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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNEI AUII,DER DEI-CARATI(}N
<br />I hc'cb, ar'ilrm undcr Fnrlr, or rjxry rha' I m.rcnfl rro,n rhc c.nkrhF Licctr{ trq' r'or rhc r.ll{,sing rcnu (sc..7orl 5
<br />Bun..s\ and Proiasnon Codc): Any C[y or Counry Ehi.h rcqutc\ 0 pcnnil ro d {tucr. rlrcr, nhl)rovc. dcnFlth or rcPli 0n!
<br />rdcrurc, prior lo irs issuamc. rko rcquircs lhc applicaDt f(tr such p.rnir b filca \i8trcd nrr.mtu thnt hco! shc t liccns.d l)Urul.r
<br />ro rh. piolisn N oI rh. Contr.rols Li.cnscd l-rw (Ch.J)lcr 9. C.mmcEin8 wilh S.crion 7nn of Divhbn I oflhc 8u\trc$ ind
<br />ProfcshtrsCodc)orlhrr hcorshe hcxcmfl lncrcl'ron and I hc hosis lnrrhc allegcd crcmrrnr. Any violalionofSs-'rion?(,.r15 by riy
<br />alplicanr ftraFnnn sxbje!rhc rprli. ror.ivillcnrlryoffr, barhrtr fivc huodrcddolloi\ ($5(X,
<br />-l-
<br />.\ owrcr ol rhc pnpcn,. (tr my c'npk,yc.s sirh *rBs n\ I hct \ok .oi4cn$r ion, eill do lhc sflk and rh. (ndm i mr
<br />i'rcndsl or.fcrcd for qh (S( 7{Y4, Burirc$ md Pmfcssiois Cdlc: Thc Conrdois I-iccnc liw dtrs noi atPly ro.nowncr oI
<br />rhc F)IEny qho hrildsot inll)mk! rhcmn. sJi wt dms smh qrrl hihscll or h$$lf or thoulh ht or h.r o*n crpbyc.i.
<br />piovidcd rh sx.h inlmw!ftn* m R, inr.uk{t nolTcrd ln {h ll !n'wcw. rhc hnikling or imtiov. bnt is $kl sirh'tr nnc rtr
<br />ol'conr0lcli(nr r& Osner Buikicr *illhnv. rrr hrr&norpmvin! rl rr or shc did not huild or in{rorc rhc rn,Fiy r(r rhc Pqnt ol
<br />-1.{so*rcrofrhcpmpcny.rflcx.lu\ivcly.ont..rir8wirhli..n*d.onlri.torr.connrucrrhcpojmr(s..7u-r.8u\iEs\dtrd Psii\st tr Cod.: Thc Coniro.rois l-icctrsc Las docs nor anply ro otr osncr of prund! ah, builds or improrcs lhcrcon.
<br />and who conlnds tnr such F(,jccrs wirh a conhcbns) liccn{d Nnxam t' rhc Cont!c1,, \ l-iccns ll*)
<br />-l
<br />mexcmpl undcr Sction ,B &PC fdrhi\rcason
<br />Ir3l.: ()wner
<br />rYanxlB,Stl:lJuf,[INsdll9N
<br />DE(I,^8 IIAN
<br />I ltrchyrll nntrtr,]cr |Imlryol pcrrur!o rrl rhclnlhsi'rgdcclx'nf'r(
<br />-l
<br />hNe mi $illroinrain aCcniftar..f c.trrm t, s.lf ln\ur. for nukcs' comlicnsd t,r. !s prcvidcd f.r hy s.dion:1700 oflhe
<br />lihor Cod., for rhc ncrforEEc ofrhc work for shti rhc p.drir ir iisucd
<br />I hlvc rtrd *lllnrii0lrir sorkcrl conr|[nr0lion in\uran.c. r" rc!uirrilhJSc.h.r:17(X)ofrhc L.horCodc. for rhc rrrnnnni{..r
<br />rr'r r r(L'ul,hr!.r( rr.l.'1, lll{!'l!r, ' g-l*+ Fi^..rJ
<br />\'comtcnsrri{in ntrurrncL u'ricr xtrd F,li.} Nnrhcr ir.
<br />o
<br />I.cdilyrh
<br />'nthc
<br />pcrrormarccolthc w.rk lo, *hichlhi\ ncflnir i\ ilsxcd,I sh.ll nor cnrlloyonrlc6on inany mtur
<br />s s to lleconE suhrd ro rhc sorld( .omF.qriotr lnws or ('alirornir. and .src hlr if I \nodd bcmn* subj.{r ro 'if,wolkcn'conrncnsarionD!o!isn,n\ofS..tn,n:l?0(l.frh.bborCdlc,lsholl.lonh$irhcomply(irhrhr{pn,vtnrns.
<br />IVARNINC: Fuilur. ro *rr. Norkctr conrtcnsario covcr0$ is nnhwtul. and shnll.ubj..r rn cnrFloyer ro dinrinrl |l.nllris.id
<br />cilll lnros rf n, on. htrtrdr.d rlNn\nrl
<br />:::-r"#i;ild"
<br />trrgc\ r\ ni(rnloJ lnr rhc
<br />I hcEhynllnrnuon.r pcnrlryol Irrjuryrh r I r'xnd.r pbvNn ol Chatrs9l.r'D.rncing wirh S.dion rux)) oal)ivi\n]n l
<br />., rh. B"(i,,.$ xtrd Pbf.sio,N aidc rlnN li.cnsc n i', hi Ll l,trN rtrtl cl1cri.
<br />l-aLtb o
<br />qilns
<br />I hcrchy !finnr undc! rcnalryoipcrjory rhd rh.( i\ r
<br />issucdlss 1(I)7, Civ. C.)
<br />crinr [.rlirgr8.acy l{tr rhc p.r,]mnftr ofrhcwolk tur shirhrhi\ Pcrmir is
<br />Ltrdcas Arldrc\\l
<br />AT.g.ICANLDEIIAtr{IIQ!
<br />I ffiy!fiianundcr pctrrllyof ncrj!ryonc orihd r.llouiit d(hturn s:
<br />l)cmlnbn PcrnrirlAshcsros Norificarion r{dcdl R.gxlarions lTirlc {0. Pd6r
<br />Rcquircd ktlcr olNolifEalion
<br />I (cnirlrh rtu ladcrnlrcgtrl n,r! rc!{dirt rslx .\ '.nn,vr c nor l'l)pll.rhl. ki rhr t)n,l.cr
<br />-[kin,r1 rru r t'^c -"a rr,,.,pp Itrr ion adl rar. rhd rh. ,trlr innrM ion h cor*.'r I lg.( n, .o rrly wirh .ll Cny lnn Counrt
<br />ordin!nccs rn,l Sxrrclj$\ ml,rirgr. hui
<br />ahovc nr ioncd [o|.ny lor iNrNrion
<br />rchy iurh.riz. rcprc\cnrdnt\ ofrhi\ ciry rnd Counrt b.nri !,rn! rlt
<br />,\!t,li(nnl.r ,\sLnl Sisnnlu
<br />OJt l(("el)"r ",,,"' tf.tt fw
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loo r/Ve nt/ ln s u lat ion
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />ln s u lation/E nerq y
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />[/lasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Beq.
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certif .
<br />FINAL Nnflc €N&-
<br />Certificate ol Occupancy
<br />Notes, Remarks, Etc.
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