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BUILDING- INSPECTOR RECORD
<br />DATE COMMENTS OWNER BUtI,DDR DF]LCARA'IION
<br />I hcrchy r{tnn unJcr Nnrlr, ofFrjury rhal I a'n.xcnPr rroh rh. Conlriclo^ l,itc \t liw hr rhc lbllowins !€anD (sc.r0:ll5
<br />lJusims and Piofc$ion Codc) Any Ciry or Coutrrl which r.iluirc\ r Nnnir t, .onsrrd. llicr. inrpmvc. dcnlolish or rcprit utry
<br />nru.rurc. prior tu ns hu0rcq aho rcqund\rhc ,plicrf lnt su.h p.mir r. fih r signcd {dr.ntnr rhrr l'd or shc it licci$d fu*urtrr
<br />h rhc nrorlsions ol rlt Conro.roas l,ic.n\cd LJw (Chl'rcr 9. Cotrnn.ncioB $irh Sccri('n 7O0O of Oilhioo .1 of rhc B!\inc* trnd
<br />Polcsions Cod.)o.rhrt h.orshc Ncrcnfl thcrclrom ind rhch!si\ forrh.allc8cdcrcmpri.n Anyvi{nrrionofscdion?0.ll5nvrnv
<br />{plicanr rDr a pcnnn subjLrF rhc aptlicur b r.ivilr.nxhyol tror rorcthrtr fivc hutrdtcd dollr\(S5(x)).
<br />I. ss owncr oi ihc pmFn y. or ry cnPloy.cs wilh w0Bcs .s ihcn sb conpcnsrt io.. will do Ih. wtrk ard rh. ir_tuc n nol
<br />lnrcnd.\l or oii'cd tu \nlc ( SN ?04,1. Businc$ rnd Proic$iotrs C{xlc Thc c.ntrt,\ l-iccNe Ij* docs tror lplly lo 0n ow.cr oi
<br />rh.tFp.ny who huildsor nrprcvc! thcrsn. rxl wh. des \uch*.,1 hims.ltorhcr*lfotrhrou8hhi\orhcroancmplovccs.
<br />piovidcd rh.r ru.h iNDn,Enrnh rrc mr inlc'rlcJ oi olTcEd nr eL:. li howcvcr rhc huilliry or i,rq)mrcnrnr is v,ld *irhin. . )tr
<br />or cotrpldi)n, rh Ownn Buihs qill hltc thc hrd.n or pmving rhd r. or \hc dt d bui( ot nnpn,rc rh. lslHy fo, rhe lory{ or
<br />l. r\r{ncrolrhc tutrdy. rucicluslvclyr.ntrr.ri',3 $irh licctr\c(l.rfLj.rtr\rL)e.nnru.rrhc lviicd iScc 7l}ll. BunN\\
<br />rnJ !ho corkx(\ntrluchtx,jc.risirhi(ddrr.tr(9|i..',\!dtu'lur0rr.rhc(in n.knsl-icci\clrs)
<br />WORKFRS' (]I)I\IPFNSAT(IN
<br />DrtL aAllllx
<br />I hcrcbyllTt uid$loMlryolrcrjLtryonc.lrhctullo(ingdccluri, s:
<br />-l
<br />have and will tuinhh ! ccnific{tc ol Cohcnl b S.lt ltrsurc ntr workcs cooPcnslrion. a\ Frvidcd for hvSecrn,.-lTfiloIrhc
<br />l-0hor Codc.lor rhc l)crfortun.. orthc sork lorwhich Ihc pctnril i\ i*md
<br />I hr!c rhd \ill irrtrtu D s.rk.6 .on!^-[rltrrcd 6vSc.ri{m l71X)ofrhc t]bor (irl.. turrho n rfonr Rol
<br />rlf e.rk for*hichrhis pcrnrii is i$ucd M,rnr in\mncccrtricr Md lx,li.y numh.turc
<br />l.cnily rhil if rh. Nnnnun.c ofrhc s lorwhichrhi!pcrnrir n i\sucd.l thrllnol cmpl('r trnylf,non innn, mrnNr
<br />vr r\t,bc.onr su6ic.r tuihc wo cis .onll.tr\J|ion Lw\ ol Cnlilnirlid, r agtc rhrr il I dr'ukl tt.oN ruhjccl h rh.
<br />*ortc cotr,pc \rr i(rl tituvhionr ol Ssrnn, .l7(n of rhe trtxtr (id.. l !h{ll. n)n hwirI coa]Pl, *irh rhoc |n)virion\'
<br />WARNINC iiilurc n' sccurc qork$( ..nll,cnsdi,in covcrrac i\ unlxslil. aid nrill {rhjccl r cnlnk,tcr t, climiMl n n ric\ rnd
<br />n) oN hd drc.l rhousrfrl ll{r{ lsl(x).(xx)). in rdJiriirr t' rlt .o{ I'l ..tr lPcnsain,n. drnnrAcs rs provided fttr rhc
<br />S..ri,r.11176 olrhr Ii[ Cotlc. tr c.cn od
<br />"'"'rglo/te
<br />t)t,,( L,\lt.\l l()\
<br />IhcRbylfli.arufdcrpcMlry.rp$juryrhriIrnlicctrscduNlcrnm!htnrofChifrcr9(connncrcingwirhSc.ri 7000lotl)ivisir l
<br />of rhc Uusircs\ r Pnrlt\siqNC{dc. MJ ry li.ctrsc is tri full li,rcc !n{l rlfcai-
<br />d/
<br />@+74
<br />OXSIBUqITANIINDIIC.ACINSX
<br />Ihcrchy rlfirnrrtulcr Fnnhy olpcrjury rh rhctc is a consr tuct irn hndiDS ,Ecmy for ric p$ro'mc ol lh. woik lff whi.h rhr t'cmit is
<br />irs'cd lscc.109?. Ci! C )
<br />I {'J' ''. \dJr..!
<br />-
<br />I ccnilrrhl dr lidcnlrcguhri,rn\ rg i(lnr8 Nlrno cin,unl rrc nor +nlic$lc h lhis |n.]-.r
<br />-l
<br />ccniryrhi lhnrcrcad rhis{plicrrnJn rl\hrcthlr lhc ah,\. n,tuiln.rioD hcorccr lrgmh.omllv wirh (llCirvand Coutrrv
<br />.nliN (c\ rnd Srrr.lrw\ rcl ng io i.g.on(rucrion- arxl hcrchyNrhorizc rcprc{.rrriv.\otrhirCirya Cotnryk,cnrduArrhc
<br />it$vc rNnrioncd pmtEny for
<br /> 0Dli.nnr or Agenr signo o/zy'e
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq
<br />Shear Wall zA
<br />Framino g*?E-ttr k.W1Q
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certif .
<br />\
<br />FINAL 7-t7-lK N.\L]C)
<br />Certilicate of Occupancy t \r/
<br />Notes, Remarks, Etc
<br />SITE.WORK ID/SIG.
<br />Erection Pads
<br />Brown Coat
<br />I amcxcmD( u.dcr seron . B & P C ior rhis rcasnn
<br />D!1. O{,.r
<br />b-+-
<br />I .rd.r'. Nrnr
<br />-AITUCANLDII;LAEAIION
<br />I hnby afnn undc, pculry or pcrjury om ofrhc follouitrs dcch'"rio \
<br />ocnblirion Pcrmits-AstE(o\ Noriicdion Fcdcral RcRUloriotrs (1irlc 40. Pd6)
<br />-Rcqutcd
<br />Lcllcr nr Ndrirr.dbn
<br />I
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