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BUILDING. INSPECTOR RECOHO
<br />SITE.WORK DATE COMMENTS
<br />Set Backs n---
<br />Forms/Steel/Holdowns X/6/r(ldfrq1
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsu lation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framino
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lalh
<br />Brown Coal
<br />lVlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enoineer Final Reporl
<br />Flood Zone Certif
<br />'1 t^
<br />FINAL fr/z/8 ATL1,4\
<br />Certificate of Occupancy ---)/a/
<br />Notes, Remarks, Etc
<br />()\\'\t,tR ltl: ,t)Ett I)tat_(,\R1 I ()l
<br />I h.rc$y afiiln trndc' p.nrlrt,,r Nrjury rhar I crcnU rmn rhc Cntrh.ror' l.i..n\. lrs'rorrhc rollo$irr! rrn{ (S.c70
<br />Bunm\s rnd Pdasi,)n Codc) Ary Cir, or Connry shi.h rcquirc\ ! p$nir ro con{ .r. .lrci nnP( c. dcmolhh ,{ rclrrt r
<br />ndcturc. prior ro irs hsuocc. also reqxircs rh. applianr ror s!.hp.rmir ro lilco stncd sla'clmnr rharncorrh. i1 liccnscd pursuinr
<br />to thc F)vnions or rhc Coflt.crols Liccnsed L{w (Choptcr 9. CoonNi.ing wi'h sccrion 70ix) ol Division :] ol rh. Busincs nnd
<br />Prcfcsioas Codc)or rhnrhc or ihc is cxcnrpr rhcElron!oid rlr bNh li,r lhc dllcgcd crcnuion AnyviolurionoiSc.rion 70115 byu.t
<br />oppliclnriorapcnnirslbjc.rsrh.appli.,nrro,civilNn,lryormrnrrcrh.nfnchlndrcddollaF($5fl1)
<br />-l-!!oFDcrotrhcnmncny.ormyeDploy.cswnhwrycsd\rhcirn,l..o.rNns.rion.willdolhcwork0
<br />l rhc slturm i. iur
<br />i.rcndcd or olTend for sl. (Se ?O1-4, Busircs ! Pmlcssions Codc 'l hc 6nlE.rois l,irn€ l-tw dfts nol ryrtly ro !nowncr ol
<br />thc lmp.ny who hoildr or in{ovcs rtEn,n, Md wlx) dms sEh work hnnsclf.r hcMllor rhmqh hh or hcr osn cntl.yc.*.
<br />Ftuvidctl rh3r such nqrolcm.h {rc nor i cndcn or offcrcd Lr eh ll txMlvcr rh. hiuiry or iqm,w nr ii $kl *irhh onc )er
<br />ol co@trion. rtE Own.r Brih.r uill haE lh. bunlcn of pruviE rhd hc or sh. dil mr htrikl o. inqrort rh. In,tdy lo, ltr I'urlr$ of
<br />-1.rsowncrolrhcpmF
<br />y. aucxclusivrlycotrtrr.ri',A s'irl,li..n\cJ cnntr.kn\ ro.oi{rucr rlt prolN {S( 7(!,1. Bu\if,rn
<br />'rl Proit rbnCodc: Thc Contncror's t,iccn$ Lrw rlocs not ipnlyro m os ncr of pR,p.ny ah() huildso, nnpi,xrr rhcrc n.
<br />rnd wn. conrrocls for such pmjc.* wirhrcoihtr.ttrh)li..n\cd pursu{ n)lhcQnrrmcr,tr s L-iccn$ t-nw)
<br />I nc\cnu trn cr Scciion . B & PC lnrr[i\ N*rr
<br />Drrer OaNr:
<br />WrtnXFtS' t:<tltttlS,rltt."t
<br />DECLABAII9N
<br />I hcrcbynmflnu er pcMlryofpcrjuryot orrh. n,lbwir! dNlddn,s
<br />-l
<br />havcnndBill nminroin 0 Cenituare ol C6nr.nr io Sel n\u!c rd workcr{ .omtcnsilion. .s fnvided ti,r hys&ri.tr:r7lx) ofrhc
<br />Lh, Cftlc. i.r rhc fslonuncc ol lhc qnrl lor trhi.h rh. pomi n NrucJ
<br />.'-lhlEaodsillnrinrrin*orkcrJ.o.r.nsariorinsuran.c.nsrcqundhySclionlT00orrhcLah.rcod..lorrhcpcriornnnceoi
<br />rhc work f whi.hrhispcnnil is iracd. My wgrtcB coqrtrsolion insuramc cmi.r "il F,li.y nun$cr 0E:
<br />fl,n,lAry
<br />- t\]rAt 7 D 4?q n
<br />I.cnily thrl nr lhc prrloruncc oirh3 uork fitr shi.h rhis lfnni is nsucd- I shlll nol cmploy liy pcr$n ln rny mrnNr
<br />s, rs n' lr.d f, sobjd tu rhc workcs conr,,cnsariotr hws ofcllifunir- trnd rsft rhar irI \hould bcco,rc suhicr t, rhc
<br />sork.r' .r lP.n{r i,,n pn,vkioN of Ssriotr 37OO oi rhc Ltrhor Codc. I sh,ll, nnh*irh $nll)], with rhosc pNvnions
<br />W,\RNINC l'iihtre ro rccule w{ crr compcnsrriiD co B. n u lx\fDl. nfd {r{ll $t'jccr rn .mpk)t.' t) .ri'iiml Ntulrc\ ntrd
<br />.ivil firs u! t, onc hundrcd rhou\anJ dollr\ (51(n,;;;;;;,i:TilT;
<br />Ihcrchyrflin ondcr Ftrrlryo, lrrlury lhat t undcr pmvi\i{r of Chllrcr 9 l.o nrErcirA uiri Scri,n 70fi)) ol Division l
<br />oi rl'. llusirus rtrd l'rolt\no'rs Codc. dnl Ny licef r is in h,ll brc. rn,l cllc.r,
<br />a4e ?qL?va
<br />//b l ll
<br />I hcrchy.llirD undcr rcnrliy o l txrjury r lrr rh.r. n $ (o.rn,n hndner3.trcy lor rhc lcrfffnum. ot rhc qork lorshichrhi\lciinir i\
<br />AITLUANI.OECI.AXAII9N
<br />I hnhy rlimr undcr pcnrllyolpcriuryonc oarhc nnk,wiis dc.ld,rnltrs
<br />Dcdolirion Pcrdni A\bcsos Nori'i. ion l'cdcral RcEuhrn'ns (Tillc.lt). Pdr,
<br />R.qutcd Lcrlcr of Norificnrion
<br />-l
<br />ccnirrrhd rhc r.dcril r.guldrioN rcgrdinS 0sbestos rcnnul urc norlPplic$L rD rhis nbjccr
<br />-l.cdiry
<br />rhar I havc rcnd s0rpli.arion n srar.rhar rhc dh,vc inLrmdiotr i\ concd. I 088 ro codply wirh rll Cny rnd Counly
<br />o i' (\ rtrJ Si rc l-xw\ r.
<br />rlr\r nrDri,n(l tn)I[ny l,n i
<br />A!t,limnl or *ml Signolure
<br />1PtlL.L.
<br />';)4;.
<br />ID/SIG.
<br />..WVsfltPr€l l
<br />7
<br />issu.d (Sc.. 1097. Cir. C ).
<br />Lrndi \ NJm
<br />-
<br />tf,ndcr s AdJrcs.:-
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