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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER AUILDER T'ELCARA IoN
<br />I hcrcby ainn undcr lcnihy of pcrjury lhll I unr cxcmpl li'm rhc G,nrltttrl' Li.ctr* ljv lor lhc lolbring rc.son (Scc7o-ll5
<br />Irusinc$ and Proicsion Cdc): An, Ciry o! Counry uhich rc{lrtc\ i Fnnir ro .onnrucr, nlicr. irnprove. d..r,lsh .r NN; rtry
<br />drucrurc- Frior b i( issuancc, rho Equn \ rh..Itli.Mr foriuch Fiinil lo fiL i siSrcd slrcmnr rh hdoi shc is lienscd J)usu.nl
<br />lo tlE provnions of ll'E Conlrtrcroi\ l-iccnkd ljw (Chnprcr L co'n rn ins wirh Scclion ?(xl) oi Dilisn,n.l or rhc Busincss rtrd
<br />Pot snrns Corlc) or rhrr h. or she h cxcnDilhddror ard lhc l,osh ior lhc lllcs.d uc ]prn,n Ary violntiotr ol Sdion 70.1I 5 h, lny
<br />applicant lorrpcrmit subjcclslhc amlicant lo acivilpcn!lryoanor morcrh,n liv. hutrdrcddollns (S5LlO).
<br />-1.6
<br />ouncrollhc propcrly- (, trry cnfloltc\ wirh Nasc\rsrh.ir $h.otrrFtrsnlnnr. \'ill&t lhcwortrndfi.q hnmr
<br />inlcndcd o.ottclcd lor ele (Ss 701,1. ar\itur\md lttofc\\i(ins Codc: Thc(inrlrrctd s Lilicn\c Lrw dodl .r amly to rn owrcr oI
<br />rhc |nrtdy wh. buildr or nq,mEr rlEFr. nnd wlp drs ruch s1,k hnn\cll or hc^.llor rhrou8h his ot hcr own c'nployc.r.
<br />prcvidcl rfirr such i'nrsrcnrnh e nor d. Ld or oltaul fr srL ll. hoqorr. rhc tuilding or irymkmir is sld wirhin otc )ur
<br />ofcon$kliotr- lhcOuncr Auiklcr will irv. rtf, burdcn of pR,linE rhr h: or sh. dil,Fr tdild or inDrcvc rhc ptr,tcny for ih. nu{n$.f
<br />-l
<br />!mcx.nrpr undcr Scrrn,tr
<br />z@.f,-41 ,+EEz\
<br />I hcrrhy arlnmrnJc. Fidlry.l |Rrjury onc
<br />-l
<br />h^c andsill
<br />'tuinrain
<br />trCcnifi.lcol CdD\cnrtrSclilNrnu lir$or(crr con]P.nurnm. as providcd f.r hySccthn lT(x)oirhc
<br />Lobor C(lc.lirlhc ncrlormncc ofrhc qod ntr whirh Ihc f.nnir i\ i{\u.d
<br />_l h t rnd sill mxi' ain workcli .otrrp.nuri.tr irNufutr.c. N rcquircdbySccrion.lTmofrh.LnborQ)dc.lbrlhcP.nirnunccol
<br />rhc wort lor *hict rhisFrmir i\ is\sd My work.rr conf.n\nriotr lnsurrtreqr[r rrn [x,licy nunth.r dc
<br />I.cnrlyrhlr inrlE D.n;r,uncc,n rhc !orI ktr *hi.h rh]\ lrnnir i\ i\urd.I nrlltror.nl oynrry Pct$]hr y'anntr
<br />brsrohcco'msuhj.crbrhcNo.r\.orpri\&oih$\.1crlintrtrir.(fldra.ccr,HrilIslniul.lh..uf,suh]c.rn,rif,
<br />sorlc .onrp.n\rrionpn,ri\i()nsofSccri( :l7lX)ofrhrl-rltr(inlc.l{h'll nin hv irh con,lly wirh rlk){' l]nrri\ i 8
<br />WARNING Ftrilurc r) sccu,. *orkcn .onTcn\in,i mr.(gc i\ xihwIu|. itrd shrll nib]ccr Jr c Dlovcr t, .{uniDrl Nnkt\ nnd
<br />r. .nc hundrcd ihorutrJ dollnr\ rSl(l)(XXr,. in rddnr'tr ri rhc..sr ol .onrFnsurion. drtrr&\ rs fovidcd lor rhc
<br />S..ri ll)7a ol'rh.ltr xtr Codr. inrcrrn rklnr
<br />**.4:9 ./-&/,BaxY-ty
<br />I hcrchv rrlnn u crN rllyorncliuyI )fChrDrcr 9 (coNNtrcins sirh Scdion 7fiD) ofDirir$n:l
<br />of th. Bxsi,rcs Md PmlcsiorNCodc. arxl.ry liccns
<br />CONSIAuqUONII:NDOG.AGIN1;I
<br />I hcrby rlfiirn uidcr Ntrdrrol lcrjurylhrr rhcrc n{coDdrucrni [ndingtgrD.t n{ihc |rr,onnlNc ofuhcso f{r$hi.hrhis Pcnnir is
<br />i$trcd (Scc :l0r?. Civ C ).
<br />AITLICANLDIiIIAEAIIO!
<br />I rurrry urnn uM& lchlry ol,rrjury oN ollhc hllowin8 dcclurnrions:
<br />D.R,lirion P.rnirsAih.sros Nolrn.dnin Edc.rl Rc8uldio.s (Tnlc J0. Ptrn6)
<br />-Rcquncd
<br />llricrof Nr ificathn
<br />lc.niryrh,r rhc rcd*d rcgubliotrs lcgodnr8 o\bcstos rctr$ !l nrc rcrllPtlic0lrL h rhis pmjcr
<br />l.cni! rhd I hiv. r..n Ihi\ 0t'!li$ri{,nrrldxrcrhrr rht atxnr lnlniiturtrtri ir.rrc.r I (!r.\ t, .otrrly wih al1 Cn} , d(outrr!
<br />onh rrr\ trisrnr Intr{ nrxri'tr, r) huil'l,!on(rudior. rkl lrr.hy rur,kr,/c rc|n.'.trrrrirc. otrhr\ Ciryiri Counry n, cir.r !non
<br />rh,v. nEnrnn,cd pm!.ny kn ins IAaEN *,",g-f-taApnliL!nl or A8cnl SiSra L
<br />()7G1- /E<t4g'iP+
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />Subf loor/VenVlnsulation
<br />Rool Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulalion/Energy
<br />Drywall
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />Handicap Req
<br />Depuly Final Report
<br />Engineer Final Report
<br />Flood Zone Certil.
<br />FINAL Z v/////r I -v14rr19-/o-z--
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc
<br />I ' -'/
<br />-l-
<br />as ovncr ol rhc Implaly. d crclulilclt cont.ch8 airh |i..tr{d .onhuktrs lo con{ocr rhc Eo,c.r ( scc 7014. Lu5incs
<br />ull Pl.r*sbn codu Th. Conracrol s Liccnsc Lrw docs mr .pply lo ai oe.cr or lrop.n y sho builds or i rrovcs rh..con.
<br />rnd who o.tracrs tor such pn,jc.rs *irh 6 Conrn.ttr(s) li..tred lununr lo rhc Co.rracl{, r l-i..n( Irw).
<br />SLAB Floor
<br />Ext./lnt. Lath
<br />T-Bar
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