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BUILDING- INSPECTOH RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS O1{NElr BUILDOR Dr]r-CARATION <br />I hcrcby rtlirm unicr pcmlry (n lrrju! rhd I im cxcnPr lmm rlt Coftn x)F l-ic.n\c l-iq lor thc lollo$i'rg rcrk lscc.T0ll 5 <br />8u\irg\s a Pfl,fc\\nr Codc): Any Cily or Cou y trhi(h rcqut \ i P.nnir kr .otrsruci. ilrcr. inrP.lrv.. dcnnnhh ot r.Prn rnr" <br />{flcru'c. lrir*tu its nnoDcc. rko rcqun srhcttpli. t ln such P(nnirb filcr si8trcd slotcnrcnr rh lEor shc is lic.N.d N.unl <br />lo lhc Jrmvisions orrh. C.nlrocroll Liccnsd Lr* (Ch.prcr 9, ConrmcminE sirh Sccii(r 7o(XJ of Di!isn 3 oI lhc B!\inc\s rnd <br />Polcs\n)ns codc) or lhll hcorshc tcrcmfl rhcrciromnnd rhchasi\ irtr rhc rllcScd cxcnPrion AnyviolirionolSe_rirn70:ll5bvinv <br />amLi.rDt hra Nnnir $tjccs iht rrPlic,nfo rcirilpcnalryoinor 'fr,. rh,n livc hundruddollrtr (S5(x)) <br />l. osrc.ofrhc Pn'Fny. or ar! cnlPlore\ wirh *r8.srsrh.ir v,lc a'nDcn\di.tr. willdo ltr solk,rd lh. {Nure is n <br />i cntrl .r orcrcd tu salc (S6.?U4. Busi.cs.nd Prol'esiots Codc, Th. Conradols t-iccn{c trs docs nor trpply to un 'wEr of <br />rhc tmpcdy *lx) h{il&ot irymw\ rhcE n. and Plxr dec qc[ Mll hinrclfot hcRll or rhnruAh hs or icr.*n cnllovccs- <br />providL'd rtul such iDpft,v.nrnrs m nol inrctrd.d or onc(d rItr klc. li k,*cvcr rlr huildins or in{rovcmfll it $tl *irhin 'rt }ttr <br />;l cohpLrion, rhc oNmr Buildcr will h!!t $c budctr of PmvnB lhal hc or shc dA not build o! iqmw ih. lmPcnv f. rB t)urlI,s ol <br />-1. <br />as .$nd df r hc nmpcrly, an .rclu\iv.ly .onk.dirr8 silt lircn\cJ cotrt.dor to coontud rlE t$j$l (Sfr 7(}1-'l Busi"cs <br />lnd PmLs\bn c{de: Th. conkmkn s Liccn\. I-rR dms ml .pt ly lo rn ow .r ol pt.Pcrl y who builds or improlcs rh$.on. <br />and Eho .onka.l\ for \uchrroFcrsRnhrConrBcio(r) liccnsJ pusuonl ro rhc conrlclois l,iccn* uw) <br />\loRKtrILS', (](]ill PINSA I ION <br />DTCLAIAIIQN <br />I hcrcnynflnrrnndcrpcnxlryof P.rjrryotrcolrhcti)ll{,*irrdcrl r rnns: <br />I hrvc rMwill nninlri', rCcrrif.rrcofC.nscflro Sclflnsdrc f.r s.rkcr\'co lPrn\dn.n.0s prcvidcd fu hvS$lio:17(X)'ril[ <br />Ljtxtr Culc. for rhc ncrlo un.c ofrhc trk (r shich ric I'.nnir is i$u.d <br />Ihryci trillnfinruinso cra c.mtcd\irion n$urrrkc, .s rcqundl)ySc.ror]'7fi)olrhcLrborCodc.itrrh'Frr'iinrmcol <br />lhc work lnrwhichrhi\ pcrn i\ h{cn Niyq.rkc( .omp.nsalin in{tun d.,f,icr alilxnict ix'nhcr rc: <br />-l <br />ccdilyrhlr in rhc pcrhrnEnccofrhc s.rk f.r whi.hlhh pcnnir is httcd.l shrll nor .nPloy anv Fison irnny nt mcr <br />v, rs h hccom suhjccr ro rh. wttrlcs compcnsr(r li*s of C.linmi0. lnd rArc rhar ill \hould t cont sDhFl lorh <br />Nnrkcs conpcnqrn,n ntuvisions olSccrio:lT0oofrhc Lnh.r C1)dc.l shnll. ftflhwnh conrlv wirh rh.* fmvnions <br />\4ARN!NC: f{ilurc ro scurc workcr'conPcnsarn,n corrrrEr is lrlrsful 3nLl shall rubjNr an cmPirrtr t'.rinrin'l P(trrhis md <br />.ivil fincs up ro.nc hrndr.d lhous.trd dollrs (Sl{Xl.(XX}), in iddirion ri, rhc.os ofconPcnsarion. d,ro8cs !s Provnllt f'r rlr <br />s.ctiotr 3l)76 olrhe lltxf Cldc, intcrc( alld lnon'cy \ lacs <br />D.rcr- Appllctnl: <br />I ICFNStrN C'ONTRACTOR <br />DECIABAUON <br />I hceby rftlfln uod$ l'cnllrrofFlu.y rh0r I m licensd uds pn,vision ofChq'rq 9(co'nmncing Nirn Setion TttD) ofDivisn'n l <br />of rhc Busincsqnd Profcssion\ C.d.. md my li.ctrsc ix in lnU raN dld clfNt. <br />(]oNSTRUCTloN I FNDIN(] A(;I'NCY <br />I hcrh, ffiirnundcr rnrlry ol l. jfy Ihrl rhcrc hrcon{r.ri{ni lcklnrerAc!.y lor rhc NrlnnMmt ofrhc w rki whichr[i\r'-'nrit is <br />h{rd rs.c :l(lg7.Civ C). <br />APPLICAN Nf.(:I ARATIoN <br />I ixr$y !,tid rhdcr pcn.lry oi,'erj!ry oN orlh. ftnh*ir-! d.clararnnr <br />Dcnmlirion Pcrmirs sh.sos Notili.nti('n FcdcrlRtguhrnnN (Tirlc 40. Pdn6) <br />Rcqutcd lf, Icr orNorifi.ariotr <br />-l <br />ccnifyihrl rhclcdcraleSultrrions rcSddins osbc{or rc'novd nE nol lpnlicJl,[ h rhn prcjNt. <br />I .cn iry rhar l ha$ re j rhi*Ipltarn r and srlrc lhtrr rhc atx'!. rnlonM bn k cod..t. l rsra la conPlv * ilh 0ll Cir v ud cl)uirv <br />ordi.,Rcs;nd Sr{rc Llws tl,riii io huildinB coinrucrkr, d hc!.b! Nlhori/c rcnrcscnhtivcs ollhis Cirr rnd Counlvlo 'n''! trlorihc <br />ah'!c n.nri{nrd lmp.ny for inspccrn,n putlx,\cs. <br />,\ppliunl or ,\x.nl SiAmlurc <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVl nsulation <br />Rool Sheathinq ,'/zo/)r ?,44 olt7-/A-- <br />Shear Wall <br />Framinq <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coal <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enoineer Final Report <br />FINAL "l\{\rr u41fiq) <br />Certif icate of Occupancy <br />Notes, Remarks, Etc. <br />I rnr.rrtrrl, rn(!r s.lrnfl Il ,t | ( llr rhr r.rlrr <br />I) 1. <br />ktcrs\Jam <br />- <br />Lcnd(i\ AJdc* <br />- <br />Flood Zone Certif .