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BUILDING. INSPECTOR RECORD
<br />SITE-WORK ID/SIG.COMMENTS O*E-Buil.Lr l).(L io.
<br />I hn.t, rr[',h lnds p.rhy of Frory lh.t I tm a.mpr lorm rh. Cont.doB- LEre Ir* ld rh. lollos'ry r&. l* 70] I t &Bi!63
<br />Md Ptofdrhn Cod.): Any Cny or Counry qhich Eq!n6. pmit to coB!rucl. rh6, iopro!., dcnolilh or Epin ey lrtuctuc. pmr lo itl
<br />itruE , rlto r.qun6 lh. .ppliod lor n h Fnil to filc. riser, 3lrtdtrl lh.t L or rh. i tk.ed pBunt to th. povilhN oarh.
<br />Codr.doai Le6.d L* lCh.DG 9, Cohffilna wnh Sd6n ?o(n of DNBEn I of rh. BurB...d Prol6rbB Co&ror rh.r lr d
<br />$. n crmpr rhd!ftof, .rd rrE bcir t r fi. .U.s.rl .r.mBo. .Any tiolnM or SEiion ?01La b, &y .pplktd for r D.rmir .ubr.cl. thc
<br />.pplicel !o t .ivil Fn.lty oa.oi mr. ln . tilc hudrcd dolliR (t500)
<br />l.B.*6oflLprop.nr.orEyopbydsnh*.J6.rrh.t$L..trp.Nrbn.*illdorh.rort..drh.nM@irmt'deri.d
<br />or ofld.d lor rl. I S< 7oa,a, A6'6, rnd Prof6rDN Cod. Th. Conhdq t I K.d. lrw d6 rcr tppl, ro .. o*M of th. pmp.ny
<br />who blild! or impror6 llson. .nd qho do6 lkh *orl hm!.lfor hmclf or ihrouth h'. or hn o*n.mrloy*!, prorid.d tni ruch
<br />inFovd.nl'eful i .id.d or ofrd.d aor rl. lf. how.!6, rh. b{ildiq or ifrpmlo..r i] alld *ilhi. on. yd ol.ompl.rion. rh.
<br />(xE B{ildd [iU h.\ c th. hd6 of Forirs lhrl h. or rlE ml boild o. 6pro\. fo. llE p{.0.* of qk)
<br />L 6 owns of rbc prop.rry. m cicluivcly .onr.dinJ w h Ii..N.d conk.croE ro oNrtuo r h. proj.d ( s< 70a4. Bsm6r od
<br />P6t*i6nCod. Tfi. Codrcroir l E.s t w doB d rrply ro .n ow of propdy wh. blrldr or mprovd ih66n , rid eio
<br />@tu.cc for tu.h FoF! *rht Conrrdc(r lr6t d plrdd ro rh. Co.r.do,'t LE.e f.r )
<br />Itrm.r.rfl und..36!i,,.I A Pc f.rrhtr l*on
<br />D.r. ._Onc _
<br />WORKTRS COMPENSATION I'f, CL RATION
<br />, hlct, .mrn lndd Fqht or p€jury oG otrlE follouing d.<lrdioo:
<br />{4". - *r,-t.,n. a..rifr.r.orcoe ro s.lr'lBur. r., E.l6'@mp.srbtr s provd.d.o. br sd6. rToo ordE
<br />llbor Cod.. for lh. pdfomnc. of lh. wt for *hicb dE p.mn ir irtulil.
<br />I ,Iv. td *'ll m'ur b*sr' @mp.drb. rn,ue, ! rcqu,.d by scrbn 17m of lh. l.bor Cork, rot dE FforuM of tlrhr\ for wh.h rlul p.rnn B au.d My 6rlq @IllEuI.n d|]tmG ffi rn Dol(' Mbd e:(m ln rrr.-Zua-LA - / _
<br />,r*,n,.'-, h-lC- (-f722,9oo./ Ep6 t Lt y'
<br />rn!rdonrcGdnorb.cooDldcd'rrh.p.d ir ror dE hundr.d dolru llroor orki!) /
<br />I cdriry lhd h tl* p.rfoM. or tlE u,orl lm rhkh rha D.mn it iru.d. I rhrlllJ-toahl .n) p.r'n
<br />,c i,rrr'houH bdnj} rbrd b
<br />h',ilh compD *'9Jr(r( pDru@B
<br />--;-xr
<br />.r.8. B unL*aol. t.d rh.llrubr(t.n.mployrr ro niminll p.Ehi6 rnd cilil
<br />lird up to oa hund(d rhou..tld dolL6 (1100.000).in rdditi.n lo th..ox of .omp.qrion. &Nt.! c pmvid.d lor rh. S<rion 1076 of
<br />tll. btor Cod.. 'd66r.ri.tofty t t6
<br />L(f,NSrD CONTR CTORS DECIIn T|ON
<br />I hftby .ltm undB F.Ety ol Fgury rhrl I m li.cN.d ui6 ,o1 ilion olchlpra 9 (co@cn.ini with Sftt ioo 7000, oa Diviion I oa
<br />llE 6GilB tnd Pr.fdbB Cod., .,td my li.cc ir i. tull r,r. rld .,I.t
<br />b3-
<br />T,-qllrlltll !!!t\Ll tD!]!i llrt}l !
<br />I na*y.rm undd p. lyof Frur: thr tlEe i!.oddtrn Lodiry.ady
<br />iqo.d (S.. 1097. Ci! C )
<br />of lhc wMr 6r rhah thi. Fn'r n
<br />a[fll(aNr.:!t(L aarIQt
<br />l).moliri{,n P.nnirs r\sh.sros Nohfi$rtr'n Fcd6.l R.Suhrn'ns ( Iitl.,l0. Prn 6)
<br />R<ur.d ldrdofNdrfi.dFn
<br />H fy lhd lh. fidmIrcgul tuNr.*!rdi !r. ndr.pplicibl. ro rhk prqftr
<br />rbor. i.fomrion s cold I .are io conply qirh rll Ci! .id Cou.tt
<br />(rd'Mn.6.nd St.r. tr*r .urlFrn. r.prqrtrr\6 of rhnC y
<br />rb\c m.nrrn.d prop.d,
<br />^opho
<br />n t*mr s,s {
<br />P..-(r.. ,rm. l pnnr ). ,(a-t1
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SubfloorA/enUlnsul
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />ln s u lation/Ene rgy
<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 ot/r9lf 2N,\244.h0.1
<br />Certificate of Occupancy II \J\J \tr-
<br />Notes, Remarks, Etc
<br />-)
<br />M \WP5t rP.mtln3,,!.ton Fo.nE\SurldrnO-lnsp€cto.r 03
<br />DATE
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