of i.r ,mrc rhm file hundrcd dollar (S5m)
<br />-1.!s
<br />ow cr ol rhc pr.Fdy. or ry cmplo$cs snh wrgcs $ lhcir $k cohp.!\eri{,n. will do rh wolk ltEsrndmtnol
<br />i'n.iddl or orcrcd r{tr strlc (Se.7044. BusiDcss ond Prolc$n,ns Codc: Ttc G)nhdors Lkctrsc Lav docr nor irlly to 0n osncrol
<br />lhc potcny who ttrild\ or impovcs rhtrfrr. a whodessu.h*orkhimsclforhc^dlforrhmuahhis.rh.towne'nPloyc.s.
<br />Drovidcd rhor such inrNrcmors @ r, ime L{ or oficGl for $L ll howcEr. rh. hoihing or inlmtmnr is sld *irhin .nc yt,
<br />orcompLriJn. rh. owncr auiltr will h!re rhc buden ol rrevins rh,t hc o. shc dd mt boik.r irynvc rhc lfi)pdy ror
<br />'lE lr[ns or'
<br />-1.
<br />!s owncr olthc rnncny, aner.lulivcly.onuacrirE wilh li.ctrsd c.nlr!cn,6 ro.on{tu.r rlr pmi.d (Scc 7(,4-,1 Btr\incs
<br />rdl PDf.r\bn Cod.r Th. Conrm(ols Liccnsc L!* docs ml lFply b an o*ncr ollmPcnywho 6uilds or imrrcvcs rhcrcon-
<br />rnd who ontBcrs for such pmjcch wnh a A'nrr,cro(o licctr*d plrumr k, rhc Conta.roi \ Li.cnsc bw).
<br />I rm.x.,mr u crS..ri,n, .8.&l'C.li)rrhi\rcr$n
<br />D.le: - O*n.rl
<br />woRxERs' coNlPF\s,\'r()N
<br />IIECI.AAAITON
<br />t hcrcby trfitmrndcr pcnalry orFrjuryooc ofthc bllowins dcclnrariis,
<br />I hivc afil will mi.r.in a Ccniff,lrc orConsaln, Sclf I'Mr. tor workcis' conqEnsdion, a\ prorid.d for bt Sccti.n lTO0olrhc
<br />Lnk)r C.dc, ror (h. Frrorin cc olthc wo* ior which rh€ Dcrnril is isucd.
<br />I hivcnnd will Duinhin workcrf co'hpcnsnnn, nNrtui.c. n{ rcqxtcd b, Sccr ion :lTfll of rhc hbor Codc. ior rhc Prrlnnmkc ol
<br />rhc work,n.*hi.h rhhncnnir is t\u.d My workcN .oqr hdriotr i.sur0nccqFicr rnd E,li.y trumhcrr.
<br />Policy Nu mber-Expifts:
<br />I .rn'fy rhrr in rhc Nrlbnm.cc ollhc w.rk lnr *hich rhi\ lfnnir 't issucd. I \hnll Nr.mdo, ntr) tnnnr i. rny mrtrmr
<br />$ rslo lEom ruhjccl t,rhc *orkd\.o rpctr\{i( [ss ol Cililanrir. andrgr.llt r ill \lxnrld hcninrc uh].trt)rhc
<br />Borkcr..mpcns ion pmvi\n,ff.lsc.rion l7{x)ol rhc Lrhr Cl c.l \hrll. tunhqirh. r,nyPilhrh.rrrovi\ii\
<br />WARNIN(i: rdhr. kr r.m sotuis' @mpcns(nr covcrqc t t ll niht cr rn cn,pbJcr t) dnnirrl prnrll[\ rnt
<br />oI conrF.trsrrnn,. rnrlc\ r! Ir.rid.d tur rh.
<br />IhcrchyatfiirnundcrFnllrtorrclxryrharIamliancdundqrmlisioiofChrPr$9(.onnlErcin-qrirhSc.rkrTuJo)ofDivisi.nl
<br />of rhc ausincs md Pmlcsioos Codc, drxi ny lkcn\c is in lull ftn.c ffd cfi.lr
<br />:;.'"t
<br />coxlIalculJNIENoINc-trcENlI
<br />I hcmby nifinn undcr i,cnllry or pcrjxry rh,r rhcr. is 0 m.nrudion hndin-q ascmy r.r rh. ptrlonMn c olrhc *ork rt, shkhrhh lctmil k
<br />issucd (sc. 1097.Cir C ).
<br />AIPIICAIfDECLABAIION
<br />I tf,rht linnr uDd.r |xnn[y ol pcrjuly onc.frhc firlowing dcclmrnrts
<br />Oc'fr,liri{nr Pcrfrns Asbr(os Norilicrlion Fid.nl RcAuhn,n( ll irlc 40, Rn6)
<br />R.onr. l d r.r nr N.rirdrion
<br />I.cnifyrh l havc toM rhhrppli.arn,nand d3tc I shrvc i'nanmliotr iscotrccl.l agrE t, coryly wirh all Cily !trd Codnr,
<br />ord rn.d a d srdchws rclirin3r0bui hurby rhorizc rcp.csenrrri!$ ()frhk Cny ond Counry ro cnrn xF,.rh.
<br />rlrrr Drnriinu] Dmnc'ryl(tr i')
<br />\ppliutrl or .\$trISixn lurr
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Boof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lalh
<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 Certif .
<br />/l
<br />FINAL t/tu/E 4,/x4:2i.
<br />Certificate of Occupancy //1".-
<br />Notes, Remarks, Etc
<br />Set Backs
<br />Subf loor/VenVl nsulalion
<br />.n'l fincr un I,, ',nc hu'drcd rhou\dtrd
<br />s-,-. n16,l,h" r-,h,.-i .h-{
<br />,",., q l,,l tq-T r_
<br />t&
<br />I€xdqa \3m
<br />-
<br />Gnd.r , A,llrc!
<br />I (nilirhtrr lhc lt,tcrrlr.ruhri(,ns rc!ritli'rg intn.s rc xivnlir. mrrff icrhlc b rIn f'.4.t
<br />,","q\+
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