|
BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER AUILDER DEI,CARATION
<br />I hcrehy {ljtrm undcr pcnalry,n ll.rjury rhri I fl crchfl ,6m rhc Conk,.b6' Lccne L,w nt thc loll{'wins rcae,n (Scc 70.115
<br />Buvn.{ rRi Prola*on CoJ.): Any Cty or Counry whrh rcquircs ! Irrm lo q,rslnrl. llrcr. impR,vc, J.ml$h or EPatr 3.!..
<br />nrucrrc, prirr t, irl isufrc. also rcqnircs rhc apFli.et n,r su.h lEmit r) lilea \isncJ darcftnr rharh.orshcsltcnscd PUGU{nt
<br />n, lhc pNvhions {i tlE Conrract,'i l.En\c't Law lch{rer 9. Comh.kins wirh Scct$n 7urc ol Divtion .l of rh. aum.* dd
<br />Pn,i.son\ C,*le)orrh, h.orrh. i1.r.nfr rh.dion dnd rh. brn! lnr.h. rllcpcd c\cmplion Anyv(,Lrii,nolStrbnT0ll5byi.y
<br />,pt'l[anr lor , lcrmI suhjc.r(rhc aptlic.nllo s crvil lcnrlry.t nor frtrc thln lrvc hun']rcd'tollrs(1500).
<br />_L ,r owncr .f rh. nbFny. or my .mfloy..s w h waecl rs rhctr n,L comFcnsarion. wru do rh. ,.& anl rh. nturG tr h,
<br />intcn.lcd orolttrcd lbr slc l Se-..7O44, Busin.$ anl ttlntsions C*lc: Th. cont,crtr-! Lrcn$ trs d(Es na0dyro o*ncro!
<br />rh. po!.dy wh) boi[s or innn)E( rhcN,n, dxt whr d,f,s sNh r *hrnr.lrorh.iscllorrhrcuphh(orh.ro*n.mpby.cs.
<br />pn,v d rhar ruch impn)v.nEirs m nor dcnd.d or oficrcJ fd sdc ,1. h)*ou, ltr huilltrg or impfl,tmnr i1 $ld wlhr .rc y.a
<br />ol conDtri,)n. rrE O*rcr Bu jtr ,ill haw rlr lri&n .t pfl)ving rhar h. or nr Jr.l mt hu! .r imJmvc lh. pDFny r, rh. l)u,Ir){ .l
<br />_L r\ own.r ot th. F)p.ny. rfr .rcluliv.ly coturnrt w h lrccns.d crn@.bF b uor(ru.r rh. n$t ct (Sc(. 7014. BusDc$
<br />anl Pnrc$i,nCo.lc:lhcConkr.i(xrl-(cns.Lrrd,rsnorapplyk'd.wncrolpopcttywh,)tuildsorinpr,rc\rh.rcon.
<br />.nd who !.nka(r lor {.h t rtcch w h!Conrr..nrnrlic.n\.n puruanr rorhcConrrrcntr'\ t-kn{ tjw)
<br />_l d1cx.nfl utuicr Sc.r0 a &P( n{rh!tr'r{nr.
<br />u9atrE88:l9uBENrAr(l!
<br />DEIIAXAIION
<br />I hrr.hy rllnm undcr p.trrlryol t}.rlury.R ol rhc,!'ll,rw0,g dcclanrklr\
<br />-lhrvc
<br />rxl w,llrui.rtrmaa.n'&rh oIC.n\..r rJ Scl, ln\un'ntrqork.r( {n{'.nsirion. rs n ()vilcd fitr hySc.ron lT(xJol(hc
<br />lrhtr C(rlc.lnrr[c pcrl.mJn c ol rh. *ork lnr *hrh rhc F-mn ( rsu.J
<br />! havc ind wlll mlinrrn work.6 .onrp.nsalbn insur!ftc. rr rcquirc! hy S.rrirn lTlD of rh. Lah.r CoJ., for rhe n dirMc oi
<br />ihc hrl lor trh.h rhtr p.rmr r. ryc.l. Ml*,,rr(j \dmrBltrin rnluraRc dt' , F,ltrvnumh.rR:
<br />.,"., . _l-...[^ A,-.r" ;.* ^
<br />\-"J C O 13 (. I (" Po^1 16; -r -r a
<br />Iccnni rhar inrh. n rlornroncc 'n lhc wolk li)r *h'.h rhr !.rnnr tr r\u.J. l\hrll n.rcfrPk'y lnypcron in uy mann.r
<br />v) rsbhc.om subJcd n, rhc workc6' co.l,.nd nrt hws olCrLn)mrd, dr,i alN lhll il I \h'uL] hcom \uhj.cr b rh.
<br />workcr.onfcn\dnntovrionrolS(rn)nlTO0ofilrLatxrC(i,..ldnll.li'nh*irhconplr*'rhrhRF)vsion\
<br />W nNNC: I'dluc !i ecurc M crr' .ompcnsarion .ovcr!3c is unh*rul. lnd \hrll subj.cr arl cfrpl,]ycr (o Lnmmd lrnrkA and
<br />(,vrl tin.s up (, .nc hnlrllrd lho(sann dollr 1Sl0(,.0(lO). nr !'lJ i,n n, (hc ro{ of con\f,n(.Lon, Jrnr3cs r\ p(,rxlcd lar rhr
<br />Sc.r!)n.1076olth. LfitrCixlc. rnrcrc{ xnn rhmcy s l..s
<br />oor", ')-?4 \\ ,tppti.unr \4-tr( \,-('r? -
<br />LICENIE!-qONISACIAB
<br />DECIJAAIIAN
<br />I hcrby llltrm und.r Fru[yorFrjurylhd I am li.useJ undcr F]vFi{}noiChlprcr 9 (cohmftm8 wnh Setio. ?OOO) ol Divhii,n.l
<br />ol rhc Busincs atol Pr)t sions Cod., rrt ny lr.nic n m InU ntr.c 8l.lt cl
<br />(-.2 S o tfr'-{
<br />u"r", - ?-)o t\ conr*.ro.\a-
<br />colsl&ucuoN.LfdtrlNc-A
<br />I hcrchy rtltnr nnd.r p.nnlty o, t rjrry rhd rhcr. r r con{rucr rn kn,iinS !8.rcy lor thc pc.Lmac of rh. work for rhEh lhis lEmir i\
<br />nsucd (Scc. llu)?. Civ. C.).
<br />AIELIIANLDECIAEAIIO!
<br />I H,y aliim un'l.r p.nalry ofr.rjury dft ol th.lnlbwm8 d.cldark sl
<br />Dcnn,[rion Perm ]Asbcdos Norirlc,rtr)n F.d.hlR.tuhri(ff (T lc 40. Pd6)
<br />Rcquncd Lcrrcr ol N.{rlluari)tr
<br />^
<br />I!(d t rha' rnc rcJqrlrouhrr,n' rF d rc J'hcr.- rcm,\rLnc n.' rrrl! dhu !',ha I'n.ad
<br />11yl t'(cn'lrrhdlhi'c(,lrhHnnl'.rrn,ns,rlnrrc,hrt,hcah,vemk,turon(colR-..t.IrsrerouomplywnhaUC trnrlCoutrry
<br />/ tr,lrnan.cs ,l Srrrc |js\ rcLrrn8 n, hu'l,l'n!L,,ndru rrn.ir hcrch,rurhrrcrlprcs.ralivcs.lrhirC(yanlCounryro.nr.rqDnrh.
<br />rlx)vc Ntrrnfu,l |Io|cny l,r fl \F-(rkn' N'rxc\-s
<br />* \-'c.
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVlnsulation
<br />Roof Sheathin s
<br />Shear Wall
<br />Framing
<br />lnsu lation/ En erg y
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL JnTlq 1?-c , sntt ,-5 ( At71
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc.
<br />W 1,v&-*- lm
<br />T-Bar
<br />r,,rr., a ) -?.' - ''\
|