|
BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS {)WNI.)T BI JII-DN:N DE!-CARATIoN
<br />I hcrcby s,tir rndf r.n6hy.l prljury thd Iflncxcnrfl l'mm rhc Cinrockm l-icc !. Law for lM rbllo*inE r.r{,i (s.c?0.115
<br />Brsinc\s rftl Proicssion Conc) Atry Cily or Counly qhich rcqunc\ r Finn ro co.(flct. allcr. inlpnvc. d.nblnh,tr rll0tr rtry
<br />nrudurc. Frior ro irs hsuance, alw rcqrncsfic anplicanr ru su.h,irnlirto lilc. sigmd srrrcntn har tror shc is liccnscd Pur$anl
<br />ro rhr r.vanN ofrh. Conlrrloi\ Liatrscd Lls (Chrfl.r 9, Comftmir8 wilh Scdion 7lx$ ol Divisio.I .r rhc Busirr$ and
<br />Iroltssion! Codc) or rhar lIo.shc itcrcn/ thcr.lioN and lh. bnsh lor thc rllcscd gc'npr ion Anyvn dio.oiScclion?0ll5byan,
<br />arrlica tu!pcnnir *uhj..f rhc npFli.dtrr lo rcivilpcMhyolnol nmrc rhln lilc hutulr.d 'loller(Ss00).
<br />l.r\osmrollhcDmpcny.ornrycnplotrc\wirhwr8csrsrh.nr'[.onrlcrsrlion.trilldorhcw.rk!]drhc{rucrEi\trn
<br />inrc sl or oficlcd lnr elc ( 56_.701-1, Busircs Md PrrLsionr Codc 'l hc Coikr.ttr's t-icctrsc l-trs docs nor lpply r) an owncr uf
<br />rhcln'|Eny $ho 6uild\ or inpRnt\ rhcrsn. !fr! wh. d,Es uch tr !thinxclforhcr*llorrhnrughhNorhcrostrcnrlloycc{.
<br />pn,vidcd rhri srch nn[ovcnrnh lrc nor inrcodcd or oncr8l lbr sL ll, k)wc\... rh. tn'i]d iry or inqrti$rnr i\ wkl wirhin onc ]Qr
<br />olcomrrldion. rhc O*ncr Blildcr sillhav! rhc hoiilctr.rl)n)vine r&x hc or shc did trol huikl o. i'nprcv. $. t)f,,lriy lht lhc puqrs ol
<br />-l-
<br />J\ownerof rtu l]rordy. a cx.lusivclyc.trlr..tirs *irh licenscd.otua.r.r\ r..otriru.l rhc Pmrccr (Sec 7OJ4. Bunmss
<br />Md PorssDtr Codc Ihc Conrructtr\ l-iccn\d Ldw docs nor dPtlyro an oqrc. of ProFny who huildsor irP(ncslhcron
<br />and sh. coitx.rsrd suchproFllssilh rconrmdd(s) liccnscdl)lsur brhccint.cl(tr'sLiccnsc hs)
<br />I am.xc'nl uidcr Sccli.n
<br />II'oRKFRS' (:o]VPTNSATI(}N
<br />DECLA&U&N
<br />I hrrcby slftr und.r F-tullyrfpcrjury uc oalhc lollosing dchrrri{nN:
<br />Ihrvcddwillnmi,air.Ccnificorc.fConsnrroSclfl.sudinrworkcrscompctrsrrion.asprcvi{t.dforbySelionl70Oofrhc
<br />tirr curc. 16r rhc p.rfornEne of $c work lbr shich lhe ,.rmil is n\ucJ
<br />-l
<br />harc and will nuinruin workcn co.,Fdrar i(r insurrm.. $ rcqu rcd iy Sccr ion .17IX) o{ rhc Ubor Codc. lor ltc ocdortutuc of
<br />rhc work lorphich lhhrarmit i{ i*ucd Mywdrkns cotrrt'ons,ion iNuflncc catrirr afrl r,]i.y nunrh.r tc:
<br />e
<br />-lccnifylhlrinrhcpcrl(,mn.colrh.sorkntrshi.hrhirIc
<br />nir is issucd,I d,rlliorcnPk,yaflypcr$r nr trny 'ntrnnovJ r\ k, trcoft subjcr ro rhc solter' compcnsd ion laws ol Cliir(mir. ind,SRrhrril I sh'uldlErom {hjcd !o rh.
<br />sorr.6.onllcn!0liontmvnionrotS(rionlT(x).rrh.Lf,h.rC{xl..l\hrll.fodhwilhonrplyvilhrl'i,*tr.visions
<br />w]\RNtNC: f:rilu6 t, {.urc wo*er{..n[cnsrtn)n covcmac is u.ln*ful- ]n {hill suhi.t Ir cnPloycr ro niminrl Fnikts Md
<br />civil ft,.s p t) onc hd dr.d rhou\r d doll.rs rSlm.UDr. in i dnnnt (, rfi..or
<br />9ypcn$rion-
<br />damccs a\ Pi(Jvidcd lor rh.
<br />Srcrn,n.1076of rhc Ld$Codc. ir .Ns {nd
<br />blp 1 8- t3
<br />I hercby aflird unJci F.n ryol pcljury th0l I rn liccntonundcr nmvhn'n ol Ch{rcr 9l.onrmncing wilhSccrion?0{D)ofDivitiotrl
<br />of rhc uusim* s.d Pn,fcsidE Codc. and nry licctr* h ir fulllorccn{icrlccr
<br />4 to )3 617
<br />"",.: fr 2x1
<br />IaNflIAUSUI.NTENDINIi.{GIN1;I
<br />I hcahy arfinnundcr Fnalryorp.rjurythar rh.rc is a $triddir hndirs :Etn.! r(tr rhc !.lfornrmc ofrhc $ork ror which rhis lcnnir is
<br />i\\ucd (Scc 1097.( iv C )
<br />Lcndcis Addrcs\:
<br />-
<br />A.TIIICANLJI&SLABATAX
<br />I lfrbr rmnn undcr pcnrhyotpcrjxryom.rrhc rolbwirg dc.l,rtri{ N
<br />D.'ft,l n P.nnirs.Asbcstos Notincarion F.teral Rcglkrions (lirlc40, PM6)
<br />Rcquiod Irtrcr of Norificorion
<br />h .rl (rrfyriJr rhc rMoal'.sul'un. rldJ r!,.h(!u\ r.'mrJl Jr. rr r|nl' rl"l. ti rl
<br />ILI\\,* ^,
<br />,n^" *,
<br />'nn
<br />JnnrKs,trin srd {Jn',h ,hr ltu\c 'nh1n'.(tr,r h."trc., I asE ro @njlllywirh allCiryond Counry
<br />ivcs ofrhh CIyud County lo cnts uF,nllr
<br />".,",-
<br />01^2_fl8
<br />hcr.by aulhorizc rcprcenralo'd rn.cs mlsrxrc l-nw! r.htin! b hul rli:r! cotrntuctrq 5.,htrr n* r n.lI,', t..'rr r,trfi,plar L{ j,ul!\$ ,/
<br />trr,u.r. nr*,.,"*,r* )4- 1.,'j::,::..il:x- r*),,,tr 7T0.4
<br />Sel Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathing
<br />Shear Wall -lf
<br />Framing .<#)
<br />lnsu latio n/E ne rgy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence A
<br />W.VLttl
<br />Handicap Req t7
<br />Deputy Final Report
<br />Engineer Final Beport
<br />I ,^l
<br />FINAL rt t4 ugf ./lvu/..y{1 a
<br />Certiticate ol Occupancy V ^</
<br />Notes, Remarks, Etc
<br />f
<br />olSlr?Tr*,.
<br />(rt
<br />T-Bar ll-H-tr
<br />Flood Zone Certif .
<br />-[tFnc.
<br />-
<br />tt
|