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<br />BUILDING. INSPECTOR RECORD
<br />Own6-Buildlr D.clrxio
<br />I h(cby lmm !nd{ r? lty ofr.dury lhr l.i Grdpt forh ri. Conmdori Lh.nr Lrw lor lhc rolloeins r.soi Gc..?olt I auiin.B
<br />Dd Pdfcllion Cod.): Aiy Ciry or C@it *hich tquilc r p.frir !o conrlDd, rlrr, improv., d.nolith o. rp.ir oy x'udu.., p.ior ro n' 'iaucq .l& r.quiru rhc ryplicur ad ruh pnir to fi1. . tio.d a.ll'M ihlt h. 6 th. i. rica&rl pmurnr to lh. ,rolnioni oa rh.
<br />Colturor'r Licmrd L.e (Cn.F6 9, Cm.Mci.r wnh Sftrion 7000 of Divnid 3 olih. B{inBr.nd Prcf.lioru Cod.) or rfi{ h. d
<br />!h. i, .r6pt thdrioh &d rh. b.!i, f6 rh. .lh8.d Grmp 6 Any viohrion oa S.crion 703 l J by My lprli.Mt for r p.mir !!bj.cr' rh.
<br />.pplid$t ro. civil p...lty ofnd nft rhe 6v. hurdEd dollr, (tt00).
<br />_1, a o*nd of !h. prcF.ny, o. ny .Ddorc€ *nh wr8a ! rh.i ol. cofrparlrior. eill do lh. work Md th. tru.tur. ir nor itri.nd.d
<br />or off6.d fn Il. ( S.c.?oaa, Bo nqr &d ,rcfotion. Cod.: Th. C6trnror'! Li...r. Lrv d@ .ot rDply {o .^ o*n.r oa lh. prcpdy
<br />*hobuild!orinFov4th@on.&dihodoBlsh*o*himr.lfo.h.rr.tforthdurhhirorhcr.nployB,Drovidcdfiiriuch
<br />i6prcv.m.n[ e not im.hd.d or olIGEd fdt.l. lf, howcva. $. buildias oimprcvd. n,oldwnhi.on.yororcomp].lion,rhc
<br />oqi+Buildcl will hrv. rh. b!rd.. of provin8 rh.( hc or rh. nol build or imprcv. fo. rh. purp6. orxk).
<br />_1, a own.roaih. prop.ry,6 d.lai!.ly .o.t.Erins wirh lic.nr.d .6ncrd ro codrucr th. proj.d ( S<. ror., D*ii*! lid
<br />Pror.lrion Cod. T!.Conrrclor'! !icci!. Lr* (l,.i nor lpply to in ow... oaprorcny *hoblildrd improv.r rha.con, lnd !h.
<br />conrmr for !!ch prcj*r wi$ rCo.rero(r licMdpu!r!$r roth!Cdrr..ro.! Lic.nr. L.* )
<br />_l h Gx.Gpr und{S4rioi
<br />-8.
<br />&
<br />C(/.-t$.)6ea
<br />.TYORKERS COM}'NS TION NECi ARA ION
<br />I h...by rfllm !i'ld p.naTry oap.rjury q. ofih.lollopi.s d.clelion!:
<br />_l h.v. ud willoliir.in ! C.nilic.r. ofConr.ir ro S.l(.lBurc for wnk(t conp.Brrio., r! provid.d forbyS(rion 1?oo orihc
<br />Llbot Con., for rnc pcrfomuco olt. wdk fo. which rh. p.mn t i!$.d,
<br />_l hiv. lnd *ill m.inlAin wrk.6' cmF ri i@,u., s Equidd b, S.crion 1700 of rh. L.bo. Cod., to. rh. p.rtom..c. of th.*d( lor*hici rhirpnirir inu.d My e*t6' c@p.n,.rion ituutuc. .ri.r lnd poli.ynuabs!ft|
<br />(Tht tdion i..d ior bc conpl.r.d illhc pmn i! for O.c huidrcd dollrt ll I ool sl.$)
<br />_l ccniry 'h iD
<br />'h.
<br />pslmuc. of rh. wdt a6 whi.h thi! pfrir it i$u.d,l sh.llnor.mploy iny pdron in !i, min..r so ! ro
<br />l8r.. thx irl lhould b.con. lubj4t ro rhc wo.ko3b(m.rubj.(ro rh. wo cn'cohlcnldrio l.w! olc.tifohii,
<br />cohp.nlltion provhron3 of Scc on3?00 of rh. LAborCod., I
<br />-t ? oos bl
<br />WARNINO Fiilur. io !..ur. work.6' comp.nori coe...g. i! unlr*aul. Md lhrll lobj*r .n chploy.r lo oimin.l p.nilricr mdctvil
<br />find up lo on. hudr.d lhourmd dolld (3100.000).i. lddilioi tor.\..drof.omp.nt.lio., ddrg6 s trovidcd for $. S.c!on 1076 or
<br />rhc LlborCod., inr.r.n&d r(loh.y! &.r
<br />LtctNstD coNTR{crots hacLAq,{TtoN
<br />I hqcb, !fllh unds p.illty of pdj!ry lh l 6 lietud und.. trcrtioi of Chlpcr , (conm.trcin8 yirh S..non ToOO)otDivisior.t oa
<br />d. Euiincs ind Protrsionr Cod., rnd hy lid.n* ii in lullfo(. lnd.ff.d.
<br />.ONSARUCTION Lf, NDnlG AGENCY
<br />I h.r.by oms !nd.r p?..Iry ofpcdury $.1thrc ir. conntudion lcndin8.i.ncy for $. p.rfomrnc. ofrh. wd\ ior ehi.h rhir pomit t
<br />nrt.d (S4 309?. Civ C)
<br />^PPLICANT'S
<br />Df, CLAR TION
<br />D.ftolirioi Plmil}ArbBroNorilicrrioi F.d.nl Rcslllrioi! (Tirh 40, P!1 6)
<br />_ R.qut.d Lrn.. of Notiflcaion
<br />_l..nify$arih. fcd.ial RSUrio.! r.Srding sb.tro. r.novil erot.ppti..bl. ro rhn proj.cl
<br />_l *njfy$ l hlvcridrhi, rptliclliM sdnI.$rlrh.rboac infomlim it c6..r.I r8.e ro conpty wirh ! City e,l Counry
<br />ordin.nc.s and 56'. Llwr r.l!ri8 ro buildin8 .onnrudioni od t.r.by nurhonz. r.pr.(nr.riy.r orrhir Ciry lnd Coonly ro rnr.r u
<br />SITE-WORK DATE ID/SIG.
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />S u bf loo r^"/e nVI n s u,atio n
<br />Roof Sheathing
<br />Shear Wall r/11l{hr yu
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath xlilrr -/z-
<br />Brown Coat at
<br />Masonry
<br />Pool Fence
<br />Handicap Requirements
<br />Deputy Final Report
<br />Engineer Final Reporl
<br />Flood Zone Certificate
<br />FINAL tolttw I nVt'toz Ola. * r/+W lil@
<br />Certificate of Occupancy I t
<br />Notes, Remarks, Etc.
<br />,, (Gt"TAVD
<br />lln-,
<br />0
<br />o9-/5,R-oa1
<br />COMMENTS
<br />Erection Pads
<br />Framing
<br />T-Bar
<br />I-T--
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