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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS O,c.Alibr D..!.r.rih
<br />I hs.6y.rrn !'nd F hy oaFru, drr I m 6hF forn r Contri.ioE LEM l,p fo. fi.folro*m8 r.&. (* 70] | 5 Asin4
<br />,n Pretcrion Cod.)r Ary Cny or Coury rbi.n ,.qrn6 . Fhil to (rErEi. ir6. imr6v.. &mlLh or E .i et .BlG. Fs to irtislllc. .lto Eqli 6 rhc .rrli.rd fo, ,.t FEi ro 6L r ttn d rd@!r rh.t ,r or tb. i li..6.n puBlln io r Fovilbr of ilE
<br />co@od r L'6.d t r (Cllpls e, Cofrnft'as rnh s.de 7m ol D'vu.n I of llE BBln6t.'d ProL.66 Cor!., or tllt rE or
<br />3h. t.rand rn6.noi..d th. b..a fot ,. .tc8cd .rdprbn Any tiohbr ols.di,6 70lt 5 b, Ey .ppliod for. ldhn.ubrc.s tll
<br />rppliUl lo r civil p.ul, ofd mE lh.r fir. h!!dr.d dolle (ltoo,
<br />I. a o*n( .f rhc DoOdy, .r ny .mploy.6 * ilh s.g6 .! rh.i, $k comp.nr.rion. * ill do rh. uork rnd rh. rtucra. n @l 6r.ndcd
<br />or oatcr.d lor {1. { S( ?oaa. 8unh6s .nd P.oL:yons Cod. 1 fi. Contrcror'r L'c.m. bw do6 @r ipply h rn o*n.r ol rh. prcpdy
<br />*ho build! or impruvd thc..on. md sho doB 3Eh *drk hidslfor h6.lforthro4h hB orlE own cmploye!. provid.d rhll3uch
<br />inDrov.m.nB .r. ml hr.nd.d or olt r.d ror nl. Il ho*c!d. rh. hildi.t o, nproven.nt i! &ld unhin on. y.!r ofcompl.l ion. lhc
<br />()9.n-au,Ba wrll h.v. th< bqdcn ofprovins lhrr lr or th. mr build or mpNv. for th. purpos ofrl.).
<br />L Bos6of lh. proFnr. d .r.luiv.ly ro.tdin3 {nh k.r.d c.dftroR ro @drud rh. F.i.{ ( S< 704,1, Bsar*..d
<br />PreGsan Cod. TIE Co daoi! l-E.M t w d6 mr.p?ly r. u otM ofpropd, who b{rldr d 'nrro6 rhq6^. rnd *ho
<br />otut for i*h For.cb *.h r Co rdod,lrcd!.d pl,ud ro nCodndofrLr..rt *I
<br />_I 6 .rdDr @.1, ScriD .B lt P C lor rhu .c!o.,"*1
<br />!1 ORI(ERS COMPf NSA'IION Df (-LARATION
<br />I tF.by irfirn undq p. lly or Fjury orc o f rn. followr* dfrl.d iDB
<br />I hrv.lndwrllmlrnllin ! ('.n'nc!t.oacoM roS.lf-l ur! ror wortcB .omp.turton. !s prov'dcdrorhvs{rk',:l7o0ofrh.
<br />Llbor Cod..lor lh. pdfonunc. of'h. work ror*hichth. p.rn a ilsu.d
<br />IlEv..ndwrllmn!.'nwo.r'of,p..sriinh3u6e,BGqutr.dhys.d.nI7mofth.trborCodqforrh.p.dormnc.oath.
<br />*ort for *+rh lhtr p.rd 't e.d My *ort6 comp..nr6. rBumc..uir Dd poli.y nuEb.r El
<br />Polt, Nwtn: _. _Erpid:
<br />(Thn <ih E d mr h. .onpld.d if rb. Fmi ir 6r Oo. I'u!.h.d dolln tt l00l o. L.)
<br />I c.dirr lh.l i, itE F.romec or0r *ort fr wtth ltir Fnn i! isu.d. t rh.ll mr.nploy ry F$n h.ny EnM s sro
<br />b<.@ 3ubrcr ro th. sitd 6np.dlo. L*. ofc.ltor.r tnd l3,* tld I rhould b6om rubd b itE wrl6'
<br />nrn! cf\. 'nn tu,nlrh. kbor {'^Jc.lrhrll l,'nhtrtrh.
<br />WARNING r!rlur.ro r(u,. worl.B comp..srion.ov.hs.'runlrwlul,ind!h,ll3ubjNt(.mploy.rtodminilp.ulrii!ind.ivil
<br />fin6 up io oft hundr.d rhoulrd dollB (l | 00,000).in lddnion |o lh. colr of conp.erion. dMAs6 a provid.d forth.Sdion 1076 oa
<br />th. t bor (od.,
<br />'ntd6r .nd .tro.n.yi f6
<br />LICENSED CONTR CTORS DECLAR TION
<br />I h.cb, r,lim u.da Fuliy of p.rj(y th.r I M li...!.d uda pmvBnn of Cn p( 9 (@ttllmcus w h S..lion 7(]((r) of Drllbn I of
<br />th. Bsi.d.'n Prcr*.6 Cod.. !d m) li@ n h tull forc. tln ciTd
<br />,""',. o0;trI \<u*ttrwS
<br />car arcrroarlllurclcENcr
<br />I hcrcby rmm unds pc h, ofpsjury thll rn6. n . coBrtuclion Lndi.3 .g..cy lor th. p.rfom... oathc wort ror which lhii p.mil i!
<br />islu.d (sd.1097, Civ. (.).
<br />ATILICAII-UIICI,AAAUA
<br />Ddrchion Pmnt-Atlinor Norin.iiJ. F.dd.l R.sulnbN (Tir k ,10, Prr 6l
<br />R.qun.d Ldr6 or Ndrnc.'n.
<br />I .cdir, rh.r lh. Hnrl Flul!6o i.rrdrs ab6rq rEF\tle mr.pplicdk b rhE Foj.rr
<br />I c.niry $r I h.r. ra! rhjr.pplic.lb..!d xrt. rh.r rh. o* 'rfomriln n cod..r. ! rsd ro o,lply *nh rll C y..dCouly
<br />ordineq .ri Sh. lr*r El.iry to hildine oletu rhn. md n@by .uthoria rp@.llris olrhi! Cny .id Coury to 6ld upon rlE
<br />rbo\. m.m ion.d ,'rop.ny ro. itup<r io.
<br />x
<br />Y AA ,,,,," p lLt),,(
<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 />lnsu latio n/E nergy
<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 />FINAL a/*/t{ffi otd-4d)
<br />Certificate of Occupancy I \J\
<br />Notes, Remarks, Etc
<br />I
<br />M \WP51\Pe.mrt-hspeciron Fo.ms\B!'ldrn9 lnspectron Recod doc 03 3l 06
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