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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE tD/srG.COMMENTS OWNER BUILDER DDT,C R TION
<br />I turchy nrii,n undcr pcnnlr,,,f ncrjury rhrr I !n crcnrpr li! rhc (i'lllrlcnni l.icen\c lr* lnr rh. following rc.hn 1S..7011.5
<br />Bunn.\\ md Prcf.r\i,nr Cod.) iv Cirt or Codniy {hich rcqut \ x Frnrir k, $n{ cr. alr.r. nnprovc, dcDrlth or eJ[n inv
<br />nru.Mc. prxtrb h\ nsud'f,c,.1$ r.quirsrhc amlicx r tur suchfnnir k,lih r \iAncd { c'Eni rh0r lEor she is liccnscd turuanr
<br />h rh. pn,vi\i,'n! of lhc Conrrucrors L,iccn\cn Llw lChaprcr q. CoDnncNins uirh Sr.rtnr 7fi1) of l)ieision .l orrhc BuliftN ,nd
<br />Ptufc$rns Codc ) .r rhrr h. or(hr n cxctrU rhrrcliomitul rhc hi(n turrturllcF.d crcnruion AtryvnnarionolSccli,'n70.ll Shyony
<br />apllicanr hrap.nnir luhlL\k rhc rpDli.,nr r{, r.iviltcnJl,yol nor nFr rhnn fi. hu rcJ d.llm (S5d))
<br />-1.
<br />rs .wrcrofthc nmFny. or nrycmrloyes wirh qlgcs as rhcir qrc .onD.tr!.rion. *illdo ttr sork and thc {MrE i\ n
<br />i' cftllrl ornftercn n, sb(S( 701-l. Busimsand Profe$io.s Codc l hc C.ntracxn \ l-icen\c li*dne\norapplyronnowmror
<br />rhc pmlMy wlx' hnld( or mrNvc\ rh.ron. arxl utkl tlle \u.h w()& hnnscll or hc(clf .r rhnueh hn r hcr own enut'yc.r.
<br />nn,!id.d rhar surh i'nfn*tnE s e dr ihictolcd or olltml lbr sak lL h)$cv.r. rh. tdiHin8 or in{hvcmd is$ld $ithitrnrc F
<br />of con{'lcr i,n. rhe Ormr Buiuswillhovcrhchurdcn.iltrovinS thol }rnrshc did an hiklor impnM ihc pnFiy ror tht puit $.f
<br />-l.
<br />r\owtrcr.lrhc l]l.n dy.r ciclunvcly.onrd.ri8wirhli.cnrd.ofti.nr\rocon{rucrrh|nojcd(Sc.7(!t.Bu$nc\\
<br />nnd Ibrssbn Codc: Thc Conkrcktr s l-iccn\c l-trw doc\ norkpply ro un osncr oflrnincny *ho huild\ or inrtro\.{ rhc.con.
<br />and who .otrrack f.r \u.h foj.ch wnh d G,nrm.krrs) licctr*d N(ua brh.Contricttrt Lrctrsc tjwl.
<br />-l
<br />m.xcmDt undcr Sdion-.
<br />?- t<>' lx
<br />DECIAIAIIAX
<br />I hcrcby arirmundcr pcnllry oipcrjury onc oirhc nnbrin8 ddrrlrtu.s
<br />-l
<br />hntr ond will Nintoin !(cnific!'cofConsctrt bSclf.lNurc for s.rk.r'compctrlrtiotr. as prcvidcd fu6yS(ri,n:170(rot rh.
<br />Ijh)r Codc. for rh. Frfortun.. of rhc eor* for which rhc ncrnir is n\u.d
<br />lh\rrnd*illmJinllinsorlcrrco'nncn\rrioninrurancc.isr.quir.dhySccrion.lT(nolrhcl-rh.rCodc.lnrh.|f,rronntucof
<br />rh. sork f(tr*hi.hrhi\ p(nnii i\ k\ucd Mt NorkcF .otrp.n\rri,n, nxurkccrni(r url lx,liy nun$.r rc
<br />Poli.y Nunb.r:_ErpiE!:
<br />I c.rlily rhal in lhe pcrLrmncc ol rhe w.rt for which lhh p.irnir k hsued- I \hall nor cnuby an, Frsoi in any manftr
<br />s as ro h.corm subJccr ro rhc solkcs corrDc.erion lrelofcalifomir. a*l aErc rhd if I should beom ul'j.rr lo rtE
<br />rorkeG compcnsorio. pmvnions ofScdion:1?00 ofrhc Lil[r Cod.- I drll. nrnhsirh ompl) wirh rh.s polni,,ni
<br />WARNING Frilurc (o Ntrr !ork.^ .om!.n.dri(,n corrm8e is unlrwful. nnd shdll suhirr nn cmflotcr r. aimimlpcMlli.s and
<br />ciul fin.s up b .i. hundrcd rhouend dollr^ (S100,(XX)). in oddirion tu rh...{ .f.orJ'..erio., danu8€s es proviid fo! rtE
<br />S..rbn 1076 .f rhr uhr Codc, inro.i r.d d omy'1 ftc\
<br />o*..4'1u /!q.,o,{ ,l1z,.rr/.+<
<br />t)tact \R,\ lx)N
<br />I hcrehy amr underlcMhyoipcrjurylhar Iom li(.{nundcr rovhion ol'Chrprc. s (conrmkin! *irhsccrb.7m0) olDivisio.l
<br />of lhc Busift$ and PmLssiorx Codc. tuxl my lrcn{ i. in full Lr.. &1d .lt{r
<br />Liccn* Nuntti
<br />roNirBueuaNri DlNtiltillll
<br />I hc(hy rlftr undd pemliyolpcrjury rhxr rhcE n r.on{rucrion lcfrtin! rgcn.y tur rh! t rrontun.. ofrhc sork for which rhi{ IEnnir is
<br />i\\ued (Sc. :llI)?-Civ C )
<br />AIIIICANI.DECI,AAAIIIIN
<br />I Hry rfim under rcnrlr, of Frjury otu of rhc fink,winA dNlaruri{'nr
<br />l)ennnirion Pcrnrih Ashcnos Notincaiion FtdcralRcBulsrions Il irle,l.O. Pln6)
<br />-Rcqutcd
<br />t tlcroINotifiorion
<br />I ccnil,vrh t rlt lc,lrftlrcEuhri,trr r.lxrdi',! x\hL(,^ rrnxNr rc nor nt)fh(nhLc ri Ihs |r,(ir
<br />l..trifyrhd lhrvcrc drhi{amlicrridr rxl {drcrhii drrhrt itrlnmniirI i!..r(r l!Brelo.otrrlysihrl]CirrairlCounr,
<br />ordinrN.(and Srdc Lrw( rclrhng ro huildiDe.dnnrudion. rlhcrchyrurhtrizcrcJ)rc{nrdivcsolthnCirylndCounrytr.nrerulxntrhc
<br />ah,vc nrnriirrcd l]lopcny lltr inspccrbnlUrr^c\'/o - 1f.*,*,**-,o*^,,-/ 2"-/ -/{zoy'ula
<br />,"^,,"" **,,"",,,,y'' /J;</ 4tqzu/<
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />R oof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsu lalion/Energy
<br />Drywall
<br />Exl./lnt. Lath
<br />Brown Coat
<br />lVlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif.
<br />
<br />FINAL l0-"r"1\),u-t)i)\
<br />Certificate ot Occu nc
<br />Notes , Remarks, Etc
<br />Erection Pads
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