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BUILDING. INSPECTOR RECORD
<br />ID/SIG.SITE-WORK DATE
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Venti I nsulation
<br />Roof Sheathinq fbn//2 #7/tr/s-/n
<br />Shear Wall
<br />Framinq
<br />Insu lation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />[/]ason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil
<br />'.///o//l I Trumz /r)'-Y'-FINAL
<br />certilicate ot occupincv ffi
<br />Notes, Flemarks, Etc
<br />OlINER AU ILDER DI]LCARAT'IoN
<br />I h.r.hy xft undcr pcnrlly of FrJUry thrr I m .rcnfl tunr rhc Colrkrcro^ l-ctrsc bw lor rhc foll,,winB rBq)n rSN 7)ll t
<br />Bu\i'Bs itrd Profcsion C{dc): Any ciry or County qhich rcqutc\ a lrnnir h .on(rucl- rhs. nnFovc. denFli\h or rFd 3trv
<br />nru.oc. prior lo ils isuMc..,lso toquncs rlE 0t'!li.anl lor such Fnnr h filca sisncd slalctunr rh,t hcor shc h liccN.d Nr'u,nt
<br />!o lhc !!r!ision\ of rlt cotrriclois l-iccnrcd lnw (chanrcr 9 connncn.ir8 sirh sc.lbn 7000 ol Divist l orrhc BNnr\l3nd
<br />PrcL\\tnrsCodc)orrh.llEorshci\$clprrh.rcfronrandrhcb.rristorrhcrllcgcdcxcml,riutr.AnyYn,hitnofS(rhn70l156yrny
<br />.pllicrrrttrJpcmirruhjdcNrhc.mlicanll{,!civilp.mlryofnotnntcrhinlivchundruddollarls5m)
<br />I.r\osncrolrhcprorEdr-ornryclduyLr\NirIwrsc{Nlh.irv,lcconf.tr{rion.\'illdorhcwo drdrlknBiurivin
<br />iNcn(trl .rofiircdforsrlc(S(lO1,1.Bu{incslndl)tr,frsi{)n\(ixlcThcConrructr'\Liccn\cLasdocsnorlPplr"t) rosrcr.l
<br />rhLF,Nny sho hurlrls o' i,,pnrvcs rlrd .. lslY,dNr{'.huorkhnnsclforhcr{llorrhrcughfinorhcrosncn{n,r_cc\.
<br />pnvidcn rhrr sNh nrymw Etrh uc nor i' eidcd or ollc(d hr {lc. ll- howc\ cr rhc htrildiiS or mDrorck-nr is r)ld wilhin r k ) cr
<br />.fconlPl:lion. rh. O*tr.t Duikl$ will ltrc rhc b! cnofpnningrlf h.or \hc iil trorhuildorn Pn^t ihc lmP-ny for rlf NrlIe oi
<br />-l.r\osncrof
<br />rhpn)Edy.0mcrclusivciy.o rr r i,rg vir[ ]r.ctrscd ..trr.!cd\ n, connru.r rl[ ,riccr iS* 7011 lrlnnc$
<br />Ih'lBsionO)dc:Ihe(bnl.rckr-(l-i.ctrscLrqdocsnoirPtlyk) dD\fcrolI'r'P(nt$l$buildsori,nprovc\rhtrcotr.
<br />anl rho coirr.Gr,tr\r.h proicclrwirhaConkrctn(t licrtr{d pur\uxnr t,rhcCofi{.ttr s I iccn* lls)
<br />\vORKI'RY C(}NIPI'NSATI('N
<br />DSCLAEADIIN
<br />I hcr.t y rfilnrndcr Fnnlr' oitErjrtryonc olltu tulbqn,g d..lnr iofs
<br />I hitr md will nxi!{rii rCcnill. col CoNc n) S.lfln\rrc r(, Nnrkcrr cotrlPcNdn,n. r\ Uovidcd liirhvSccnoi l70O.l llt
<br />Lrtx/ C.d.. f(tr thc pcrfo'nriccofrhc sork lor shich rhc pc.nir k i*u.rl.
<br />Ihrr.and*illnr ain work.'r compcn\ tr nNu.rrcc. r\ tcquir.dhtSc.rior:lTlDoirhclihorCndc,torlhcPc'r""N'r'"r
<br />thr work lor which rhh p.nnir i\ i\{xdl My wo cr{ comDcn$rnrn in\urM.c caflicr trrxl plicy numhcr rc:
<br />-l.cnilyrhrr
<br />n,rtu prrtunnrNcol rhc sork lllr *l,i.hihi\ Bnnir ^ i\sucJ- I \hrll or c {'k)t rfyFrvnr i'r riy n trrcr
<br />\) x\ b h.cunr {rhrcr r, rhc so*c^ .otrrtn\xrittrr hss of( ililomir. rnd r!r( rhir il I
<br />*o'koricon,I[n\rridrl),ovi\iofsolSr.ritn,lT(x)or!hcl-11rtr(({n:.1\l l.l,nrh\(h.,
<br />$ARNIN(; lJ'luR n) !.tr'c lvolkrr( d.i,,r covrrnrc i! utrli\tl rnd \h ll \u dn cnlpb]rr ni .ri'ninrl JtNlri!\ itrd
<br />civil liNs up b oR hutrdrcil rhouu l{xr.lrxr) n rJdir.f L, th..on fl rnnr. dxtrus.\ as F)vidcd f.r rhc
<br />Sccrior.1076ofrlt Lrhr C({c. irlc
<br />*-,OEltiril<6
<br />ol].l.\&\rcl
<br />I h.rc6y rlh. rutrd., p.rrk'lnrurrtr'yI d I rn licnslrd utrdcr Imvili,m ,,f ChrPl.r 9 (.omENir,! qith Scdio. T(xxr)ofOivni,ri l
<br />ol rh. Bl\nrs od Prolc(n.n\C.dr. x nry I'ccn\r n ir rullntr.c nBl.ll..r
<br />c-3q 4 52,5 5d
<br />o," OY f1o tr\r llii'tnt.Na"/5
<br />I h.toh,!{lir un(lc! IrDrlryof Frluryrhrr
<br />is\0cd1sN rl)r]7. civ. c )
<br />con(ocri'n hndirts rscncy lbr rh- p.rlnnnMccolrlt sorl f.r *hkh rh( Fiinil h
<br />ASPLTCANLDE.CIABI]IO!
<br />I hc({,yrlIrntr r1.. p.naly olFrtury om olrhc folhwing dc.lndn nr
<br />Dcnrlirtin Pcrn rs Ash.{o\ Norilrcrli,r I'cdcr!l Rcautrri,,n\ lTnh 41), P!d6)
<br />-Rcquircd
<br />lrrrcr of Mnii.$on
<br />is.om.r Irlarbcotrrdy\irhJllCiryr dConrr,
<br />\cnrdivcs ofthis Ciry Md C.xdyh cnler uBn, rhc
<br />,",",O8(\toltY
<br />Nl luez**'-^y'i'c14 w\r\i1,
<br />COMMENTS
<br />Erection Pads
<br />lrnr.r.trrtn, rl.r S..rir r .B &IlCInrrlr\r.r(n,
<br />I)str ()*ntr
<br />r\{.
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