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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BTIILDEN DEI,CARATION
<br />I hcr.byafiir rndcr Fnrlry of l{rjury rh lnmcxcmrl fm rhr Coitr.krs l-i.cnsc tia for rhc followins rca$i (s.t 70rl5
<br />Btr\in$r a.d Pr.fcs\6n Codc)r Any City or Connly Nhich rcqutcs a rcrmit lo conslrud, rlrcr. imJ,rolc. dcnblkh L rcFn rny
<br />srucru.c. prio. to nc issulncc. alb rcqung rhe applicdni fd su.h f.mrir h ilc a sigmd {,b 4,..ll.i{t9.hc i\ li.ctr*d nrrurnr
<br />b rh. ptuvirn,ns orrh. conlmclois l-iccnsql lrs (Chaprcr 9. Conrmn.nr8 wilh Secrnrn 7(x)0 of Divkion.l of lhc ltusinc$ r d
<br />Pmfcsi.ns Codc) or rh.l hco.\hc isc&dtr rh:rcfi.mrnd rhc bNis lor rhc(lhEcdcicnlFrion AtryviolilionoaSccri,,nT0.ll5bydny
<br />!u,li.!or 16rapcrnn subjNF rlf, appliconrro 0civilFnalryoln.r nxftrhri fivc hundrcd dolhrrr3500).
<br />I. ,s owmr oi rlE nmpcn y. or my .frnloy.c\ wirh wr!.s $ rhct n,lc oml).n\ario.- uill d. rtr rork .nd thc nturh n *i
<br />inrcndcd or ontrd for $1. (s( ?01-4. Busirrc$ ind Pmrcs\ions Codc: l hc Conta.tu-s Liicnt L{* dms nor ap/v ro M owtrcr of
<br />rh- nmpcny $ho builds or iiqh6 rh.Nn, llld qh, des {,.h *or} hi'n\clfor h.t$lfo hou8h ht or hcr o*tr cmployccs.
<br />F,vidcd rhlr such i,nl ovcnrnN m nor i' drlcd oi oltcrcd for srh. ll iowcilr, rl* huiuing or imfl ot$EDr is sld aid onc,tat
<br />olco'npbri6n. rhc Owif Bnildcr willhtrrc llrc hudcn olpmrin-s rhll hc or ihc dil ret huild or tlllnnt rlr lmp"dy for rhc luqx,r ol
<br />l.r\o{nrrofrhcnn'pc y.rmcrclusiuly.onhcringwirhlicc \cd .onka.hF ro con{rucr rht trrcd (56 7I}14. ln'{trcs
<br />uRl hrBsion O)dc: 'fhc Co.kr.ktr \ Li.cns. Lasder mr rntlyh atrotrrcr.f[nn ysho huild\ or imphrcs rhcrcon.
<br />rnd who c. nErslorsucl,ImJccr\*irhsConricron9li..tr\cd Dururnr rorhcConr ttr \ Lf,ctrr Lr*r
<br />-lamcxcnrpr
<br />undcr Sccr
<br />Da(e ()sncr
<br />\YoRl(ENS-CONIPFNSATrcN
<br />I2SCLABAUON
<br />I lErcby alfirm undcr lcolhlorrdjuryo.c orrhu rblb$ins d.chrulion\:
<br />I hrvced sillnui rinrCcniliQrcolCo \dnrr.Sclt hr{rclirtrvorkcrrco Pcn\arn)n. r\ Pr.vidcdli,rhySNrn{:l7lX)ofrlrc
<br />L(tx, Codc. forrhcrnnirnrmcolrhc *ort ntrs'hi.h rhc Pcrmir ir i\itd.
<br />I hrvc r d will rri rir sorkc$ conl|r.n\rri,r in\ufuirr. r\
<br />rhc *o'khr$lri.hrln\l]crNir istsucd Myrorkcr!.onfcn\rr
<br />(.,ric,, -57+*€ F.ul
<br />rcqtrircd hy Secrion:1700 orrhc L{hor Codc. ttr r& l.ltutrnmc of
<br />n insurircccntricr rrl noli.y nunrhc.:uc:
<br />lrcniry rhar i'r rhc pc'ftrnrincc.'llhc w.rk lnr *hicl, rhi\ Ilcrmir nrsnrcd.Ishxlltrorctr.trtrr_l]crornran)_nnnicr
<br />nJmhhccofNs$jcdrorhc*orkcBort.is iflhrv\olcrliturnir.xndrgrtrhdlilIshouldhc.oDcsuhicdn)rhc
<br />trrrkd\ collr|rn.rri.,n pnrvl\i{rn\ ofSr.ri, r? )olrltc t]ht Co(l..lslflll. tunh$irh $ irry wirh lho{ Inrvili( \
<br />.ivil nncs up ro .nc hud,cd Ihousotrl d.:\ry'i
<br />rutir,,N
<br />). in rddiri(r ro lhc con of co,nPrtrsarion. danm8$ r\ Prordcd fM rhc
<br />8!
<br />rl[ Irtu (itc. i crc{ xl Gc//*2v /K av4 e{
<br />LICEXSEDI;I.TNIIACIOB
<br />DIS.AAAIUN
<br />IIrcrcby.ifirnruNlcrpcrlry.rncrjurythatImli.cnsdundcrPmvti{)norch{frq9lc.nrnrcncingwnhs..iiotr7Ux))olDivisn.l
<br />of rh. Bu\i'rcs\ Md PmfcssionsCodc- lnd hy licrnrc is in rrllnrcrf,lcilc.r
<br />.",,..,,".. ds /0\513fa\-G -1."--{,;2
<br />CANEIAUEIIQNTI;IDINC.EqD&qI
<br />I hcrb!.fl, n uklcr Fmllyoit rjury rhd th..c h. connflctiotr bldins r!ci., ror rhc P-rt,nnrlEd.rihc Nork ror $hi(h ihi\ Frhi n
<br />i\!rd lscc rl)1)r.(-ir ( r
<br />AIEUCANLDES.AAAIIQN
<br />I hcE$y sfiinn lrdcr pcnrlry.l!.rjury orc ol'lhc foll.*in8 d$lnrarionrl
<br />D.ifrririon Pcnnih-Ashc\ros N.rifi.dion Fcdcfll RcBUl0rions llirlc 40. Pdr6)
<br />_Rcquir.d Ir cr of N{,liliolion
<br />l.cdifyrrr rhc liddalrcsuhri{) \ 'cx&li'l! rsh.norrctrrivalrr. nn rpp]ir lc r, rIiltr{!ccr
<br />-l
<br />ccniryrhar I nr!. rdndrhi!rtiDl trnlnrtr.rl rrMrhnriritur flr D i\c.ftcr lr3'crk)(o rwirhxll(irrr dCturry
<br />.rl nxn..\ rn(L Srrtr. I N\rurhorizc rcprc\cnrrrivcs orrhk Cily ond Counry ro ctrrcr u[lon'lr
<br />tivc n*nrlon d propcny lor
<br />Alplirm( or /\g.trl Si8nnl
<br />\) t "-1 c 1( r,-..
<br />*.2" - ttr
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Roof Sheathinq K /zs//B .t'._)
<br />Shear Wall
<br />Framinq
<br />lnsu latio n/E nergy
<br />Drywall
<br />Exl./lnt. Lath
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />^t-14FINALvt1\\ \(,fl 9> r(J-)o?(-r^//\
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc.
<br />Forms/Steel/Holdowns
<br />OW^ )
<br />Flood Zone Certif .
<br />"nr**"*,' ?2) ? L t/
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