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BUILDING- INSPECTOR RECORD
<br />SITE-WORK ID/SIG.COMMENTS OWNER BUILI'ER DET,CARATTON
<br />I h.rchy rrrln uDdcr pcidry (,f Frjury rhd I dn cxcnrpr fronr rhc C(,ntd.ro^ Li.cnsc ljw for rhc followine rc.$n (S(70:11.5
<br />ausircs md Prorcsn,r codc)r Any Ciry or counry whi.h rcqrircs , !.nnn h ..trdrucr, alrcr, nnpr(nc. dCnnlnh ar rct'on any
<br />slructurc l)rh!lo ns issuonce- al$ rcquircs thc trprli.atrr for su.h llnnil ro 6lca si8ncd (urcm.l thot hcor \hc k liccn*d pur$anl
<br />k, lhc povisions ol lhc Cotrlractor's Li.cn*d ljw (Chrpicr 9. Connrn.inC wirh S.crbi 7UJ0 ol Divhion 3 ol lhc BusnEss lnd
<br />t\ofcsni ns Codc) or r hd hcorshc ncxcmpl lhcrclioo rnd lhcb,si\ ror rhc lllcgcd cxc q,riotr. Any viohtnrnotSNri'n?O:rl 5 ht uy
<br />rppliclnr li,ru pcnnil subjccrcrhc lprlicanl l. acivilrcmhyolnor mrcthatr fivc htrndrd dollun (S50o)
<br />-1,
<br />is owrcr ot rhc pnJpcny. or nry .rnpbyes wnh w.B.s $ r hcn rh c.'np..sarion. s ill do rhc work ad ltE (nalm n nor
<br />imcndLt oroncred for $L (S( 7044. Bu{iks nnd Protessions Codc:'llc Conrrrroi\ Licctrsc llw docs nor "rtly k,,tr owtrcr or
<br />rhcpBFny who liuilds or inrmrcs 6cmn. un {h. dms such w.* hiNcllor hcrrlfor thmu8h his or hcr oancmpbyccs,
<br />D.ovn,cd r har slch nnfr.wrE.( m nor iNcnd.d oi olftrcd lbr slc ll h.rcvn. rhc bu iHi S or i'nl)rok'Enr is $ld wnhir oft ]rJr
<br />of.oq)lcrirn. rh.Ownfi Build$ *illMw rh. h cn of povif,g rhd lt or rhc did nor buikl or inq,n,v. rh. pn,tffy for dE l'll4i,$ of
<br />-1.rsoNtrcrolrhcl,ft{cny.a.xclxsivclyconrddmgwi'hlr.cnscd.onra.tuRkr.otrsrucrrhcpn+cr(Ss?04.1.Businrsr l Aof.\sir Codc l hc Conrncb s l-iccnsc l-a* doc\ nor opply ro !n .sns ot pruFn, sho hrildr or inrpro$s rhcr.on.
<br />rnd sho co.n.ds lor $ch pmlsls Nirn a Conhclo( O li.cnscd tunuonr ro rhc a:o rado l-icensc L!*)
<br />-l
<br />am crcmpl !trder Sccthn-. B. & P C forlhisrcason
<br />lrat.: oPmr:
<br />IIQAtrE&T:COUIINTAIION
<br />lzElLtBAI9l!
<br />I hcrcby rllirn'utuld rnilry ol'p.rjuryonc.ilhc ri,llowirS dc.lurrnlx:
<br />lhrvc tuxl qrll iai a .CcnrficdcolCotr$nrtuscllltr\urcnrrwolkcrjconrp.N.lion. \ fovidcdi{trhysccrnn,.l7(x,ofrh.
<br />Irhr(i'dd,li)rrhcrc'tunlknccofrhcworkbrahichrh.pcrnir isn$i.d.
<br />)in $orkcra.otrlxnsdi insurntr.c.n\ r.!uircd hySc(ior.l?(x) ol'rhc LrhorCodc. fn rh. Frranuiccof
<br />Nmir is isucd Myuorkcn ion innnrrcc cnFicr mi Frlicy Dunr6.r dc
<br />tzlru
<br />fy rh.r in lh. prrforroncc olrhc work lor whi.h rhh lcrnir is issucn. I nBll mr rnDloy:,J-;;",,..."",
<br />v' x\ b hcconf, subl.d b rlrc s.rkcri c.n,lf,nsrri{)n hws olCrlilni,ir. rtr{lrERc rllr itl shxld hdo t suhlc.r ro rhc
<br />sorkc^ conrp.Arri,nr pnivi\n,n\ olS(ri,,n.l7motrlE l.xhtr C(dc.l shrll. ft)nh$irh.otrrd! wirh rlnr pnivi(i,rr\
<br />WARNINC Fa,ltrrc o sccurc w(trkcrs compctrl{ior.ovcrU. rs unli*1nl rnd {ull\uhjccl an c'nphycr b ci'ni',nl t^-'ultic\ rtrd
<br />clvil firs!r,nronchu rcd rhousrnd loll s (Slr)O.rno). in,trllirir)n ro lhc.o{fll)"***'*"0'"""rhnd r!{nE}}.ccr, _--.
<br />?LJd
<br />l]rl.lfl.lut
<br />I h.rhy iltnn undcr ,.mhy of lcijry rl l !li.cn$du crrDvni, nf Clr|lcr 9 (c.rtrEmin8 gilh Sccrion ?(xll)) of Divni()n l
<br />of rhr llusincr\rDd profcssn,ns Codc. xl n,vlic.nsc k in fulltur.c mJ cft.rr(htt-b c07
<br />",,", --T--lq,lt,*"
<br />CANEIAI]GIIONIENOIN!.ICEICI
<br />I hcEhy lfrtrn u.dd Fmxy of pcrjury lhal lhcrc h r consdcrir hnJin8 ucncy to, rhc PcrlomNc orrh. *ork rnr whi.h rhh Fmir is
<br />tru.dlsc. 1097. Ci! C ).
<br />AITUIAII.DICLAAAUON
<br />I lllriry,fim nndcr ,.naliy ofFrury on oflhc f(rbwing d.ckrrin,ns
<br />Dcnolirion Pennih'Asbcslos Nolificalion l-tdc,!l Rerulalions (rnL 40, P!n6)
<br />-Rcquncd
<br />11llcr of Nolifi cdion
<br />I Lrdilyrh,r ih.lcd.r.l rcguln'ions rc8ddir! lsbcaor rc'mvJ ..c nol apdic.hlc to lhn projc.r
<br />-lccnilythlllhavcre0dthisnpplic(li{nra'xl(arcthalrh.0lnvcinfffruhniscoR{rIrsero.omllywith0llCityoftlCoutrryonlinJn((s nnd Srarc bw. Eld rns f huilrinF ! nn{rucrinn. Jm hcrchy turh.n /c r.F r*nhrn.. ,,' rh'. c yrtul( ou r ro cn'cr q{n rh.
<br />::iii:i:iiffi 'ffi
<br />,,, r.,' """ cl r v/t o
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Rool Sheathinq I 7*2,/tr Ar.aL ,/*-
<br />Framrng
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lt/lasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif.
<br />FINAL 9/2/18 -at4gfta 're-
<br />Certilicate ol Occupancy (
<br />N otes, Bemarks, Etc
<br />DATE
<br />Erection Pads
<br />Shear Wall
<br />tJndo ' AJdrcs'
<br />=
<br />It-
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