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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE tD/slG.COMMENTS OWNER ITUILT'CI' DELCAR.ITION
<br />I l[rchy afnnn undcr ncixlry or |r.rjry rl l m crcmpr liom rhe ('onta&rr Liccnsc litr,{nrhc t)lk,win8 r.$otr (Sc.7o:ll5
<br />tlusircss .nd Ptufc$n{ Codc): Ant Ciry or (iutrry sh'.h rcquncs a ltnnn t) .otriru.r, .lrcr. imp.ovc. dcmolnh o. rcnln any
<br />{tucrurc. prior k, ns i$uanc.. al\o rcqutcr rhc a,'plicrnl lor su.h potrrir h filc ! \i8ncd slarcrmnl rh hc or sh. is |i...\cd llrsd,nr
<br />t, rhc pDvhions oi thc Conhckn s Liccnsd tiw (ch{rcr 9, Co'nnEn.irg wirh Scdbn 7(xxj ol Divi\ion I ol rhc Busnrs and
<br />Pmicsbns C.d.) or rh tu orshc nexcmpl lhcrctronrlnd rhcb.sh lnr lhc rllcscd crcnprn,n Anyen,hri,nrorseli.nT0:ll5hyrny
<br />S:d'MK;i.;ffi ffi ;;;ffi ffi*il* n i",,,",,
<br />rhc DDp(ny *h) builds or inDtuvcs rh.dr..nd who dd\ \hh trt* hm\.lfor hcsclfor thmuth hi\ o. h.r osn.nDbyccs.
<br />poli{lcd ihrr \urh i'nprornr s d( mr inrcftlqt oolt!rcn ntr srlc lt how.v.r. rh. hnikti',g or improlcnr is y,kl wirhin o c rtrr
<br />oicon{,[li,n. lh, OwE. Buiklcr willlnvc rtE burdcnof!r,vi'r! rlDr lt.r dr dit rkn hoitl or iry.orc rh. pmpcny tor rhc puryn{ ol
<br />l. r\o\\mr olrhe n'o|r.ny. aflcrclusivclycontr.riDE wirh li..n\rd.otrrrrttr\ t, conndcr rfu t,flijccr (Sc.. 7(|l-r. Ru{trcs\
<br />rn(l I'('li\\irCodc lhc Cotrtrctr'\ Li.ctrsc Lrwdoc\ tror nfrlyk) rtr tfcroltn'|Entshohuild\orirpnrlc\rhc'coi.
<br />ditl sho (n rJ.6 nlr such jn+.r\ qirh rCofkr.n)(\)1i..,,\.1fu.\lxtrr brhcCofixctr's l-ic.tr\c Lns)
<br />I rn.r.n,pr trnhr Srri,tr,-. tl & r'C lar rhnrcrnn,b?4(b tt7,"Y.- Se{?- / t\(,RlitR\'(O\lnrNs\lllr\
<br />l,t< n u2
<br />DI:CLA.B6.IIA!
<br />I h.rubyrlnrmundcr Nnalryolpcrjuryotrcolrhc fdl.wir! ddl rior\:
<br />!harranlwillnBnnri'rrCcnificrrcotCo\cirr.S.llh\ureft,tr.'krrr.ofi|tilrri,nr.r\providcdlorbySectioDll7fi)olrhc
<br />L'h, (](xlc- fitrrhc pcrli,rnrrcc olrlrc ror[ ror which rhc p.nnil n i\su.d
<br />lhrvcnnd will hidrnin w.rk$a .o'npcn\ i.n nRuBncc. r\ r.qtr'rdhtScri( 1700ofrh.I-aborC.dc.torlhcpcrlhnumcol
<br />thc s.rk lnr whirh rhi\ pdnit is i\acd. Myworkcn co'npcn\rrion insuricccrfti$ r*l B,li.y numbd {c
<br />P lii) Nrn,hr' _ I \ni'r./l
<br />zZ'.clili rhor rhc Brlorn'rncc ol rhc trorl lor $nr1 rhtr n.rm * h.us. I \holl Tra\ .. *-* -ry.ir, rt. sdc^ m'nFn{rion lJtr. nf (,tirfln,J. r lolmcrhar I
<br />cmrloy ao, pc6on in rny ranicr
<br />sh.xld h.om subj.rt t' ttE
<br />workc*.omtcnsarionprovisn,nsolSt.rioo]?OOolrhclitxnCodc.l+ll.foahwirh.onplywirhrho{povisiotrs.
<br />WARNIN(:: hilurc r, sclrc workc^'conp.nslrion covcrogc n utrbNlU. dd shall \ubFr an c'nplorrr b dininrl pcMlras Md
<br />civil linc\ u! ro oie huodrcd rhorslnd dollan (SlOo,lXX)). in addirirn io rh. cod of codpr iarn,n. dimgcs as providcd lhr rhc
<br /><';::",)d' V ;8 "'iir",,Z *rc thr /o h /-oL I LICF.I\SID IONIRA( I(IR
<br />Ihcrcbyalirnu cr p.narry or nca*v rr,"r r,, ri.""*r i,a", r,E6ffififchlnrc' e(comnu.ina *irn s&ri,n ?(xn) or Divisi,,n l
<br />or rnc Adnnc\\ r'd l\olcsr.r\Co,lc. itr,l ilvl'.cn\c h,Lll lo'.c rrdrrc.r..-
<br />IANEIA]J{:I&N"I,ENDINTi.AGENqI
<br />Ihcrcbynr'ti,rnundcr pc.altyoipcrjurythat lhcrc is aonslrucriflr lcndbsrrck_] lor lhc pslonMmc olrhc work r(rRhi.hrhn Frn n
<br />nsucd (s(. r(D7, civ. c ).
<br />i.etuc rfLDIilLALAIlO!
<br />lllrt'y illirnuodcr Fnrhy ol Nrjuyonc., rhc n'llosir)E dtulrfuri'rN:
<br />DLnx)lirnm Pcnnir Ashn.s N.rificrrn,n FcdcrxlR.!trhrion\ (Tirlc.l0. Pr 6)
<br />Rcqui'cd l-crrrof N.rli.nr r
<br />J,diryrh,l.,.li.J{dla.FLldri,rrrIrJ-,ri.h.rvcn1r,,l,cr,iJfrli.:'rlc.,rhnfl.Fr
<br />9rk'ayrhrlhJ\rrcr'lrh^rrrltrr!,n J{rcrhrrhcrhrri'rr{r'turnnri\com.r.lr8rcchrcill)l!wirhlllcyrtrdL.unry
<br />,,,rh"c mnrinmd pr.ncn) lhr inspccri, r nurlFes
<br />irppr.rnror&enrsismrum 544 Hrdl/-
<br />\P?m lmmncrp'lnl):
<br />22$,*" /o lY
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground )
<br />SLAB Floor
<br />Subf loor/VenVlnsu lation
<br />Bqof Sheathing /t /t,tlr//t( t '<lilrk '/^."
<br />Shear Wall
<br />Framin s
<br />lnsu lation/Energy
<br />Drywall
<br />Brown Coal
<br />Itrlason ry
<br />Pool Fence
<br />T-Bar
<br />Handic ap Req
<br />De puty Final Report
<br />Engineer Final Report
<br />FINAL r&a/fi 6tttlur*
<br />Certif icate of Occu pancy 7
<br />Notgs, ftemarks, Etc"
<br />ot- |
<br />Ext./lnt. Lath
<br />Flood Zone Certif .
<br />7rL|,rD frV/tzH-*t>--
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