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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE COMMENTS I hcrchy alltr !nd.r ,rnali,
<br />Bu\i'id* !'d P(,fc$nJn Codc): Any Cily or Coutrl! uhi.h rcqtrircs r lcnnil h c.n(ru.r, rlrcr. nnpnrvc. dcmri\h ,tr ruFn Jn!
<br />{ru.lur. pritr b irs i\$.ncc, rko rcqunN thc r,rplica for $c[ pcrnri o filc r \irmd {d.mn h hcoi sheh lictntd nuNianr
<br />h rhe nrovisi.n\ olrhc Coniructr\ l-ic.nrdd l-rs (Chrnr.r 9. c(nnnrcmine eith Sccrbn TlXl) of Divi\n loirhc ln^incsand
<br />Pmfcsi,,o\ Codc)o.rhrr h.or shc scxcmrr rlrcr.froD rnd rh.bnsis nn th.lllcscncxc nrbn Atryvirn,ion.iSc.riotr?o:ll5byany
<br />+tli.rnr rn a p$nir luhjc.Brhc ipplica.r ro n.ivilrMlly.lnol nnne rhrn livc hund(ddoll.s (S5u)).
<br />-1.
<br />a\ D*rcrofrhc ptr'i.nr. (tr mycntlolc.\ wirh siScs rs rhit slc cnmpcn\arion. willdo rhc sork rxi rh. ituluc is mr
<br />iN.frtcrl orotlcrcdinrstrk(Ss?044.Businc$lndPronsionsCodcTh.Conhi.kr'sl-i.cnscl-rrdocsnorq,rlyr.anowncror
<br />rh.pmp.ny Nho builds or ihpn,lcs iltrd,n. *rl sho d@r .h q)* hnnscll'or lEr*ll or rhroulh hii or hfi owtr cmPloycc{-
<br />pruritd lhd su(h impmrqEnh aE mr irlcdcd .r.ltcBl for ek Il k'ac!cr. rh. tiriklinA or nqmvcnrnr is sH *nhino'* )tr
<br />orco'qncrion. rh. Owncr Buil,+r eill harc rhc h!.detr ol proilra thll hc or sh. did ior hxiu or nnPm\t thc tNlrcny lot rh. purrr\c ol
<br />l. a\ owncr of ih. trutdy. nncx.hsirclyco raciir8 s h li.cnscd conlrickr\ lo rotri .rrltnroj.crlscc TOir4- Bu\inc\\
<br />ili Pnrfcsion Codc l hc C.ntactn \ l-iccnsc Lawdo.\ nor applyh M owrcr of nrapcny who buildror inpmvcs rher..n.
<br />rtrd who conrr.r itr such pmJltls wirh!C.nrracro(s)liccnscdl'u6! nr brhca rd.rols Lic.nsc lnu)
<br />I am.r.mr under S(botr .B &PC for rhtrMn
<br />D.t.: Owner:
<br />tlll8trE8S:rOMtlNSATI!.t!
<br />DE!LI&UI{}!
<br />I hcrdby rmrhxndc' p.nalryorNtury orc ofrhc louowirs dNlfations
<br />-l
<br />havc a,xlwill mainiai'r aCcnillcrrcofCon\cN n) SclllNrrclor workcn co'npetrsrion.ns tn,lidcd for bySc.ri{nr ITOO.trhc
<br />tjli)r Codc- ldlhc pcnnmakr.lrhd *.rk f.r whi.h rhot nnir is Nrucd
<br />IhrkxtrdwilLnui' n sorlfs .onrJictrsrridr inntrircc i\ rcquir.,lhyS.cri,n,llT(X)(,rrh. Lrbor Codc. Inr lhcncrfonn.ircof
<br />{rcd. My wor kcN' ornlpcnrir
<br />lnL
<br />f /r'/t*
<br />-l.cnify
<br />rhrr in thc pcrforrume ofrh. work ntr {hrh rhis !(rnir i( i\rucd, I \hrll n.r c'npk,y rny l.^otr nr rny nrlnn.r
<br />*, nsk,b..om subjc.r t'rhc wo rkc^' .o
<br />'n!.ns!r
<br />ion !r*aotCtrlihrnir tid 4tc I
<br />workcr\.onrpctrliri(rprcri\i,)NolSrcrion.rTfi)ofrh.lrhtr(,)tlc.lnrll.ir)n h.oDIny *irh rho\c pn)!r\i, !
<br />W RNINC, &ilurc b {corc workcn comp.trsilro Llvcrdlc n un['wt,l. und hrll \uhjcci r r tno)rr r' (rirni',rl lxMlri.r x
<br />(ivil fir.\ ut ni onc hun{lrod rhou\rM rl.llr^ (51(X).(XX )n of cf'npcn\rdr, dn rgci rs Fivi(lci liir (hc
<br />xJ-z#l
<br />DES.AAA.IIAN
<br />I hmbydflli,nuturcr pcn y.l p.rjury rh.t I an liccnsd undcr pmvhion of Chaprd 9 {.onmRine wnn Sccti TUD) or Divi\n,n :l
<br />of lhc Businc$ lnd PDlc$t,ns Cod.. nnd my li.cns is in rull Lu o,xl cflcct
<br />[r:r'f
<br />CONSItsUEI]ONIIINDIXQTIj.ENC.I
<br />I h.dhy lfir trndcr !.nilryofpcrjryrhllhcrc isac.r(rudion tndin8agci.y tur rhc lalonnrNc .l r hc worl lar whthrhi( |f,nnir t
<br />isucd (Scc :1097. Cir C )
<br />AITUCdNLDECLAEAITAN
<br />I tmhy amm un<ler pcnlh y.r I,.rj!ry on. orrhc rolb*ins dc.ld,riotrs:
<br />Dc,mlirion P.irnrtsAshc(os Norificorion Fcdcrrl R.$hrn,ns ('rib40. Pd6)
<br />-Rcquncd
<br />L.ncr oi Nolificllir
<br />lccnifyrhi rhc l.n.'alr+uldrion\ rgrdin! ishc{.lrctrk*rlrc Nr rppli.rhlc i) rhi\lni(r
<br />I..niryihd I hivc ro,J rhisrfpli.atiotr d slslcth.t rhc drvc inlonDri, n.oncd I !8rc b.omply wirh rll Ciry ri coutrrt
<br />ordin kc\ Md sra'c has Nl.titrE robuiklin8{otrslrucl hcrcl,yrurhori?r rtrc*nhrivcs olrhn Cilyand Co{trrr ro c d uAJn rh.
<br />r}'(trc nrnri(,rn f'op.dy tur
<br />*,", , /,, /raNr'-'
<br />)"-,r*/h,, h h.,rk
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathino
<br />Shear Wall
<br />Framino
<br />lnsu latio n/E ne rgy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL *\u\\"\ll,4qhe )
<br />Certif icale of Occupancy
<br />Notes, Remarks, Etc
<br />ID/SIG.
<br />Erection Pads
<br />I
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