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BUILDING- INSPECTOR RECORD
<br />SITE-WORK COMMENTS OWNER BUILI}I]R DET,C RATloN
<br />I hcrcby rllirm undcr pcnrlry.'l Ntuty rh l!'!crc'npr fb thc Conrrrnns L'ccn$ Lr$ in rhc f(nk,aine rcNrn (Sc'70:ll5
<br />BNinc$ lid ltolc$ion Codc): Any Cn, or cdutrry wht'h rcluircs r l.iln io con(ru.r. trlrcr. nurotq d.nxrirh L{ r.Fn nnu
<br />ntu.rrrc, In.r to irs hsumce. trno rquncsrhc $pliclnl lor uh lthnir lo lilc 1\i8ncd {dcnrnr lhal tE or \hc n licctrsd Pururnr
<br />ro Ihc nmrnion\ of rh. Conrtuckn s Liccn\cd tjw (Ch. cr 9. C.nnncn.ing *nh Sccrion 7(l(Xl ofOivision I ofrlt' Rr'nx* in'l
<br />ProfersionsCodc)orrharhcorshcncxcnnrlhrtuf n.nd rhc h!\is lar th. rllc+cd . rc mpl ion A ytbl ionoiSccrintT0ll5bvanv
<br />rpplicrnr foi JFnnir n'blccrsrhc rrllic{trr k, 0 civil pcnrlry ot nor nkn th$ fivc hndrcd doll$\(t5OO)
<br />-1.
<br />!s own.r orrlr. pmtEny. or ny.nDk,yccs sith wiscr $ lhct \.1c comNnsllion- *illdo rh. work 3nd rh. nrurm s nijr
<br />i'n. ldl .roflcrcnlorslcrse.-7o4trt.Bu\ilc\s.trdltolcssi{m\C,ll.-rhcConlticroi\Licnttrsdocstrorirllvroano*ncr{)'
<br />rhe pFlicny sln, hnilds or nnnro\cs rhcm,n. uxt whr de( su.h wo* hims€lfor h${ll o' thmu8h hh or h.! o*ncnrpk,vcc\.
<br />nn)vidcd rh r {i.h imI(r!.ntnrs rE Mn inrc.dd or oficrcd fttr slc ll. h.*c!.r. rh. hrldin3 or i'r{,m!.n is s'kl wirhi'r odc tur
<br />ol.oi\ncrnn !h. Owncr lluiHer willhr!. rtE bunl.n otPnrlin! rhd h- ot shc did noi t{ild or illlmt rhr pmP-iy lor rhe PU{xx or
<br />l. asowtrcr ofrrc propcny. r.xclusivclycotrtrrdirrg*irhlicci*dconradr(tr\t,.oi{fl.rrltfmFi(S..7(}l-l.llunms
<br />akl Pitrlts\iotr Codc: Thc Conkrlois t-iccnlc t-au docs noraPply h !nown.i olF)!.nt Nho huild\ or imProv'\ rhcrLur'
<br />r d *ho .otrrocts i.r slch l)mjcck wilh r Conrra.ro(r) liccnsrd N6uanr brhcG[r..rois L,i.cnsc tjw)
<br />I ncxc rl,r u crSc.rid,
<br />Dat€ Osncr:
<br />W(IRXERiCOTTPFNSATXIN
<br />DEIIASAITON
<br />I hcrcby rlfimundcr p.nnlry.lpciiuryonc olrM tulkJwiu d.clirlrion\
<br />Ih.vcn sill rinrrintCcnificrtcolQ)nscnrtuSclflrsurctitrslnkor.onPc.sllbn. IrR,vidcd lorhvSccrir)n 17(xrolrh'
<br />Latrtr Cud..lor lhc pcriomEi.coinrc woft {.t*hich rh. rmir s i$ued
<br />I hav. ndsillnui'rrxi',*orkcrrcompcnsriioninstrrr.c.r\r.qutclhyS.(i( lTlDoirltlrho'Codc,lnrheP'rron'Mtr"r
<br />rhc wo* lor ehich rhisp.flniris is$rcn Mrrorkcrr conn.trsrnon in\urmftcanicr ir a)licvnu rh.rrc:
<br />pnri.yN,u,b",," D uuc- t%'72 L*rn",
<br />-l.adiftihxr
<br />in rhcr.rlornuNcofrhc work f(tr shkhthh r^-irnir t rsucd- I rhrll nor cmllt)t rDvtcrsotr i'r rtrvnrnncr
<br />n, rsrohcconE\ubjc.rt'rh.workc(coarP.n{ri,,dlrwcor(nrin,.is.rndasd.rh ill slnruld h..onr subiccr torh'
<br />worhcrs coNf.nsrrn,ntnrvisioosolSrcri(n l7(Xl.frhc Llt t C.<lc- I {ull. r.nhsilh comply wnh rhos Poltbnl
<br />WAIiNINC triilurc ro s.ud qo*ctr conPcn\xrifl, co\.osc i\ utrhwtul. rnd shdll sunrd u. {lovtr ro oirnin'lt'frrh's ond
<br />(ivil 6n.s up n, orc hondr.d rhou{nd dollan (Slu}.(x)o). in rdt,ilion h rhc .o!l ol comFn\rriutr. danugc\ rs fovid"l for ihc
<br />",,", 841-(
<br />lodc. inrcresr and artncy s fccs
<br />1B ^,,u*"',Vr U4--
<br />LIC!'NSII) ( (!NTRACI'UR
<br />D[IIJ3AI,&N
<br />T >@Yz-rJ
<br />I hcrchrrllir rundcr ncnnlry.fpcrjuryrhd I i li.tntoal undcr nn,vision nr Chllnrcr g (conrnf,minB wiri Sftri 7(XX))'lDirision l
<br />ol rhc llNircssatrJ Pnna\(nns Code, alld 'ny
<br />li.cisc n iD fnlllhrceundcflc.r'
<br />to(o 4b I
<br />B{iJ l9 ..",..",".K +fr ^lcde.-lcoNsttlLc l l()N l.llNlr\(1,\(;llN( \'
<br />I hceby 0ftir undcrFnittyotpcrju.yrhdrhcr.isIconsrrulrionkidinS.gc.cyfttrrhcp.rf.flrunccolrhc{oikiorwhichrhipcmrilis
<br />issucd(s( 1097.ciY c.).
<br />l-ctrdcis AnJ..\s
<br />APPL!CAN'I NF(]LARA loN
<br />I lIr5tllltr u crlcnihyof Ii]rturyoncoilhc n,ln,sin8d.clnrnnuns:
<br />Dcn!nni{,n l'cirrn$Asbcslos Noril_'rdhn F.dcrilRc!uldionr 1, iilc {). Pan6)
<br />Rc!ui'(l l.rrcr oiN rilicrli(trl
<br />l.cnn.!rhrrrhc lcdc$lr.Suldtr,ns rc8{dirSrs6(d.srt r)vrlrrc nol nfPli.rhlt k,rhis proiccr
<br />I ccdilirMr ltuvc tuM rhis0Dtliclrn,n rnd {rrcrl rhcnh)vc inlbnlariotr sconccr l rArc h.otrll
<br />dum. r." 'SrcL3".rlrr'ri,htr'Urn!,'{rnd.rntr..r,lhflch,Juil',r,/r,_*o1rtr^rlrln"(Jhr. rrlrtrri'J n,'ncnJ 1,1 l''p,.r," 1"n,*. /' ,al/
<br />^*ri(u,.r {*enr si*norurc < \=-'- / V--- ' I,are
<br />u"-,,*nu.",nnn,,K Dp+5- Nqf2^/
<br />nywirhrll CItin(l Coufrr_
<br />ily and Codnry r) ctrrcr uEinrrf,lsl n
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation I
<br />Roof Sheathinq ,i ,dr)
<br />Shear Wall 4,A<J4-)-a
<br />Framino 4,E-J -,olrj)s@,alr-){fr)lnsulation/Eneroy r"rAL.r,;1*,ul
<br />Drywall tX*-t"-' i 6)
<br />Ext./lnt. Lath )I lLs I ())
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />dcra-V, C,v\*'-11 ,a n I -.'tt *txt)!
<br />FINAL i tup12 vc'rCertiticate ol Occupancy
<br />Notes, Remarks, Etc
<br />--+
<br />DATE ID/SIG.
<br />t)ul,< I6it-ln t
<br />Flood Zone Certif .
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