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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE COMMENTS ()WNER BI JII,DI]:R OEI-(,ARATIoN
<br />I herch, arfirn undd fnilty rf Frjury rhd I dn cxcnFl irun rhc Conlrlcro^ l-ircnst llq i(tr rhc folbsine relbn lsc.7o.rl 5
<br />llusincss rnd Prolt$ion Cdc) Atrt Ciit or Cotir! which rcqunc\ r Fnnir lo coo{ru.r. llrct- i.rProvc. &fr,|i\h .r rcllln my
<br />{ crurc. pri.rb i( n\usi... rllo r.quncsthc alplicaflr Lr su.h pci,nir ro fih a sigmd \rlr.rmnr rhar h..r shc Ls licen{d nn unnl
<br />lo rhe nrovhions oi rhc Conrracroi\ l-iccn\ed tr* (Chrflcr 'r. Comnri.ine rvith sc.rion 7(x[ ol Divhn,n ] or rhc Bxlncrs n.d
<br />Pmlcstnr Codc)o.thrr hcor\hr is.rcnrrr rhcicfn, rtrd th. h{is tur rh. rllc8cdcr.mnrion Anyvi(,hri( ofScdi,nT0.ll5byany
<br />nprli.,N lor a pcflnir subjccrsrhc opflic.nl ro r.ivilpcnniyor nor )rc rlun liv. hDndlcd dolld( ( 5(xr).
<br />l. as ownd of rhc fl oJrn!, or my carploles silh wrsc( as rhcn sb coupersai ioi. will do rli w(rk Md rh. $trruE i\ noi
<br />inlcnLd oroltcrcdlhrs0lc(Ss.7(144.Ausinc$odhofesion\CodcTheconkd.ttrsLic.trscLnwdocsnoraprlyhMo*ncr.r
<br />rhc nmldt who build! or iqn)rs (lxd,n. *xl wtD d{rs n'.h uoilt himscllor hcrulf or rlmueh hi{ or hfown cflrploycei
<br />prnvacd rnsr su.h inlPmrcmnrs m not inrc'dLn .r dlTcdd Lr sL ll h(rrcrq. rh. ttrillilr8 or inlarvrnrnr is skl qihnr . ( )rnr
<br />ol otrpLrion. 0f, ON.cr Buits will harc rhc huden ot Fovins rhd hc or \he dn nor btrik ot impnrvc lhc lmlEny f.t rhc tuln{ ot
<br />l.rro*rrofrhclrop.ny.mr.xc[\nclyc.ntucringwirhli.cn\cdcotrtdck)fik,.onnrudrh-pn']-cr(S(?(]14.Bu,i'rr\{
<br />rnd |-hrisshn Conc thc C,nn radtr s Li.cn\c Lrw doc\ nor rmly ti dr o\1rs ol noll.n y sho h iLls or nnPro\cs rhcrcotr.
<br />rtrd sho conh.r lor such tn.Frs {ir[ ! C.nrn'ckin n ]icgrsc pr^otr hrhc Chtrrrrcl,tr'\ l-icctrsc li*)
<br />-l
<br />rmcicnrJ! und.r Sc.ri,r,
<br />llsie: Osn.r:
<br />\voRKFRS', ( r )t\rPrN.SATI(|,\
<br />DECLAXATA!
<br />I hc,cl,y rffinnundc! pcnrlry oapcrirry nn ofrhe firlowinE deltidriiJnr:
<br />Ih.ttd sillmrinr.i,r!CcnilicrrcofConscnrbSclflnsrrcfitrworkcN'ompcns0rion.aslrvidcdto!tys(rnrlTmrlth.
<br />hb(r cudc. tdrh. p.rroanlnc.oflhc rnt lor whichthc pr.nil is n\ucd
<br />I hr\c rf,L\rill n nrr tr *,n1,. s ronrl{ rsrltrtrr n{trr !r. r\ .(ttr lr(Lht \..r
<br />'i. \' '.'r qhr lrr'.J r '.'nr'l \l)r.,!f.
<br />ion.l70O oarhc Lrk)r c.dc. ror rhe pcrlorm{n.c of
<br />icr arlri,lirynumhcr rc
<br />€Enzlur4
<br />v"t,, ",,,,r* 1Z ll)584f \<2U
<br />-l..nilyrhr!i'rrh.p.rn),!nNofrhcworklorNhichrhr\lxnn
<br />ir is{rn.Ishrllnor cnfloy rn,ff,Fotr h.ny runncr
<br />ni Nri hc..nr subjcci k,ihc qo*.6 .otrrcn$rion las.olCrlilbn,ir.3 gttrhJr il I $ould t .otrE suhJc.r t, rhc
<br />*.rkcr.onrpcnqrionlrcvhionr.lSc.ri,rn:lT0oofrhclrhn(hdc.l\hdll.fonhwirhconrplyq'irhrh.ylnrni('ns
<br />\ RNINI; Fx lrr r, \1ur. r.'l0\ r.f l|r.tr\J.f ..,.'r!. \ n,lN h,l. rtrJ .trrnk,ycr h ci'niml l[nnlrics nn,l
<br />i(!r. Llxmr!.\ \ fturdcd r,tr rhc.ieii nnc\ uI ro on. hutrdrcd rhou$nd dollrs (llll0
<br />Sr.rii)r:1076.1rlic Lrlrr (ixlc. idcrc{ r
<br />*<lzolrs
<br />DECI,AMIIQN
<br />I tuEby afilrm undcr Fn!h,ollcrjury lhar I am liccnsn u c. rin|nin or Chapr6 9 (.ommnci.a *ilh Sslion ?fiD) or Dirision l
<br />ol
<br />'hc
<br />Ausimss !toI Porccsions cod.. ,nd my liccns i\ in full nncc ord ctT(r
<br />4".*" ar*,
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<br />F
<br />u*"'3pl:z
<br />@* tat111(1)
<br />A.TILIIANLIJECLAXAIION
<br />I ho$y !,Im undcr rcnDlry.rl)crlury onc ofrhc followinB d(larnrions
<br />Dcnnlirion Pcrmirs Ashc(os N.rin.rrk,. F.d., R.gul0in,nr (Tnh 40. P.n6)
<br />-Rcquned
<br />lf, ncr ol Norin.ad,i
<br />l.cnilylh0l rhc Ldcrul rcSulal ions rclardins a\bcdos rcm)vtrl Br. ndr amii.ablc lo lhis !mj$t
<br />fl cdily r,r l haE rcad rhis lrpliarion ard d c lhnr rh. .h,v. inr nulion is corccr. I asrc ro contlrq lr rllCill rtrd (inrrv
<br />y rtrd C.u.tylo clllcr nJrr] rlEonlirutr..\ itrd StarcLa$src!rins ki h!ildinE.o rhoriz. rcprcsqghr irc\ o I rhi\ Cir
<br />lh)v. nr nnd For.n, tu i,
<br />l13/a.'t'/\t,r,lir nlor,\8.n1Sitnrl
<br />oi be',1 \Vale n z \.{d4
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Rool Sheathing
<br />Shear Wall
<br />Framing 1/l//L fi8<
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />Masonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Beport
<br />Flood Zone Certil
<br />7/ t/rS >q f6
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc
<br />tD/stG.
<br />Forms/Steel/Holdowns
<br />Pool Fence
<br />FINAL
<br />A6c
<br />I hcrcby alfirm ldcr Fnrhy ur Frjury th,l rhtr is.oflstrucrion lc ins ascmy r{n rlr p.nnnruDcc ol lhc sort lo' *hth rhn Fnnir i\
<br />nsu.d (S.c..1(})?. Civ C I
<br />IrnJ '\ Nrnr _
<br />txtrdcr':
<br />^Jdrc*
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