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BUILF NSPECTOR RECORD
<br />coM EI )SITE-WORK DATE ID/SIG OWNT:II B(III,DER DELCARATION
<br />I l.i,r.by rfilrnr uMcr p.nrlry of t'crjury lhrt I m crcol)l fmrn rhc Gn rdon Liccn\c hw for rhc lollonitrB rcann (Scc 70ll 5
<br />Bu\inrss ud Pnrlcsin Codc) An, Ciry or CouDry Nhich rcquir.s r li.nnir n) connrd. alrcr. inF)tu, dc'tulirh ur
<br />''n.'n
<br />Jiy
<br />nrucrurc. rrior to irr issu.rrc. al$ rquirs rh.npplKr nn \tchFnnir ro libn $g cd nic,ft.r rld h-.r \hc s ](cns.d puBu.nr
<br />to Ihc provki.ns of rh. Co.kr.rtr ! l-iccn\cd I-rs (Chtrpi.' 9. ComtrEicn,g sirh S..rnrn 7{XD of Divkion I .l rhc Bnsirc$ and
<br />Pdt$nn\ Codc) or rh h. or shc r.rcnu rh.rclion rnd rh. ha\( nn rh.alhlcdcxcmflion Atry viohrninoiScclhnT0.ll5 hyony
<br />rpplicunr lo.! ncnnit sutj(ls lhc ap,'licrnr ro rcivilncnrhyoltror nmrelhu rivc hu rcd.lolli^ ls5(x)).
<br />-1.
<br />is o$ncr of rtu flol{nt. or nry cmplorrc\ {irh srlci is rhcn $h .onfttrt,r ioD. sill
<br />']o tlE $uk Rl llE {trluR is ftn
<br />i culcd oroltercdhrelc(SN.?O+|.Dusincsnndl'rotsn,rCodcThcCont..rx!LiccnscL,$docsnoilpplyn,ano*n.ror
<br />rhc !n,p.' ry who buil,ls or i r(ir! rhcrsn. rfrl wh) docs such *)A hnrsc f or lrr sclf or rhhugh his or IEr owf, cn,plo)mi
<br />povidcd rhd srch in,rn^r rrsrx, inrcidLrl or o ftiBl ftr {k ll k)qcrci rh. bxikliq or nrphvenr t$ld $irhinonc ltu
<br />olconrphli,n.lh.OwncrAuiucr*illhlvclhctldcnolpovin8llu{hcornr.d nol ttril,l or i'npr.vc rhc pmFrry ftrrrf, purlr,{or
<br />(kt llNt!\inr Coic lhcconlrrcru \ l.iccns. l.i$ ,locs rolinplyro rro*1rc..l f'.pc y*ho hrlld!.r i' t(r.r rh.icotr.
<br />rtrJ sho .ont \ lnr such ttr{ds wfh r (innr rkd\rh.c'ncJll^u]Nk,rlkCo rrrrr \ Li.cisc Lrw)
<br />I rcrcnlpr u rr Sc.rn
<br />]!ABtrI8T.C!IITEN,TA.TION
<br />DECI,A.BAU()!
<br />I hdcbyrlln und.r,rnrhyoflrjuryoncofdEfolk,singd.clru.on\
<br />Irhtr Cixtc. iar rhc ,[rfonrtrn ofrhc s.rk rnr whth rhc p.nnir n n\u.d
<br />I hav. rid q,llrrimrii wo*crJ.o pcnsdi(). in\u'n Q, n\ rcqun d hySc.rit lr00olthc LrtorCodc. Ior l[c Frfonnrn(ol
<br />r|t u.rk lor uhrh rhtr Fnn r\r*u.n Mtw.rlr^'.,{nr'\"tr1rrn\u'htric,Jr'r(rJndflEvnunihcrrrc
<br />, "" €A.,te-+r.4
<br />- a?t, /'111-
<br />-l
<br />.cnify rhrl ir lhc ncrr'oflrxrrcc otlhc sork tnr *ni(h thn rErnrir h i\nictl. I \hrll mt cnlPloy riy pcry,n n' any tr'r.trcr
<br />*, Nrohc.oftn rjei t, rhc sorkcrs .o rf.isrri(inlnw\ofcalila'iir,a 4rcc rhd ii I llrJuld h.onr srh.,,:d lo lhc
<br />workc co'np.nsrn,i pmvi\iois ofsdcr n:l7U)ofrh.lltrtr Codc.lshall. tu hwfh..nrdywirhrh.eUovti.nr
<br />w RNlNc: hilurc ro ccurc *or[c6 conEnsilnr covcr.Ec is unlu$lu]. lDd \hrTl suhFcl arr cn,plotq b aimind l*hlric\ d
<br />.ivil fitrr! un lo onc huMred rhou\rtrd dolhr\ (Sllo.(xro). h rddii.n ro rhc con olconipcn\ rbn. da'mscs r\ ftuvid.d nr rhc
<br />Sc.ri,)o.1o76of rhc lihn ry H;,[:8-u
<br />I k*rbyrmnnu $ ND.llyoltrrjury rhar I0tri liai*d und.r fn)viriotr olChrDrd 9 (.sNncrin8 $irh Sc.rion 7(IX)rorDiv not.l
<br />ol rhc Bu\irc\srn l'roli\\i,ns Codc. rl ry lncn\c i\ i,, tullturrt d.iirr
<br />r.icenfc,.s! u%q,,.'Y'U1F alq'l
<br />..r-.* ,)(-S,.r{a fiptc
<br />/!-.J..iil),hr rhc L!lc,rln gulntn,rUcE tr'li"! r.h-r- '.nr,\rl r,r,'rrl,','l,I'L.t\h t'.jnr
<br />N\J*r,r., , *'",... *r nprru,M drxr r.r,h,he ahnr inror.krion i!.ore, rnsrc b(npry w h r, ( yrid cou,y
<br />1ffi")'{.- i^a s"" r"*..r,',j i. r',tu-g .,,n"..r i"n. *! hcrchy rurhrri/e rcpr.scnrrri;?..irhil cirim,l counrib sr., upotr r
<br />"Jb,{" nLrr{.J Fi..r'rJ tcr,n,tsri. t{rF{,. Z1,
<br />n,r,"*,.,nr.",',r*,,*4 -tr f,lln *,, t z'tVlg
<br />pem,,REme,prin,,, ><.\\Ju4ql.tfa U ^" p S
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Roof Sheathinq I //s/// t 't*tm* /'tz-
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />1
<br />FINAL I llzzlt *=nvrz /D----
<br />Certificate ot Occupancy
<br />Netel, Remarks, Etc.,,..-\
<br />-+
<br />I hcrhy{rfiflnuldcr lxn lyolprrjulyrhnrrhcret{condrucrioolndin!rg.ncyr(xrhcl.rtuhrun.coftltRorklorwhichlhhFnrilh
<br />ksucd(s( 1017. civ. c )
<br />trl'J.r'\
<br />^,lJ',..
<br />a.ttut xfDIicLAnaIlQN
<br />I h.rchy afin !n undcr lNnllr, ol pcrjury onc ofrhc follos inB dcrlarart,ns
<br />Dcndition P.nnilrAshcsros Nori6c0ri(r ltdcril RcAullrionsr'l irlc,1.(). tun6)
<br />Rcqutcd kfi cr ol NotilicalioD
<br />Shear Wall
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