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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE OWNEIT IJUILDER DI'LCARATION
<br />I hcrcny aflnr undcr pcnully (,f Fcrjur! rhol I am cic'npt lir lhc Contrt,^ Li.cns. Ltrw ror lhc iollowin8 rclsn (S.c 70315
<br />Busnrs and Prnis\n,n Cod.): Any Ci'y or Cou.ry whkh rcqunc$ trnit ro conslrucl. ohcl inomlc. dceli\h,.r tolan any .
<br />slflcrrrq prhr lo irs issunncc. fto rcquncs rhcaptlicanr ror suchFrmir ro filc asisned n,rctunt rhd hi or shc n lian\cJ t'ltsund
<br />b rhc pmvisn,ns of rhc Contlcnn s Licc scd bw (Chrflfi 9. ConnrErcir8 rilh Sedion 7(il) of Divisio. -l of thc Busirr$ aM
<br />Pronsio"s Cod.)or lhal tr or snc h cxcarpr lhcrcfmmond lhc hr\i\ tur rhc rlldscd crcnDrion AnyviohliotrolSecrion 70.115 brahy
<br />appli.. tu!Fn,irsnbje.hrh.,ptlicamt,,.ivillcn.lryornor,m..rhontuchuDdreddollm(S5(x))
<br />l, rs owftr orrhc propcny. or myemnloy.cs wirh wrecs m rhct solc $au,cn\ari{,n- uilldo rh. wolk trrl thc ntulw is nn
<br />nncndc oroltcrcd forslc(Se 704.1- Busincs ond Prorcs\ionsCoJc rhc Conk&ttr s Liccn* tjw dms nor oplly ro M o*rcr .r
<br />il'itr lrbtrdy *ho builds or inlm^rs rhcNn. urd who des sRh wurr hnnscli or hcrrlf or rh()u8n hi\ or hf .wtr c doyccs-
<br />pn,vidcd rhor srch it.prommik m ior inr. ldl oltird f(n sL. Il h)$rvs, rtE ttrildmg or inpnrcmnr ii bld *irhin ok jtr
<br />ofcom0Lrion.llEOwncrBuild.rwillhaErhchrdcnoiprevin-!ihlrhrorsbcdid't huikl.r nnprew rhc !$pcny r'or rhc purtiHor
<br />Lr\owncrolih.lxllcny.u,dclusirclyroikrcri,rlsirhli.cn\cdroitrcrlsr,.otrrlnl!1rltnmrc.r(S..7(r1,l.B!\n.{!
<br />rhl Pio,i\\htr Codc l-hc Conrrlois l-i..trr l-as,l,Bs n.r amly b xro*tr.'.fproPnyqh. htrild\or irnP(xt! rh.r..n.
<br />n d sho co r rr\fdnrht)n'lc.tssirhrCotrtr(ro,r!rl'.cr\clllursur blhcG)nrr oi\ l-iccnsc Lrtr)
<br />I rn'.lcn,t{ trndc' Scdntr,
<br />Dale: O*mr:
<br />WORI(ERS' C'(IIIPENS1T()N
<br />IIECI.AIAII9N
<br />I hcrcby,rfifln und.r Dcnalryo, periury orc oilhc folLai.r dNhrllions:
<br />-l
<br />hNc lwillnEintaitrrCcnilic!'col'Cotr\enrloSclflnsurct,workcrs.o rpctrsdior. rs trovidcd lbr$ySecrnn,.]TIDorrhc
<br />hbor cudc, ior rhc p.rionnaNc of lhc work hr q hich lhc lcmir h i$ucd
<br />-:r'ha'r aod will nEintain work.h conD..sniion insunn.c. Li rcquncd by SNt ion l7lx, of rhc Lihor Cod.. tor rh. pcrroniumc ol
<br />mc.Micr md policy numbcr 6e,rh. s.'Ilnrs[i.hrhnJ[nn '\ $urtl Nlr\orl$ .otrr|cn\rrnn'
<br />{
<br />t4 a9t 1
<br />Iccnilirhdr iirh.|x ontuiccorrhcworkrorwhichrhkpcirnilishsued.Ishrllnorcn,rloy,ntlcrn iD.nymrnncr
<br />$ mu hcmm uhjcd ro rhc wo.Icrs ompcnsdn,n L*\ oacllirurnir. md nBm rhd ill sh.uld taom sut'jd io rh.
<br />wolkoa mnDcnslrion pmvilbn\ of Sccrion ]7m of rhc lihtr C.xlc, I shill. ftnhsirh conlly wil h rhos lr)lisn r.
<br />IT,\RNIN(;: fJihru k, $curc wurkc^ .otrNnsnrion ir trtrhstul. rxl n lL {,l,i.r rtr r rd,'ytr t,.riNimlJrfuLric\ Jtr,l
<br />.nil li r\ 0p ro om hu icd rl'or!r0(l dolfur\ ($lol).lx liri('n r, dr. ro{ of.o rtr. sdriotr. drtrr8cs rs pn)vnlcd lnr rhc
<br />S(rirr 1076 orrlt l-J!tr CG].. i1 crcn r J T/"J3-)t ^/ I
<br />DECI,ABAITO!
<br />I h.Eb, amnrlndcr l.mxy oa p.rjnry rhar I
<br />"m
<br />liansed undd l,mvhiotr ofChaprcr I (of,mnci.g wnn s.ctun 7000) ofDivhion l
<br />or rhc Bu,ircn and Pna.\nn. c"d.. rd mv tkers * fl rurr roR .l1jlFl
<br />2o x7/
<br />I hcrby xftrn undc' lr.ulry or p.rjury rtur thcrc n a corslru.tiofl bndins asdncy rd rh. rsfffroncc of rhc aorl ror whi.h rhis p.rnn is
<br />isslcdlsa 3097- Civ. C )
<br />A.PILICANLDICIABAI,I!}X
<br />lhnty,fmundcr p.nrhy or Fcrjury onc oirhc lollo'itrs dccl.rlrn,ns:
<br />llcmlirion Pcrmih Ashcdo\ Norifi.&on Fcd.hl R.Sulrrnrn\ (Tirl.'10. Pd6)
<br />-Rcqutcd
<br />L.(cr of Norif{ i.n
<br />I ccni,yrhd lhc ltdcrrlr.Bulalion\Egrdilr8 a\lf,{o\'.n$rl fu trord|)|]licfilc lo rhn Pn,rccr
<br />lr.niryrhflhr\crc&lr[irrDp]i.r!i(trirn{rrrrl[rh.]tx)v(inli,rrxri(t\eo,'.crl13'{n)rotrln!wirh dllCiry(trd Counry
<br />iM Counly ki cnrcr ulx)orh.
<br />frl^ 1F
<br />oirtirr..cr rd Sldc Llss rcluriq 1,, huilrti (nr. {lhc'chtntrrh.ri7cr.J,n'\.fhrnt\ol rhi\CIv
<br />rlxN. nrnr(nr !'rt)c'ryr(tr
<br />,\puli. nl.r ,tgenl SiAnoltr
<br />Oon., I
<br />dLo 1", /<
<br />Set Backs
<br />Fo rm s/Stee l/ H o ldown s
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsu lation
<br />Roof Sheathinq A
<br />Shear Wall / &PrdJ) ,^l'E \ u ar!l0-l *.tukNFramino p/qLf V"V;Ad f}sht-r Lrbtl ftr2-l
<br />lnsulation/Energy \,{
<br />Drywall kJU\A
<br />Brown Coat
<br />lrrlasonry
<br />Pool Fence /A
<br />T-Bar Y.Vr)q
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certif.
<br />/a
<br />FINAL 1^,-l)).U+x)\
<br />Certilicate of Occupancy \\-/
<br />Notes, Remark-s, Etc.\-2.Ll
<br />er,Atwb ?tl JItt
<br />ID/SIG.COMMENTS
<br />1
<br />Ext./lnt. Lath
<br />1
<br />n,," 7.2 [r.1 5
<br />TT-HqT
<br />t-+-
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