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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER IIUILT'I]R D!]t,CARA-I'ION
<br />I hcrcby (rilfln uMcr pcmlry oI lcrjury lllar
<br />'
<br />an cxcnrpt lro'n rhc Cofirct,r' Li.ci{ Ldw rd lhc lolloqira rc!$n (Scc 7o.ll 5'
<br />Bu\i',c$ ud Pronsion C{xlr): Ant Ciry or Coumy shich rlqoncs r frnnir b .onsrud. all.r. imp(,vc. dctrolinr or qun rny
<br />sd.rurc. Itrn,i(, irs i*udr_c. lho rcqurcs rhc !p})li.M( nrsu.h l).irn lo liLr \ilncd ialcnrnl rhlrh.orsh. r lrc.cJ Ituh Mr
<br />t, rhc l)n)!'soN o, ihc L1n rL!tr s t-rccn\cd ljw (( hrprcr 9, C..nnrn.ng wirh ScctrD 7UI) of Drvrsion I ol ihr Burnrs rtrLl'
<br />Ptufcssiotrs Cod.)or rhar hcorshc iscxcmpl rhcrcliomnnrl rhc sis ior llEtrllcScd ct.lll)rn,n Anrviolari,,nofsc.rnnTl,-1l5hyrtr,
<br />apnlicrnlt)rrpcnnirsubjcclsrhcrpplicanrr.acivilpcnalryofnormncihufivrhundr.ddollnrs($500)
<br />I. ns owncr of rh. ptultny. oi my cmfloyes sith *aSN .s rhct wlc compcn{rion- will do rhc $(rk 3il rtr nMrE is trol
<br />inrcndcd.roltrcdnrqb(Sc.7ls4,Busi'EssrndPnrrcsi.nsC, c:Thc co.trrcrofs Liccnrc li{dcs nol apdybano*ncror
<br />rhc Dn)!.dy whot ilds or inrlmr$ rhcmn- and $ho das ssh f, * himrll or hc^elf or rhmu8h his or hct .*n .nlt'loycc{.
<br />prcvidcd rhtrr such inpturmnN m nor inrc ld or ofrcrcd aff srL. Il h,f,tr.r. rlk tuilding or impnErEtrr is $11 wirhin om )tu
<br />olconphlior thc owns Buildcr willhrvc lhc burdc ofp!'vins rh hc or \hc did mr huih dr nrrmvc fic Pmpcny for rhc ltrPE oI
<br />-1.
<br />as o*ncr o, rlt pmp.ny, aN cxclu\ilcly conl,ocl irs Nilh licctr{d .oftr.b^ h .on{rucr rhc ,mjccl lslt 7ls.l- Bu.irus
<br />akl Pmf*sim c(d.: Thc CotrtrrcroCs Li.ctrsc Lrw doN not nftly to rn o$ncr olpn,perry who l,uilds or impiovrs rhcrcon.
<br />rnd who .onkactstorrEhr.ojccrs*ith!Conrradoni liccn{d plrurnr t, rhc conk ttr s Li.ctrsc Lrs)
<br />I rncx.'npr undc.Serio ll & PC turrhis rcavnr
<br />ttxxtBlljQltfllsallQN
<br />DECI.AXAITJN
<br />I hcrchy nrfinnutrdcr p.MkyofNrju,ronc oflhc lnlloNirs dalu(rnnN
<br />lhrvc trd will nuntrdir r Ccn il(al. of Cbtr*f b Scll.l trsrtrc io qor[.r' com!.fsar bo- !s Irniidcd f(tr bySccrid] 37($.llhc
<br />litxr GxG. nr rhc pcrforrmc ofrh. *ork tur whkh rht p.rmir a i\sucd
<br />I havc rDd willnriirtrir workcrs conrpcnmrion iNurun.c. rcqutcdhyS..rn,n:lTftlofihcLrhorCodc.lorlhcpcnnmamcoi
<br />.onncnslrt,n in{lrun.cc. .rd Fnicynunhcr nc:
<br />f\
<br />5
<br />-l
<br />ccdily rhil iI rhc pcriofl.rrcc otrhc work ittr *hich rhi\ n nnn i\ ir\$d. I \hxll nor ctrPk,y rtry tcNr in try nrnn$
<br />n, r\ t trcomc \lhtccr t) rh. ao&dl conn nrari( lr*\ ofcnliturnl', rkl a8rcc rhnr ill should hcdntu {ibj(r h rlr
<br />sork.ri .. rp.tr\rr n r pmlNiotrs ol s&tiur 1700 ol rlrc Lnbr cd.. I slnll. lhn h*irh cotrlPly wirh ik)s |nivsion\
<br />wARNIN(;: lrildrc t, {cor. workc^ ..nrfcns trrn..vcn'gc i\ utrlrwtul. nnd sh{ll \uhjccr r! cmpk,yor ro.ri'niml Ntrtrkics itrd
<br />civil finc\ uI b onc hun,lrdd rhou\a d dollrs rSI00.UX)r. i'r nsrion- donrg$ ,s providcd lor rlr
<br />Scrrion.1076 ofrhc trtrr Codc. inrcrcn md ormy s tucr
<br />' ?3 -><:l? ,rnpri.,nr, /
<br />I hcrcby aflnr undcr pc.0hy of pcrjury thrt I am liccnsl undcr prcvtion ol Chatrd 9l.o nkm inB wnh Serio. ? n)otDilhion.l
<br />of rlr Businc*nd Pofcsions Codc. and my liccns. is in lull lorcc i cliacl.. tsB>-\33
<br />I a-r",O* A
<br />CONIiIBIJqIIQNIENDIIGACDIII
<br />Ilrreby,fllnnu dcr Nniryuf,Erju'ylhal lhcrc is0con(ruclion lc ins sEc cyrorrhcocnnmrEollhcwo ro!whichlhtpqmir is
<br />is\xcd (s( .1097. cir c )
<br />artut NfDEclrlxanla!
<br />IlFEtyalllrn,tr d.rI)cialryof tcrjuryomof rhcf(rlowin!dcclamrions:
<br />I)cndiri{ P.rmih Ashc(os Norinclion FsdrBl Rcgold i('n! l'Intu ,rc. Pnn6)
<br />-R.quicd
<br />lxlicr of Norifi carioi
<br />l.citrli rhdr rhc lcdcnl rcEUlrri{nN r.!udirs rslE(or rcnn,vrLnrc mr rntlcrhlc t, rhi\ t,n,F.r
<br />><l\rt r) rl \! rs,rl'h.
<br />'t,l
<br />l!.(r h. rt v. hronmrim t.orcl.I rsre lo.omrly wnh all Ciryind counry
<br />rizc rcflcsnl ivcs oflhhCirylndCotnrykr. r$uB rh.
<br />ahovc nrtrrtrtrlL.d n(,lrny lnr
<br />Appli.anl or,\senl sisn r'rc f
<br />II,rnril$ nrnr lpritrl): )(.(-L;
<br />.*Z->cl?
<br />Set Backs
<br />Erection Pads .,rty'u
<br />UFER Ground ^ I 1.t.1
<br />SLAB Floor b,t t/,{V,
<br />Subf loor/VenVlnsulation tla(' rL0i ,ff(--,q
<br />Roof Sheathing 7-'1.10 Jl .*?/1/1 )' ' otf, .-,^*l'/
<br />Shear Wall ilr'"',f r 5r"u
<br />Framing ' lL" . y'u t l.loy,;.,
<br />lnsu lation/Enerqy I r/ur- fl- (Y
<br />Drywall r
<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 Certil.
<br />FINAL I 'illhlt!UTnW /((\/
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc.
<br />Formsi Steel/Holdowns
<br />p...2*-?,cQ
<br />l.trJ "-. \'iJ'r$
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