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BUILDING- INSPECTOR RECORD
<br />SITE.WOBK DATE IDiSIG.COMMENTS OWNAR BUN-Dr]R DI'I,CARATIoN
<br />I hcrcby aliirm u cr p.nllry ()r p.rjury nu Ln cxc rfl rmn rhc Conlrrt)F Ltune hw lnr rhc ft,llowilS rcnsr (h\ 7o.ll 5
<br />Aurinc\s $d Pnnt*n C.dc): Any Ciry or Cotrnry whi.h rcqotcs n Fmrt ro coDsrd.r. trlrct, imPrcvc. icm'lth or ePrn mv
<br />inrcrurc. ndnro ni i\suancc. al$ rcquio\ rh. lprli.$r for such Ennir x, rilc a \ignL{ s{cnEN rlur hc or $c is liccn\c{ lursur
<br />b rhc fmlNions of rhc Conrrucrofs l-iccn*d Lrw (Chrprcr L C.nnrncing *irh St.ri.tr 7(X)0 oa Diviri l ofih. Btrsnts a
<br />ProltsionsCodc)orlhar hcor \h. ilcx.nF rhcrcfo md rlt br\i\ rurnc allcscd cxcnrlion Ant vn,hrn,nofscctbnT0.rl5 hva v
<br />rnrlicanl for r p,.nir \ubt.h rhc r!flica lo ncivilDcmltrolnor isrlh tivc hundrcddollars($5tro)
<br />-1.!soqncrol'rhcptr,|tny.(,.rycnr
<br />oyes wilh Nlsct rs rhct slc co'npctr(dnnr. will do nrc {orl u'rl rhc slmlurc is nor
<br />i' .tolel or oltarcd fr $lc (Sa 7(tl,t. Bu\im* nnd Prcfc\\i(n,\ Cdic: Thc Conrrct, r Li.cnsc hw docs nolrPplt b atr n$rcr ol
<br />rhcpmFny wio builds or iqn,vc\ llLrcn. lllhodrrssuc[w(trkhtnsdlforlfrcllorrhroughhisorhcrowncn{].yccr.
<br />pn)vntd rhri $rh nnlrk'nnh m nor inrcnd.rl or ofit(n lnr qL. lt hrtr cvcr. trt huiHin8 or impn,vcnEnl is $lll sirh]n lnr rr r
<br />.tc.i1l,cton, rhc O$ ncr Builds will hnk rhc budcn of F,ving rh.r hc or shc did tror h ild or i'Er(trt thc pmldy for rhc l,tr4b* of
<br />L r!.w'rr.f rh. ptrrlxny. rcxclu\irrly.otrkr.ring $irh h..n\L{ co r.cl{n\bcoidtu.r rlt fmicr (Scc 7(lrl. Buqncs
<br />r PnnisionC,xlc:thccontNttr\Li.ctrscLdwd..inolrDtlybrn.wn.roi|]ll|EnyrhobuildsornProvcsrhcrcotr,
<br />rnd *ho onrru.rs li! \uch lF,ccr \ $irh r Conrrrctnl\) li{ \cd DuFUanr h rhc Contr.(tr's Licctr{ L's I
<br />I rmri. nr urdcr Sc.r A & P(' li,rrhi\ reavn,
<br />E ltb t*,,-Ilk,,,,"
<br />DECI.AXAIII]N
<br />I hceh! afinn utrJcr rEnollyolFrjuryonc ofrhc f(rbwi'{ ddlnrdrotrs:
<br />-lhDecddsill,tuir
<br />rin!Ccnin.lrcolConEnrt'S.lfln\urcnxwotkcn conrFosarn'., r\ lmvidcd l'or h,Sc.rion 170troirhc
<br />L.tx, Codc, nn rhc l)crinrmn.c oI rhc wor k tor which rhc Dcrn,ir is hsucd
<br />I hNc lDd will nninrrh worr.^ .onll)Lnsari innmrcc. ds rcqlire{t hy Sccr i.n ]700 ol rlE Lrh.r Gdc. f lhc Pcni)Irumcc ol
<br />rhc wort for whichrhispfmir is isNd My sorkcN- comFn\rrion insrrrtu..rfticr md p.licy trumber rc
<br />Poli.y Nutrlb(.-ErPncs
<br />-lccnify
<br />ihrr in rhc p.rfoflrNc olrhc vork lor {nich rhi\ p.iinir n $\ucd. I shall ml.mpk,y rny I'-non io..y mlnn.r
<br />v,rsk,b...mc$rbiLrriolhcworkcrscorpcn\dn,nlrw\olCrlin,arir.rndrgrccrl ifl rlFuld hcconE bicdrorhc
<br />q.rk.( coryctr\rrion pmvnions ofS.crn,n.lT0OofrhL trlrtr Codc.l rhrll. tunhwirh.o y wirh rh.c F,vi\i(,ns
<br />WARNINGT tiailurc n' {c!( sorkcrs conl,cDsriion covcra8. is D lrsrul. rfd shrll suhjccr xn.nPk,ycr b diDirrl P.ixlric\,trd
<br />civil ,itrcs utr io oDc nundrcd rhuusn d dollds (5lUr.00O). irr ,tddiri(r t, rhc.o{ of comPcn\lrion- drn!'8.s rs pmvidcd in rh.
<br />1)
<br />ql !hc taL$r C,,'iqinrcrc{ rtul rktrmy-\ lics
<br />-
<br />,
<br />lJ) llt noo,**,,I J/@
<br />! rdFkilrr c()N rRAeluR
<br />DIiCIdBA.UTN
<br />I hcruhrrltnnrndcr p-Mlryolrcrjury rhrl l,o licdnytrt undcr pn,v$tunoiChrrrer9lconintmii8 sirh Scclion7(l( ).rDivi\i.n l
<br />ol rhc Busi',.\\rn Ptufcs\idN Cod..0nd my liccn$ t in liill lnrc. and cIla.t.
<br />(aN AIJCII9II.I,EIDINC.IEINCI
<br />Ihcrhy fliitrrundcr pcnrlry ol pcrjtrry rh t rhdrc i\ r.otriru.ri.n lcMirs asency nn rh. p.rlo.uncc olrhc $olk nn'$hich lhn Frmir is
<br />issucd (sd 1097, civ c.)
<br />ATTUCAXIDLCLdXAII!}N
<br />I lrsby tlnundc! Fnnlty ol Frjury oe ofrhc following dLth.llions
<br />Dcmlirion P.rniir\ A\hr{os Nolificolion lcdcral Rqrhrii,n\ (Ti'1..10. P!n6)
<br />_Rcqrncd brrcrof N.tiic iotr
<br />-l.cniiyrlurrhcfcdcrrl(Aularions
<br />rc-sornins ashctus rcnn,ralarc nor.!|lic.hlc t' rhi\ Intrr
<br />I c.di,y rhd I luvc rqd lhi\ appli.rrion Md {.rc rhd thc $orc inlbrmrion is cotrr.r' I.E( tocomply sirh.llCiry.nd Counlv
<br />ordinanccs rnd SIarc tiwi rclaritr! kr huilding .otrntu.r i([ fltl hcrchy aurktrirf, (trc{ntfivcs olrhk Cilyand counry ro ctrro uP.n rhc
<br />al,orc ftnlt,ncd tn,p.ny ,nr in
<br />Appliunl or AEenl SiBeluc:
<br />Pemilee n.me (p.tni):
<br />g//)//{
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Su bf loor/Ve nV ln s u latio n
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />It4aso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />-ltFINALITtutt/5 riltflrL / 6ll -,/
<br />Certiticate of Occupancy / t
<br />Notes, Remarks, Etc.
<br />UFER Ground
<br />Flood Zone Certif -
<br />t, trJ '. ,lJc.\ _
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