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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNOII DUILDER DEI,CARATION
<br />Ihcrchyltfiflnu.rpcmlr,ofFrjurylllalImcxcmprlmnlh.Gnira.t*Ltutrscbwf(trlbcfollo*iryreN,nlsdc7)-ll5
<br />Ausincs a Prolts\ion Co<lc): An, Ciry or Counry shrh r.qlifts i Fnnir t, .otr{rud, .llcr. imPn,vc. dc.mlnh or rPafu y
<br />rrto.rurc. prior lo ns isradcc. rl$ rcrluircs rh.4/i.n r r{r {.h p&nrt h filca sisncd (llcrmnl rhar ltor sh. is licctrscd Pursutrtrt
<br />ro rhc ,mlhions ol rlrc Cotrrrmroi\ I-icc {d Law (Chapicr 9, Com rn.nrE wirh Scction TU ot Divniotr , ofrhc Busi.cs rtrd
<br />Pn,fcssnnr\G r)orrhar tuorshc scxcnn rhcrclioflrM rhctusis for rhc olLgedcrcnrrion nyviohrn olscctbn?rr1l th,rtry
<br />ap,rh.nr ror r Fnnir subachrhc atpliconr ro acililFnalryoanor mrcrhrn nlc huMrcd dulld. (3500)
<br />-1.
<br />ns owncrolrhcpDFny.,rnydnrrldyccs sithtr,Bs rhcr k,lc .onFnsdion. silldo lhe eorl dt rrr {urua i! n.r
<br />i.ndLrl oroller.J air eL1Se.7O44. Busimsutr Pmfc$i sCilc:'lic Contackn \ l-iccnsc Uwddsnor {Plyrorno*n.r.l
<br />rh. pn,lxn, *txl hilds or i'rproLcs rlEB .andwhod(Bssh*.rkhirn\.llo'hcrcllorrhollhhisorhcr.sncn'Pbycc\.
<br />pmvid.d rhar such i'lproven.trrs ft nor iircd.d or oftcrd fd sdk l( l[qcvcr. rh. h! il.ling or i'npmanf is erkl wlhin n E Ftrr
<br />of.onphrnnr $c osnc. Buiklcr will hnrc lhc burdcn ol pDvirs llnl hc or {t did nor buiu.r hpn)vc fic pmtEny for rh€ pdrIi){ ol
<br />l. rsoqNr.l rlr |lop.ny. anrcrclusivclycorlftcrirs wir[ ]i..n\cdco kxcrn\n).o irucrrhc noiccr(Scc 7l)1.1, Bu\i"c\
<br />r lh'tt\snn(\.:'IhcCoiir.r.r'\Li..trsct-rwd.cstrorntflyroatrosncroinn,r,ry*h{)huild\orltrrltr.vcsrhcrcon.
<br />af *ho.nnriclstnr\u.hlroj.crs*irhaC.nkrcn,nnli.cn\cdpururrrrorh.CoDfu.ttr\Liccn{lrtr1)
<br />-linrcxcn,pl
<br />trn .rSccri{n, . A & PC.lnrrhr\ rcr{ri.
<br />]YOf,KEtsIiI.:AUIIBIAIION
<br />DECIANAIIAN
<br />I hcrchyrli nu cr pcnrlryolpcrjuryon.of rhcnil[)si,,gd.clxrrrnntr
<br />I hrvc rl will mrinlair ! Ccnilmlc oi Conrnr ro scli l n\ur. rar *ork$. .dmp.trs{nrn. ns Povidcd tnr hySc.rnn lT($orrhc
<br />tibor codc. rd rhc Nrroflntrrcc oithcBork for *hlcnlhc l,cnnir k hucd.
<br />-l hntr rnd u'illnuinrain solkcr'comp.n\arion in\uB'r.. r\ rlqunsd hySt.riotr:1r(r0oltltr ljt$rCoJ.. n, rhc,r onndnccoi
<br />lhc so'I lor shErh rhispcrn,yaork.^ drnl[i\ rion iNuror.ccrricr ulFlicynunrtcr c
<br />I crniry rhrr in rhc pcrfonencc ofrh. work fu which thi! frmir ii i\\ucd,I shall ior c'nPk,y any ncron h r.y mrnNr
<br />s) ns!,bconE \ulrj(rt turhc $ortcr(, co rr.r\r|ion l{*\olcllif(xtrir. ri rg'tcrhd rl I should ta.om subjNr n,rhc
<br />$orrcrs conrDctrsrrionpnrvnionsofSccri.n:l7U)oflhcliho.Cod..l\lrll.ionh*irh.onr ywirhrhocIrnvi\ion\
<br />WARNIN(;: trrilurc ro *.uE workcn .ompctrsoltr,i .orcritc r unhwtul. rtrJ \hrll sub.jc.r rtr cnrnlolet !) Lnnri'ul nli hi.s dd
<br />.ivil hrcs up t' otrc hundr.d Ihousind dollm I h rlt con nf$n[rtrhrnnr. ditrmFcs 3s prolidcd nr r[c
<br />il"'"'"'?;i7;;"*-''
<br />IhcrchyrlltDunncrJurllyotpcrjuryrhrIrnrli.cn\.dtrtr,lrrtnorni..tch.ptrI(.omnEiEnrg*ith Srrrrm TlXX)) rl l)trninr r
<br />or rhc Busirccsand PmlasnorsCodc. trfrlnryliccn\c is nr tullior.c rnd cff.cr
<br />-\0 4r (6oy{6t
<br />,L tr
<br />I hcrcb) trnir lnJcrFnrlry.tFrrxryrhdrhcrckn.o.(ru.!k'nLndinSaaencylorlhcpc.,o.tuccorrh.workforwhichrhisIEnnin
<br />issucd (Scc 30)r. Civ. C I.
<br />AIELICANL.OICIABAIIO!
<br />I ir4hy Imundcr Fnrlry orp.rjury onc ofrhc rullowine dc.lrnrons:
<br />txDmlirtun Pc"nirs'Ashesros Noti6c!tion l-cdcrrlR+rhrn,.\ lTirl.,s). Pdn6)
<br />Rcqutcd Lrrl.r oiNolillcoltn)
<br />onc.r lrgrebconrply!irhrllCiryr dCuuniy
<br />cpr.\c krivc{ olrhis Cir} atul C.uniy kr cnrc' u|rnrrh.
<br />elte
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Roof Sheathing
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL 4 It.// r(iiltium^y9
<br />Certif icate ol Occupancy ul
<br />Notes, Remarks, Etc.
<br />t ndcrs Addrci\
<br />-
<br />,rppr,.,"r./. rs."r sit'"r,.u
<br />""-,,""\(
<br />Erection Pads
<br />Shear Wall
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