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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS Owc-&ild6 O.clr.lion
<br />I fi.r.by.mrm undd p.olry ofp.,r!ry rh€r l.n.r.npr form tlE (-onrndoR' ten! trw lor rh. fotlo*'ns r.!on{k 7orl.5 Bu'n6t
<br />d, PmfBtbn Co<L) A!, ( ky d ( ou,ny wlr(h Equi6 r Fmn h 6Biru.r,.hd, mFor.- it elnh or ED.n &y {rudm. Fsr ro nt
<br />i!!u@, .lto cquiB rh. rpplicd fot rkt Fmit b lil.. ligGd rl.lc!6t lhr li or ]tE n li..Ed puuur ro E pmvlbd of $.
<br />Conin.lor'r L'c.n*d t^ {ch.pr.r e. Cohn.*r.s Btrh Sdb.7000 oID'v86.I olrhc aur'n*.nd Pror6ront Cod.) or rh.t h. or
<br />rh! a .rcmpr rh.clioo .rn rh. b..n for rl* dks.n .kmpr ioD .Any riolnhn ol SE.l i.. 701I t t, Dy .ppliotn lor . Fmir sbidr rh.
<br />tpplic. ro.civilF n, ofmi mr. Oo nr. huldr.d d,olL6 (t500).
<br />l. s orE oalh. propcly. or hy.npk'rG *th *.36 a,E &l. $m9.n.rFr will do rlE ro* .,n E nMe i! mr idcid.rl
<br />or olfdld fo, rk ( Se 7o.{,4. B6rEr .ri ProldEn (o& TIE Cont.d{'r !rc.M lrw do6 mr .prl, ro .n ow of rh. DmFny
<br />wno build! or inprcvGlh.r.on. lrd who do6 rEh *orl hi@lror h@!f orttreuSn hi or ns wn.mployer, pmvid.d ihrt ru.h
<br />ioForm.ttrr e nor i'n.nd.d or o,f.r.d 6r d. l( ho*.G, rh briuirs d impm\trnr i &B *nnd o*,r of corpkrior th.
<br />o*8.BurH6*rrl h.s rh. h{rd.n ofp.ori.s lh.t t or rlE d hild m iDFn\r for fi. FrF* of elc).
<br />I. a ownd or !h. Drop.ny, rm .r.lurircly conrtuirr *nh li(.E d.odrdoE !o oBirud rh. Foj(r ( S< 7().l4. Buin6r.,i
<br />trcaaio. Cod. Th. Cd..dor'! L..e tr* d6 d.pply ro.. ow of proFrv *ho bu'ld, d 'mFo\6 rh.r@n , .na stb
<br />conrEdrlor su.hDroJ.dr*nh.Co.t..ro4rt h.or.d plBu ro rh. Co.r.d6 Lr..n! lr*,
<br />lu.\.Dpt und.rSdhn
<br />lloRxfRs ( ol$pfNsalloN Dfcl {lt^TloN
<br />I h.r.b, !flirn und.r p.tuhy oapcrjury onc orlh. aollosrns d.chrrrioB:
<br />I h.r !n *1U tuirr.in r ('.n'4K1. of CoE6r r. s.lr.lBuc ror mlt-t @mp.ME4 I pror d.d for br sd.i ] 7m ol rh.
<br />l.hor Cod.. for lh. p.rfomnc. of lh. eorr ror which th. pmn n i$u.d
<br />p(*,,.., *r, -,-. *,16 Ntr D.flr.. ,iu.rt ! oqur.d br s..rDn r7m orrt. !.bo' code ro, rtr F orme orrtE
<br />qr,l L q\'rhJh( nflnnr * tr\u.,.i \t! $o'1.'r .on,f,.n$'on
<br />fu-<ftCt^.. )-vt{ r
<br />,nrurrn.. rirE an,l Flrv nurnb.r a'..q ,/r'Pr,i.yNumba: : tr(--:59? 7 3oql Erpr., l
<br />( ttir <ioo r.d mr b..ompr.rcd iIitE F6n n for OE hut'dEd doll6 ttlml or Ls)
<br />I c.nify th.r in rh. p.lforflnc. ofrh. uo.l Lr *hi(h rhs p.rh't is ir!u.d. I sh.ll not d.pLy snt p.r$n in.nv m.nnd n) s ro
<br />hr.m 3uh)d t E 6dn snrp.NlEn Ls of Cthforu
<br />:::-"^'il:"il!:f
<br />comr.rllEa cov.'rs. tr unl.wtul,..n.mplor.r ro oinrn.l p.n.lri.s.nd.n il
<br />6n6 up io oN hurdrqt lnoutald dollB (1100,000),in .ddnih ro rlB or ol corq.rt rior d.m86 r poii.d lor tlE S<rb! tO76 of
<br />lll rrbor C.d. 'ddd.,i oB'! f*
<br />LICINSf,D CONTRA(-TORS Df CI.ARATION
<br />I kr.rry rllm u.&r FEl, of Fiury rh.r I 6 lto!.d u,'d6 pmvLbn of orpr6 9 (cr],rft(os *nh S.dnn 1000) of Divnion .! ot
<br />lh. BBiclt nn Prcl6rio (od., .nd my lic.M i i. tull lorcc Md .ncr.
<br />9r
<br /><..".". f R
<br />G olrlrjr*'for ehrh rhs pmi il
<br />r r)\\IrL( IIr\ I t\t,l](, \(J \( \
<br />I hd.nr .,fm ui&r p. tt orFjut tLr lh6! ir . odru.ri.E kdi.r {Gy tu rhc Ffo.lluG
<br />irN.n (S€. !097, Civ. C.).
<br />AIITI(AIISDECI,Af,AIIO!
<br />lxmlirion Pmi*&b6ri Nonric.rnn F.ddlt R.SUhh!.stlik,r0. Prn 6l
<br />Rqurcd ltll.r of Notifi clrion
<br />I cdift rh.r ih. t dn.l r.tulri66 cgrd'nr Bbdlor r.mr.lu. mr.prlkrhk ro rhi! p.oJ.d
<br />f,';rs.'*:ll;Dn i5 cotr61 I .gre to co.nply s irh rll Cirr- rndCoumy
<br />r&\. m.nrnn.d pnp.n) nn
<br />Pmifi.. Mm (pri ) <T-9 :::"";/,';^-"*-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SubfloorA,/enVlnsul
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsu lation/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 otlttUt{'24,.Ayrt,,Olt
<br />Certificate of Occupancy IVU
<br />Notes, Remarks, Etc
<br />'-D
<br />\WP51\Pormil-lnspeclion Foms\Bu(dinq-lnspeclDn Rocord.doc 03 3l 06
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