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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE COMMENTS OTVNER BUII-DER DELCARATION
<br />I hcr.by ftnnr undcr 0cnrlly of pcrjuiy rh l a'n cx.hlr liom lrE ConnNlon l,iccn$ Las itr rhc followins rca:.i (Sk.7oll5
<br />Busincss !fti lrofession Cdlc): Any ciry or Coutrly which rcquircs ! Frnnr t' .onsrdd. rllcr. improv. d.'mlnh or rcPan {nv
<br />lrtucrlrc. prior b irs issurtr.., also rcquncslhc uflrlicair for luch pci'nir lo n[. siSncd (arcmnr rhd tror shc L! liccn{d Pu^Ltrir
<br />ro rhc I,rovhnnF olrh. Co.ta.ro. s Licctrscd tjw (Chirrcr 9. ComnEncins wnh Sccli(r TlxD of Divkn,h ] oi rhc Busirrc* !"d
<br />Pr,rdsnn( Codd)orth,r h.orshc iscxcnrfl rhcrcfloh snd rht hl\is lar lhcrllcscdctcmpri(,n. Any vnnriionoiSccri{,n 70.115 byrnY
<br />{'Dli.ant lor a Fcnnir sutj(ls rlt trppli.rtrr ro r.ivitpcnnhyot rcr nFrcrhsn fivc hundtcd dollns(3500)
<br />-l-
<br />as o$r, of rhc phFny, or my cmpbyccs tr ith * racs !s lict q'k .onrFnsal ion- *ill do rhc sdk un rlf ntrlm i\ n
<br />i'nundul oroffcicdforsrlc(Scc?()44.BusincsMdPrt,fc\jionsCodclhcConllacl{tr\Li.{n$tiwdocstrottrpllyhrnoun..ol
<br />rhc rmrrny wln hoildsor i,roorcs rhcNn. od wno de( sEh trott hihs.lrur hc6clfor rhEuAh hn or h.r own cmPloyecs.
<br />pi0vided rh.r such nnpm!..Enc c mr inrc.d.d or oflcBd forslc.la hostrct. rh.hikliryor i'rYidRnEN h sUwirhinom Fa
<br />ol comtlcri.n, rh. owmr Buildcr will hrrc thc ttrrdcn or nmvins rr rr or {hc dil mr build or nr'{rcvc dr lmPcny for rhc IrliFM or
<br />L as oq ncr of rhc fmFny. *rn crcltrsivcl, conrrtu in! *irh lic.ned conr.doF xt co.ntu.r rh. !mi{ (Sc Torrt Bhi".\\
<br />a Edlsion Cidc: 'rhc C.ntmror's l-icctrsc t,rq docs nol lntly ro rn own$ olttfl,Pctly wh,) l,uil& or nnfrolcs rhcrcon.
<br />r who.onraclsio!slchpDrc.kwirhrconrmu(9liccnrdp!^ux b rh. conrdot s l-i.cn* llw)
<br />lrtr,crcn,nI updcr S.rr
<br />-", ,o/r lt Lope.L
<br />IIEII.A.BIUAN
<br />I hcrcby nmnnundcr pcn,hyorrdjuryonc ofrhc rolloqins dcchrrrion\:
<br />-l
<br />havc uJ eill'uinr0innCcnilicdcofCooscnrroSclf lnsxrc for workcls omPetrsdn,n. as povidcd for $ySecridn:171D uithc
<br />Llhor Code. for rhe Frfi,mn.c ol
<br />'hc
<br />sort for shich lhc permir n i$ucd.
<br />Ihr\c!.dwill rir dflr Norkcrr conr.nsrri{r nNo'rtu-c. r\ rcquircd h} Se.ri,r:l7lX)ofrh.ljhorCodc.,i,rrl[ pcrfoi unccof
<br />rhc *ork ftn whichrhi\ Fnnir is ksuc My *orkcN .rnnpcn\srnnr iNurincccatricr 3nJlx,licy ! rb.r rc:
<br />Cstrkl
<br />-
<br />Policy Nunrbc.
<br />-Exrircr
<br />l.cnilr rhir i,r rhc pcrhrronc. olrh. work htr which rhi\ PLlari i\ nrucd, I shrll nor cnDk,y 0n, p.^oi i[ rtrv nrtrEr
<br />s,!srobcco'rtsohirrorh.qorkcr{conrF.snlbnhs\olCrlitun. d rlrcc lhrritI \horkt b(.otrf, sul,jccr t,rhc
<br />iorkcs co'npcisrrion ptuvisionsolSc.ri,in l?O{}ofrhc lf,tttr G}d.- t dEll. lhnhwirh co'npl! wirh rhosc Pmrisnnr
<br />W^inilNc l.iilurc lo surc w{rk r(.o.rr..\.rotr..vcmac is unhwfll. and shill nrbj(l !r, cmfbltr b aininrlpculrics rnd
<br />.ivil fir\ uI roorc [undrcd rh.u{trd doll0r ($l0o.lxx)). in 3ddiri,n] n) rhc cnll olcotrrcn\dn r. dtrnr ccs as provi{h(l r(r thc
<br />Sccriotr 3076 oarhc lix,GvqddA L"c pptiLur: y'?e-Ltl(t,:Nst.l) (i()N I R/\( loR
<br />DECI,AMIIOI!
<br />I h.sby rrfinn undcr NnrllyofF.jurylhd I d lia.rd undf p$tisn,n ofChaPr.r s (.onntrfti.8 with Secrion 7fiJ0) oro;virion:l
<br />oI thc B!\irss,r PrcrcssionsCodc. snd mylicco* n in lull tor.c tcflal
<br />Conlrocl..:
<br />c(|NsTLucl IoN I FNI)IN(i A(;l-Nel
<br />nn'.J (S.c :1097. C,L ( )
<br />AIILICANIDECIIEAIIO!
<br />IMt imuudcr lcnihyofFljlryonc orrh. ftnbwing d.chdiotrs:
<br />Dcmlirt,n PcnnitsAsb.sios Nolificlrion fcdcrdl RCBUlarions (Tirlc 40. P 16)
<br />_R.quncdbtr.rorNolilE ion
<br />1..(lli rhr rlr li,Irx] roNULrof\ r.!rdirP n\f.(o' r.nrnrl rr. Dor rllli.rhL. ri rhn n(!..r
<br />nilyrhlr I hricra.lrhhaptlkrrnrrldsl clhrrrhcJh)rc inionMlion is cotrccr IrFoh.onr ywilhollCiryandai rry
<br />ordinaNcs rnd Sldc L,ws tolditr8 ro huildinB con(rucrn,n. und h.r.by.nrhonzc rcprcscnrrrilc\ orrhis City Md Counrv b.n!$ u,nrn rhc
<br />rtr'h f,trr'okd pmltcny lor instecr i' , n ,rFpo\c \
<br />;;,,-;,;;;;;,;,."x AAJ+,^elz\ \.orcz-
<br />n"-u**.",0,,,,L (5J<1Cr€ll L0+eL iolhi I 1/
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/aso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Cerlif .
<br />FINAL tl)lt41a"rntuel:-lrZ)
<br />Certif icate of Occupancy ur
<br />Notes, Remarks, Etc
<br />n
<br />tD/slG.
<br />l,r'..,'. \JJ'.\.
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