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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE COMMENTS oWNF]N BINI,DN:R DE!-(:ARAToN
<br />I hcrcby 3flirm undcr Fnrxy.l lrc jury thd I am cxcnBl fr.m thc Conrracl{m l-i.cn\c lf,s ld rhc rollorin8 icls'n (Scc 70.115
<br />ausincss lnd Plora$i.n Conu) Any Cn, or Cotnl, shicl rcquircs r Fmrir ro .o {fl.r. tlrcr. inr,,rove- d.mlnh or rcPrn $,
<br />( ciurc, prix r. iri i\ruan.., aho rqutcsih. rrtlic.nr n, u.h Frnrir to n[ r siSncd srarcnrcnr rior lEor\hc h lien*d prFunnr
<br />ro rhc Folhions of rlE Conhcroas l-iccned Inu rcharrcr ,. G,frden.nr! wirh sc.ri(,. 7fix) of Oivision ] of lhc B!rinc\\ lnd
<br />Pmfcsiois Codc)orthrr hcor\hc is.rcmrr rhcrclro'n and rhc ha\is tar thcrlhScncx.mplion AnyviolationolSccriotrT(l.1l.5hydny
<br />amli.,nr lor a p.nnir subjccF lhc rptlicanl lo ncivilpcml'yo, nol nFrclh8n livc hrnd..d d.llar (s500J.
<br />_1. rs .*ncrofrhc pnrlrdy. (tr n1y cnployc.r virh wr!.r as rhcn sob.onpcnsirion. *illdo rtE $ork and rhc {fldurc a nur
<br />inrcodd.roffcrcdfoisrL(S.!7(t4,r.Busi.NsnndProfc$nrr(-odcrThcConrrucrnsl.iccnscljldn.rnor{tlyrn romrol
<br />rhc pmrcny wtu ttril& or irnprorcs rhcN( ad wh, d{f,s st.h \ort himsclf or hcrell or rlrou8h his or hcr own cn, Dyces.
<br />pn,lidcd rhar su.h imntuEnrnheft)i i.tendcd o..lTcql for {k ll k)trrkr. rhc }rrikling Dr in{x,vcnror k $kl $ihi'r onc )tr
<br />ol d,tr{'krion. ihc O*n.r Buil .r *ill horc rh. hordcn of l)n)ling rh.r hc or shc dil n.l ttrild or illlpro}r rfie poF{y fo. r}r nu lFt ol
<br />I.r\owncro{ihrln,ncny,nrcrchsncly.otrtr.ritrEsirhlicci$d.onrru.rnsro.otr{ru.rrh.pmFci(Sc..7(}r,t.llun&\(
<br />rtrd AolBion Codc IhcConrrrror\liccnsclawdoc\norafplybriotncroft(,l]cnysh.huikh.rtnfRrc\rhcrtotr,
<br />!trd who cont(ttursuchptujc.tswirhrQnnck*(()h.cnscdfurrur0rlorhcConrrcrtr\l-irci\clrN)
<br />I a6cx.frpr und.r S.crion- B. & P.C. ior thh rcan,n
<br />Drl.r OPEr:
<br />]TOAKE&::COMTIINIATIAN
<br />DE TIAAIA!
<br />I h.rcby iflii,n undcr |xn,lrt oll)crjury om oflhc,ollo*in8 d(lirilions:
<br />I l[tr nM will nuirtiin tr Ccnificlrc ol C.nscnr n, s.lrr lnsft fin w.rkcr! .odNtrsi!.D. rs F,vidcd fu iy s(r i,nr :l7lx, o I !h.
<br />it)1:l7lX) ol lh.l-ihor Cotlc. f(tr rhc ff,nnnnxrc.l
<br />icr iri p.li.ytruo,hcrm:
<br />2A
<br />I ccnify rhlr in rh. pcrrortun d ofrhc work f(r whkh rhr Nnnir F k{cd. I shall nor cuploy rny P.ro. in.., nrMncr
<br />$ N tu b.om {bj.d b thc uo.tcn compcnsar ior lx*s .I Cilili)rni!. aad 4nt rhdr ir I \hduld k..oit suhic' ro
<br />'hc{.lkcis'..mpcnsnrionlnvi\iosofSccrion.lTO0otrhctnhrCodr.l\hrll.fonhwirhconrDlywithlho{trolhion\
<br />WARNIN(;: Failor b $.ur. w.rk.F .omp.trs nnr (ovcrr8. is unh*Iul. a rhrll sohjcd an cnploycr o ai iDnl n!ml'i.\ dnd
<br />rivil lidc\ trt t, odc huidrcd thousnDd dolhrs l$lllJ(Xx)). ln ol ..ntr qrn{. drnrFc\ r\ llivi(l( l,n rlr:::3W::
<br />I hcrcht 0ttm unncr tcmllloiFrjury rhrr I Jm lChaprcr 9 (.onnm.cin8 +irh Seri,n 70(Xr.IDirision 1
<br />or
<br />'hc
<br />Busincs\ and Pk,r.ssi nsCodc. lnd rryliccns h ir iullr cc mdctielr
<br />.).1-a,1-
<br />I lrrcbyalfirmundcr pcnllryolFqtryrhd rh.rc ktcointudi)n LidinSaB.myforlhclcrlhrronccolrh. so n Ehi.hrhtrcrmi! (
<br />Lctrd.isAddcs
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<br />AIIITCAXLDICI.ANAIIQN
<br />I hddry ailinn u ndcr rcn0lt, ol !.rjury om olrhe folk,win8 dcchrlrions
<br />Dcnxrirtrn Pdnir\ ,^\h.qros Notificnrn r'cdcml Rcguldnrs (Iillc40. Pan6)
<br />Rcquicd lracr or Noriierir
<br />I r.'lilv rhrr I hx!. rcrd r[n ]tflrxri,nl
<br />,tr,lrxDc.\ xftl Srnr I r{\,rLdi'r! (,lJtr'l r
<br />hni\roro.r lrsrek,.oillltwirh.llCilyindCouniy
<br />rhorizcrcprescnrrrir.sof rhi\Cny dCounlyl(icnlcruponlhc
<br />7 8:224
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsu lation I
<br />Roof Sheathing ?hn/n r-turrH ,+- -
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lalh
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL
<br />Certilicate ot Occu nc
<br />Notes, Remarks, Etc
<br />ID/SIG.
<br />Forms/Steel/Holdowns
<br />turhc pcrrbnnrmcolihc *o ror whichlhc ncnnn n isucd
<br />ind sill n nin *Itrltr'\'
<br />/)/-
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<br />rsu.d (Scc 1(})1. Civ C.)
<br />I .rlir'\ Nrnr
<br />_l ccnifyrhrr rhc hdcral rgulrri.ns medrdin8 a$.ros rcfr)vrlurc nol atrli.lhlc ro lhis nmFd
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