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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OIVNIiR AUILDER DELCARA'I]ON
<br />I hd'chy rrfirn u crpcnrlry{,lFrjuryrhrr, lnr cxcnrfl f.o rhcConrncr,tr\'l-iccnsl-rslitrrhch]lo*insrcrvDrsccTr.ll5
<br />au\in.ts rtrd I']rorcs\ion Crxic): Any Ciry or Coriry whi.h rcquircs tr pcnnir h con{ru.r- rlicr, i'nnrcvc. dcmolish or rpan any
<br />eructurc. Drtnh irr irsunn{. ll$ r.qu,ar rh. lppli.anr for \kh Jl.nnirb lilra \r!tr.d ndtunf,nr rhd hr or thc $ h.cnrcd lu6unnr
<br />k, thc ntuvnoi\ of rlt Co r.acr.is l.icdn{d lrN lChrprcr 9. Connncn.i',S wirh Sccrn,n ?OX) .f Divi\ion I of ihr Btr\incs rnd
<br />PnnasvotrsCodc) orrhar horshc iscxcNnr rhcmno rid rlr b si\ lorrhc rllcscd cxc r iod yviol.ri(rolSc.rt'n7():ll 5hyany
<br />pplicr lnr rrurmil suhjsh rnc rpllicanr ro rcivilpcnrllyoftror,!x h livc hundred.lollors (r50lr).
<br />l. i\ o*ncrul c pn'p.ny.or nry.mpkJy.dr wirhwaAc\asrhcn $lccomlcn\arion. willdd rh. \(rk 8*] rh. ik-.lum is k
<br />iDlcnd.d..olicr.dforsalc(S(7041.BusincssrndPmf.s\bn\Cod.ThcCofktr.toisLiccn\chwdocstrotiptlylorrowrEroi
<br />rh.pnrFny *hobuiklsori'r]Ilmvc\rh.rd,n.urlwhod(f,\su.h*.khnnsclforhcr*llorrhnnrEhhtorhd.*trcn[!)yccr
<br />pn,vidcd rhd \uch nnlmr.n.nrt m mr inrcndcd d onu.i rbr ulc li b{ cvcr, rh. bdiuing or i'r{,R^rnr r i\ sll wirhi om lta
<br />orconflcli,)n- llE Owncr Duiticr willlurc thc budcnoll)lovi.8lh.r hc or shc did trol hikl or imnmrc $e rmEny lor rhc puqx,soa
<br />I. * uw0oolrls lrontny, rnrcrchliv.ly coitr.ril8 wirh liccn\ctlronkrtnsro (u,{fld rh. ptuF.r (Sc.. ?(NJ, Insnc(\
<br />md lhnsion Conc thcConlrodois l-iccnsc Lrwdocs rol.jrplrl(i nnosrc.olprorcny$h. hxild\or improvc\ rhcrcon.
<br />rtrd who .onh hfor su.h Jtroj(c sirh a an ncro(\rliccnscJ purumr r)rhcGnnrmkn'\ t-iccnsc tjw).
<br />lxD,r\rtrrPruotlcr srcri,,, .ll &f(- l,trrh\r.afn
<br />lratr ()sn$
<br />]IABTE&':.COMII:NIAIIQ!
<br />OESANAIPN
<br />I h.rcht arftd uidcr p.nrlrr.lpdjuryonc olihc n,lk,$i'rg (lcchrrrn,ns
<br />I hryr rd sillairi ri'1r Ccnilictrr..l Con\ctrrkr Srll:ln\urc i,r *orl.^' conllansd n,n. r\ Jtroridlr] ror brSc.ri( l7u)olrhc
<br />trtxr C{x]f,b! rhc p.rinru'{c orrhc *ork for whi.h rhc pcnlir h nsucd
<br />rltrtro'klnr{h(hrhisN irr\ '\{hl. Mtaorkcri conl,cDlii{trr i'\urr.c crrid rndIrili.yitr rlf,r c
<br />*- -o8/0)lt1
<br />l.cni,yrhrrifrhcpcrli,n,Lmc{r'rhcwo lnr*hj.h lhi\ lcmir is h{ic(1. Ishrlltror.Drploy ,y pc^on n,rny it.icr
<br />q, air,luoN {ftJ..r t,rh. workc^ .onf. \nri,n lnlv\olCalilffnir. r d +tucrhrr il l\h.uu tr.otrf, nrhlccrhrhc
<br />wolkcr( com|Enuriotr tmvisions ol Sccrion ITIX) of rh. Lat$r Codc, l shall bnhw h .om/y $irh r hr$ !rcvi
<br />wARNINC: ljni["c h scurc sorkcr conrDcnsirhn cdvchrc i\ trrhstul. rtrd shr]l suhrccl !r .nrployc!
<br />cilil fin$ !p ro ooc hu rc{l rhourand dollrs (tlll).(xa). in lddirion ro rhc co{ olconDcnslrn,n
<br />S.crion 1076olrhc lnlnr Codc. ilrcrcn rndanorrcy s i.csgl418 ^**..i6;=#.R#,ft8
<br />l.2tI!:!B:Ml1A
<br />I hcrhy rrfiirnund$ pcMltyolFrjury
<br />'hr I dn li(nsd und.r ln,lisnrn .r Ch,|,d 9 (.onnmn.i|E wilh sccrioD 7txl0) olDivnnrn ]
<br />ol rh. Bu\i'rcss trnd PmfcsnnN C{ ., arl ry liccn\c i\ in tiill fore dd rftu.r
<br />t\
<br />Li++lg-.".,-",".p( ({, e,\610.!4 b13-t&4
<br />ci1lslf,ll]Ircll.aDlls-ac.Ell;l
<br />I hcmbyolfirmundcr lcn.ltyofDcrjuryihor rhdc is..onstru.rt,n hndi.EaBc..yforrh.0crfoflnMccofrhc work lor trhichrhhrc.m n
<br />hsucd lss 109?. Civ c.).
<br />AITL&ANLDESAAAfIAN
<br />I lrEhy lf,lnn nndcr pcn,lly Drtcrjury onc oflhc followinS dNlardri,)ns:
<br />D.'tulirion Pcrnirs asb.{os Norin.arn,n hd.tul R.guhr ionr (Iirld 40. Pan6)
<br />R.quncd klrs olNorifi crli.n
<br />I rc'ril_v rlirr r1( f.drrnlrcgrlrh(nA tulrntr'g r\hr{o\ rtnnrrlrr. mr rfflnx[]c n) rhr\ pn,]t!r
<br />*#xily rh[ I hnvc rcM rhrsl|)nlicrtio..nd$rrcthat rhc *rv. nrftrrnElon i.conccr lneB rocomnlywirh lllCiryand Cou.ry
<br />aulhorizc rc!.cscnlolivcs olthis Cilyond Counlr lo cnrcr llnn lhe\ lnn Sl.rc ljws rehrfu to huildinEcotr{
<br />nllJvc trf,nr trnotl f' o|rn, tur i'npuri{nr
<br />A0pli..nt or Asent sisMtue X .",,,'8ll-B
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathi ng
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/lasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL ,tt,/zt/a ?-r''7bM '4t,/
<br />Certif icate ol Occu pancy '/ /'u T rv
<br />Notes Remarks, Etc
<br />1.1'J. '.
<br />^'lJ'.r
<br />y<-w o'2 --
<br />Erection Pads
<br />Flood Zone Certif .
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