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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS ()*n6-Auikls l).cll,.'rn
<br />I hd.hy . mrn undd p.Ety ol Fru,y rh,r I .m .x.mrr forE I lE Conr.cro6' l.r.hr L.w fo, rh. lolh wng ro$n (* 70t I 5 BBin6r
<br />!d Phf6.Fn Cod.): Any Ciry or Counry *hich r.{un6 I p.mil tooBlrud. rlls. improv.. d.molilh or r.p.tr inyntudr.. Fnnro t
<br />isrurtu.. rLo r.qutr6 lh. rppli.lnl for 3ucfi pmrr b 6lc . liSEd i.r.ftnt rh.! h. or sh. 6 lk@d ponMr ro rh. prori.ioG 6t rlE
<br />('ont.dc ! l,,c.B.d l..r lch.prd 9. ( omftm'ns *dh SdEn 7O0O oaD'vrrn I oarh. Bu,6! lnd P,ol6rBNCod.) or ih.l h. o.
<br />th. n.r.npr th...6om.nd ih. b.!n tor rh. rlh.d.r.nptFn A.y viol,rrn6fS<rio.70ll 5 by Dy.pplidnt for!pmit tubj.ct! rh.
<br />lrplicanl nr r civil p.nihy ofnor moE th.n fiv. hundi.d dolla (lJoo).
<br />l, s owF ol lh. pDp.ny. or my .mDloyB *irh *la6 [ rh.i ok .omp.roIi6n, * ill do rhc lork ud rh. sl,ucrur ir mt inrod.d
<br />or olf.r.d for &1. ( Sa 704,1, Born6r..d Pioa6rbm Cod. Th. Co.tr.ror'. l.'c.M L.w dc tur .prly ro .n o*E or rlE Forcny
<br />who buill, or inFovo lhd@n. ..d *ho dG ruh $ort himlror h.rnlf or rtroqh hir or h.r tun .6piryG. previd.d lllr tlch
<br />inFor.n tuu.nor inr.nd.d or orlBl f6rnk Il how.v.r.rh. building or inpror.m.Dr i! mld wilh!. on. y.e ol conpld 6n. rh.
<br />(n{n('Builds !ill filr. rh. burd.n orprcvin8 lhr h. or rh. d borld or ihpro\. f.r rh. p{rpor of{k)
<br />l. a ovEr oa rlE proD.ny. .m .r.luriv.l, .ontr..r ma wnh lic.Md conrr.b6 to sErtu.t !h. prq6r ( Sft 704,1, I)6in6! .nd
<br />ProfBion Cod. Th. (-onr.doir I-E.n!. lrw dc mr .pply ro r. o}* of piopay *ho b{'kts or ,mprov6 rh<on . .nd *lE
<br />.od!.dr ror !u<h proF! wih. conr.do(t) nc6.d plBdnr iorh. codrdofr L..n-l,w )
<br />I .h.r.nrr u.dd S..rion -B & PC nn rn6 r.Mn
<br />WORKf,XS COM'ENSATION DECT-/IR fiON
<br />I hn.hy.rm und6 p.6lry ofr.rjury on. ofrh. followi.r d*lnrioBl
<br />Ihrt..idsill idrh. C.nildrc ofcoe b S.la.l Mr. fo. s,l.re- con .ur bn. ri p.ov'd.d lor b) Sehon r 70o oI rh.
<br />l.bor Cod.. Ior th. pdfomrc. of lh. work aor *hi.n lh. pcmit L tru.n
<br />*;;tnd *']l 'nrln ro'16!,.qutrd hy S.clp. r?0oofrh.l,bor Cod.. aorlh. p. orronc.oflnc
<br />i ,r '3ru.d Mv wort.6 conp..qr ,d. 'duDc..rrid r.d mli.r.unZtr <L-..
<br />oO / FrDir6:
<br />L L x.<-
<br />""",""^*,UCE1ZZ 9
<br />I fti G' ion m.d mt b. .onpld.d if ilE Fmn t lor oft hundr.d doll,. I I I m I or l.s)
<br />l..niry rh.r iothcFr.@m.of rh. so* i, *hih rnn Fnn ! Bu.<l I
<br />rFEran h$ of C.l'ror.u...d !s,* thrl
<br />llz
<br />^"r,,.r",
<br />^
<br />lo I
<br />*dL6' €np.Mrp..6srg. E unLwlul..d ttrll rubjl$ rn rnploF to ciniEl p.rlri6.id.i!il
<br />nn6 !p
<br />'o
<br />oc lu.dFd rhoaun dolll6 ( S 100,000),in .ddnhn lo lh cosr of cotrlp.Mrio dmsdaprovid.d for$.Sdion.1076 oa
<br />rh. lrbo. Cod.. rm.rsl lnd.hortuyi fa
<br />LICI NSf D CON TRACTOXS Df CI.ARATION
<br />I hn.by trtrn und.r p.uhy 6a pdjury lhal I h lic.nt.n unds provirion .f Cn d6 9 (onnocins *ilh Sd io. 70m) oa Oiliion ! ol
<br />rhc ,rB'r.$ ..d Pof.$hd ( od.. lrd my lic.B. s in tull foR rn.lfd
<br />,,:,;r;/,s-/4
<br />( r )\\ rrrr r r!(,\ | rtr'r\(, \r.r \r !
<br />I h.r.by rmm unde p. lty.fpdjury rhir ih.r. ir! coNrtu.rhn kndintq..cy rnrh. plrtom sod fdr *h(h thu p.rn[ E
<br />i!tu.d(S(. 1097.Cir C.).
<br />lrtie r N.m.
<br />ATEUCANLIDTCLAAAIIAN
<br />D.mlniotr P.mtrt-Arb. or Norin. ion F.d6.l R.guLiirN (I irL .l0. Pd5)
<br />R.quiad L.rld or Nriif(.rnin
<br />I c.nrayrh.r rh. f.d.nl..sul.ro.. r.*rd'na ah.sroi r@r ' l rr. mr 'ppl'.$|.10 thE riofn
<br />I ccnil rhl I hrL.r.rd thts innlr tr'.'.rnfodlr'o.ncom.1 l4rdrocomtlysnnill(' yrndCounry
<br />ordrnrnc6 rnd Srd. trqs r.rr'inr io rlsnr r.pr*.hrn.r of lhi. (' ) rnd Couhlytoordrb\. m.nrbn d FoFny aor
<br />/L b*=
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subfloor/VenVlnsul
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<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 />Engineer Final Report
<br />Flood Zone Certif.
<br />Rtuail- &<t*'o s)z/t-zPlrqcr\_
<br />FINAL 2/tt/t+-'- t>-1.'-zt.-,-(rs/'
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc.
<br />Lt 51\Pcmrt-lBp6c!on Foim\&,rldrn9'lGpoclon Rscod do. 03 3l 06
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