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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS o\t\tR t t'tLt)Eu t,ut (-ARAI()\
<br />I hcrch, llftm undcr pcnalry of l.qury lhar I !m ercmlr In)m rhc Cotrlrtn'n' l-r.n{ hw nr rhc nrftrqin8'rcdn]n rsi ?0:ll 5
<br />Bul r.\s Pnni$ion CBl.): Any Crly or Counry *hi(h rcquircs a pcrnnr L) (onNrud. .lr.r- ihpft'lc. Jemolal r': rq)'; 'nv
<br />{nr.trtrc, nritr t' irs tr{rrn.c. .lsr requk\ rh. rrplrant ti}r n'.h rrmi n) lilc ! n!N't drd'ft.r rhar lr or dE s lic'n{d Pu6unr
<br />h rhc 8)vrinr oi ltE Cont&lors LrcnrcJ llw (Chnnrcr 9 Cofllnrcn.in! qirh Scli.n 7O(n ol Drvutrn :l of ih' Btrqn's rn'l
<br />PNlc$r'nsC,rlc)orrhar h.orshc i\ crcmfl rh.r.honr$d rlE hrns tur rh. alktcJ crcmpton Anyv! rlionotS'dnn70ll'5hv3ny
<br />iprlrcanrnr aFmir suhjcch lhc lpnlrrnr t, d.rvrltenaliyol nor morc rhan livc hunnrcd doll.n ($5(x))
<br />I. !s o*ncroirhc 0n'Itny, or mycnrployccr *irh waScs as ihct nrlc ro'qcn\ trm willdo ilt wo.k 8l rhc dturr N
<br />'kninrcftlcJ or oflercJ tur qlc (Sa.?l)44, Busincs 6n! Pnlisi,,ns Col. TIt Ci'.rrrnn \ L(cnsc Ltw di$ nor ,o)lv to an oc ncr of
<br />rh.p$tEdy *lx)I
<br />'Us
<br />o n\htv.s rhcNn. ml who 't(rs 1u h q,ft hrm\cll or hcr*lf.! rhn)u3h hr or lFr trwn cmlk't'c(.
<br />gov'J.J rhd sueh Dpn,vctrn( N ton n cd..J r orfod kr \rld 1,. lDwcrcr. thc huilinE or rrpl,wnrnr t $U wihin
<br />' 'nc rx
<br />;icompLriln. rh. O*mr Buiucr *ill hak rtE bulhn ol lnlvin! rh,r h. or $c drl,rn tr{'U or mP,l)rc rhc pR'IEiy ntrrh otrqrr ol
<br />l. riown$ol rh. rrorny. rmcrclurvcly.onlra.rin-! *nh lirn\.J (.n,cn)F r, .on{fl.t ttE Inojc.r (S.c 704'4. Au$ncs\
<br />r Plr.(vmC,nlc lhdcl,nkr.MiLi.cnrcliw'to.snoraPPly!)inowncrotPrrcnv'hoburld\orimPnrvcsrh'r'on.
<br />rtrd who ronrarr\tursuchnn)rc.h *irhrc.ntaclo(n lNnscJPuisu,nr h'thcO,nrEcttr'r L'.cnt Li*)
<br />I io,.!.m.r tr,,.1.r Scdi.in ll. & PC lnrrln( rcrn]n.
<br />lrrlr
<br />-
<br />WOI'KERS' COI\IPENSATION
<br />IJEIIAIAIIQN
<br />I h...hy rtlrm undcr g:nalryol t rjrryonc.lrhc ri)ll('wms J.clrdr({\
<br />I hn* rftl *,ll frrnrM iCcnii.arcolConscnrtu Sclltr\urc l,n workcr'.onrncn\rhon. !s ln)! cd li)r$yscrNnlT )ol rk
<br />Lrlltr C'ilc.l,n rh.0rtLhrnL. ol rhc work ntr whirhrh. p(m r ssucJ
<br />-l
<br />hltr Md wrllmrinrain workc^ c.mFns,lon insura(c, d( rcqurc'l I'y Scru.n 17(t) ol (h. I -rhor CoJc. lor thc ndn'mnc or
<br />rhc work ii,r whihrh( p.rnrit rr ssu.J. My workcF- co mpcnsrr tr)o rn\urdcc (iFrcr lrl lxn(y nu.rbcr ac:
<br />Poliey Nun$.r
<br />-
<br />I ecnily rhrr 'nrEl P.nn.nutuc ol rh.*orkforwh(h lhr P.rm ir r\\ucJ l shrllnor cnfk,vrnv pcron hany nrMncr
<br />v, r\ n, lEonr suhje_l i, rhc wolknl . nll].ns,r i()n hws ol CalLlnnrd, ,DJ 3-!r.. thar iI I shoulJ Eiom \ul'l.cr lo rh'
<br />wortcr $nUEns.i i,,n Iln)rNont .f Seron l?tu ol rhc lrhtr C'rlc. l slHll. ndhw h conrplv wrrh rh){ lr)vsio.s
<br />WARNINC: Fa'|trtu h cu.c wtrkc6 coml(nsr( !..vcnsc is unhwtul rn\t dull \ohic(i u .nrplt)vcr t' diminJ Fmirics 3n'l
<br />.iv1l ,lnc\ up n) on. htrnJrcJ ll$usrnJ 'lollu\ (S100,m0), rn a(B ion r) lh. co{ oi (r.,ltrnr!.\ r\ I'itrrlil 1,tr rh.
<br />sc(roD lr)76 orrhc l-ahtrc,iic. in(q.n 3n,t 3tunry'slccl.
<br />t.t ( u\stt) r\)Nt R,\( 11)R
<br />IESASAIION
<br />I h.rhy.ltlrm under pcnaltrotocriury lhlr I &m li6h*J tr.dcr r,rviri,n olChapln I (omBNin8 wnh Se..tbn 7UJ}) 'l n'vrion l
<br />.l rh. Bu\ncss .nd Pnnissions Cdlc. lrl my liucnsc t in tull fttre rl cllc.r
<br />I h.Rhy ! rrnr undcr Fnalry n! rx.rury lh{r ihctc n i con(ru.l hn Lniina a8c^.'y t,tr lh. pcdnrrun.. oi th. wolk iin which rhr JEm[ i\
<br />n\udl (S.c l{I)7, Crv C.)
<br />APPLICANT DFCI,ARATION
<br />I trd,y xlln utr.lcr |xnilryolF.-rjuryoncol rhc l.l,lk,*in8 Jcclardrtr)n1:
<br />tknx,li(rn Pcrn vA\lieno\ Nothr ur l;.dckl R$ularn,nr (1 lc 40. Prn6l
<br />_R.qtrtr.d ktlcrol Norillc ttrr
<br />lrc,r'lvrhrrrl'cl.derrlr.!trLrr(itr\'.!r'lrrist'.do\'.nx,r'xrnortl,flr.'.i'ill\l)r,jc!r
<br />l-nllylhJrl hrv.krJ rhN {'t,lrdirrr,al drrcrhar dr rhrv. rtrlnmrr(rn r\.onc.r I x3r& nrondy *,rh lllciry rnd coutrr!_
<br />iv6 ol rhr C y dnl o'unry nt cnrc! !r,n rlr.rdnrrtu.s xtrJ srJrc uw\rcuttr8 k) htr,l'li"r $nnnrrirr. drl h.r.hy rur
<br />$ovr nr tDtrc,lpr)t^-ny lnr
<br />\pplionlorl*€trlSisn u
<br />Pennilec n{'n€ (pnnlr:
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulatron
<br />Roof Sheathing
<br />Shear Wall
<br />Framino
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil.
<br />, ,z-_ -;t
<br />FINAL tlilq D^P{l tg
<br />Certilicate of Occu n
<br />Notes, Remarks, Etc
<br />Forms/Steel/Holdowns
<br />,,^,.,?1bnq
<br />I
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