|
BUILDING. INSPECTOH RECOBD
<br />ID/SIG.COMMENTSSITE.WORK DATE
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathinq
<br />Shear Wall
<br />Framino
<br />lnsu lation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Beport
<br />^lFlood Zone Ceflif .
<br />lJ)e+T AW^,/ Il.LEl' 0/141.Ji\05tP P.lb lbtd nllrl
<br />[..,25 ,t-' ftpndv wL q'rtgFINAL4t[ltq
<br />Certif icate of Occupancy
<br />Notes. Remarks, Etc
<br />DE?
<br />()\!NIiR Bl It.DI,:R l)lal.( i\Il,\'ll()N
<br />lhcrchyafln undclEnllry (,r prrjury lh lamcrcrrr rhnr rhc Contark,E' Liccns. llw r(n rhc rirll'wine icabn rsc' 7011 5
<br />lJusinrs\ aftl Proicssi.n Co'lcrr Atry airy or C.r y whic| rcquir.\ 3 P.rnrir ro .on{fl.r. ,1r.r- i,nPotc- dcmohh 'r rnrr Mv
<br />ntu.Mq rior ro ns n.urr.c. rho Eqrncsrh. aPllicunr aar \uchrcnnir o lilc r rig .d sdctrcnr lhnlhr'r shc is licosrtl It htrinr
<br />lo rht Pn,*iotrs of r1r Codkrtttr's Liccnssl l-a* (ChdPrci g Con nc irr8 sirh sccrnrn rfix) oi Di!i\i( :] oflhc Burnc" 'rL'
<br />Pn,ri:sionsC.de)orrhrrrrorshcncxcmPrrh.rcrr.,n!ndlhct\tri\ntrrhcrllcscdex.nrIn,r'Aovvi{rhrnrnolSccrbnT0]lshv nv
<br />Jppli.{nrnna!.nnirsuhjcchlhcnplli.nillorcivilDcnalryornurNrcrha.firchutrdrcddolltr^($5u))
<br />l. i\ osmrofrhc noFdy. or nry cnlPn))d\ wirh qrScs !s rhcir {,l..onl'ctrsr(ioi. willtlo rlE sork rBl rtu '9ocrI
<br />i{ n
<br />i"r*l.rl ". "n"-a r," *j" r i* 704.r. auqncs nnd Praltsi{n! cDdc Thc ((n ra.ror s Liccnsc I -r* doc\ tror I'ntlv ro an owocr oi
<br />rhcpmlf,dy {ho build\or nqr,vcsllEr&n. lnl wlrl dds such wolt hnnsclrorhcrrclforrhn'u8hhi\or hcr 'wi cmDlovec\'
<br />p"'iia".t ,t a *.h nnthvcnrnh m nor inrcdcJ .r ofnrd fff !,L ll holcvcr' rhc hu ilti4 .r iDl,nnrn.trr t \old wirh o'c v!'r
<br />;r.oirl)ldbn.lh.(^'n:r Driltld willhnrc rlt tu ctrofPn]vinsrhd ltorshcdil'Dr build.r nrl'Dvc Jrc ln)Fnv rhrrhcN!r$or
<br />I
<br />l.r\osrrrofrtupn'lxny. ,.tlu$rclyconr.aciing qirh Lirrtr\cd..frr.b hcon{ru.lrh. Pn,i..t (scc ?l!'1. Btrsirc\s
<br />Pn,rL\ri C.dc::lhc c.trrrr.ror'! l.i.cnsc Lrs rl.c{ Dor 11)Ply ro xi otrNr oI!(ifc'r} wh' huil& or i'nP'ovc\ thcrcod
<br />sho..nki.rsloruchtnic.risir|rO)ntttn(nll.crrc.lpnr\u k, rhc inn' .kr'\ l-icctrsc l-rN)
<br />_l umcxe'nlr uMcr Secln,n-
<br />l)et.' ORner:
<br />.l] &P( lhr llrn rtr0r
<br />WORKFfS' C(TMPENSAT!()N
<br />DECL/$A.IIQN
<br />I hcrehy silrd undcr pcmll, ol ncrjuty orc oI thc lollo{ing d.clnEtn'ns
<br />Ihivc! will lmifain a Ccd iaKarc .f CoNcnl h Scll lNurc (r workcn conpcflsariotr. as ltuvidcd |orhvS'crion ]7lx)olihc
<br />Lrtxn d{lc. Io rhc Il.rrormncc oi rhc work ror whi.h thc Pcrnrir il ir\ucd
<br />rlr s.rk tur *hich rl,i\ rnril s is{'.tl M!q.rkc^ coDPctr\rtnnrirr{mrc.c nicrrlxlt'li.vnu rhcrtrrcl
<br />I ccdilvrhnl nr rhc tcrfonmRc,r rhc *ork fd whichrhr Pcnnlr i\ n$cd.l firll orc rdovr'r! P'^o ii rnva'xnNr
<br />$ rs I. b.c.mc sxbjc.r ti rh. \rorkcr\ .\ \xNarion b(s of Crlif(mir. rnllr!r[ lhd ill should hcotrtr subJtr r' rlE
<br />*.rk.!( con,p.n\[drtmvi\i{]tr\.fSc.rion:lT0Oolrhcljhtr(i{lc.l\hrl!.lrtrrh$lrhcomplvwirhrh sIBNn'otrs
<br />\TARNINC i{ilurc ni {.tr'c wo,kcr' conrl}. \dn,n ..t$rgc i\ r h$tul ind shall \ubl..r n'r . rrt)r$ ro crinrinrl n(drhi:s n
<br />\i. rr, I xi 1,.,t rlc I'hr r 1,.ir. tr q"{ JrJ Jr,rncl-. li"\
<br />Ilst.r ADPlidl:
<br />r rcrusir, crrritrcron
<br />DECIdEAIIAN
<br />lhcrcbyafirnlndclPcnallyofFrjuiylhurl!mliccnYdlndclplovtionofChl,lq9(conft'kinSwilhsccli{7tD0)ofl)ili\nln]
<br />ol rhc Eusinc$rnd Pn,icsnnN Codc, $n my liccrsc is inrullrorcu cilccr
<br />.rn\. ('lr$I-r.rtr\c Ntrn Lr
<br />(:0NS1'RfIC'I'ION I,ItNDINC (:FNCY
<br />i\{rd(Scc :1097,Civ. C )
<br />Ltnd.is Nrrrc:
<br />lrtrdrr'\ Add..s
<br />Subf loor/Vent/l nsulation
<br />"c-tv
<br />'rx4;r PadL f?E)\dt/r+L:
<br />(rrrcr-
<br />llll,l( \NI l)ll( L,\R,\'lll rN
<br />I li hr., nmutul.r lir l l! !l tn, [r,y ]nr. L'l rhu lriLL^\r rs iL..lrnt, r\
<br />l)ltrrnri({r l'Ly rl\ /\(..!,\N,irl'rxr,u,jcJ('rll{r!trrr L'Nll rlt'11) l'nl(rl
<br />l{r,1,,r.,1I.rr. !)lN,i rn trktr'
<br />lr.,rr\ rhr rlr lel(rr '.!rln ,i\ r!!mlr3 x$.nt \ rrnn^ | r. ,I .,|'Jn.rh I rr rlr \ l'rt{rLr
<br />,,1\r. nui .f.d tn,[rr\ lt{ "!l].!1 ,{, t)' l)o!\
<br />Applirnnl orlBcrl SiAnr!trrr l)xk'
<br />I(rnrilN n rr lprnrirl
|