|
BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUII-I'TIR DELCARATION
<br />Iherchy.{lnmu $ lci(lry oi pcrj'rr} lhir Iancxcnfr rior Ihc c,n nIos l.iccnse ltrr'ihr rhc iolLvir8 rcrson (sd 70.115
<br />Rtr\inc$ and Pror'c$iotr Crlc) try Ciry or Counl! which r.quncs ! pcfl.ir k, con{tocr. rlhr. i rtov.. ddtuliih ,tr (t'Jtr Jn!
<br />{tucrtrrc. priort, ir\ i$urncc. rko rcqrtcsrhc applicanr lor $.h pcrrnirlo lllca \igncd irrctu rhd h..rshc is liccnscd l'uFurnr
<br />t, lhc F)visir,$ ol ih. C.ntri.ttr s Licctrscn Lrs (Chn0rcr e. corncrcirA siln Sccriofl 70{)0 of Divi\hn :l or rh. Bus;'cs riJ
<br />Pnn.si,nNCodc)orrhrr tu or \hc tcrcn,rrrhcrclnnnr rhc htr\i\ in rhcxllcAcdcxc llrhn Anyvnndio.olScdionTo.tl 5hylny
<br />ip!licrtrr r d!cnnir subjc.hrhc rpfli.0ri lo rcivi!pcnrxtortroi ror. rhdn fivc hundr.d rl.llrr (S500)
<br />I. r\ owturofrh. px,Icny. ornlyc'nftof.i wthw"Cc\ N rh.ir v,ld conrpcnsrrion. willdo rhc work a rhcnMUrchnor
<br />inlcnd orofiircd nn *t (Ss ?044- Busims md Pnrt$iB cftl.: Thc Conlrlclrtr x Licc"sc L,$ doc\ nor aprly ro a.owncr.r
<br />rhcfn!.ny wb hlilds or nvn)va rhcd)n. tuxl wh) dft\ $rh ${)* hinsclfor hcsclfor rhmugh hh or hcr own employecs-
<br />pnvidcd rha, such impnrlmlrr 6c mr inrc'dcd orotllr.n !i,r eh l[ h.wera rhc trilding or iq'mvcftm i\ $ld wiib,n oft ]tr
<br />olonDlcrion. rh Ownci auilld willha\t rhc huftlcn ofFJvin! rhrr hc or shc did mr buikl or inlmw rhc Impcny fo.lhc !u,FN of
<br />!L .s owmr of rhc tld,p.n y. rtrrcx.llsivclrcontncrirg wirh li..nsd .onrncrns h coNlrct ttE tmjccr (Sec 7044. Bu\inds
<br />Pnnlssi[ Co'lc lheConrrocrnr'sl.iccnscLawdQsnol!pnl!lo!tro*ncrolpro,r ysh. huildr or nn|)rortsrhcrcon.
<br />who.oira.rsntrsuch|n.,c.rrwirhrCbtrtrtrtr(rli.ci*dpfruMrrorhcCbnrricrolsLictrstjw)
<br />Id cr. rpr und$ Slrrit
<br />\,,,"-tlzo l& h(
<br />DECI.AMIII}N
<br />I ncrcby ofilrmundcr t'.MI'yollajuryom oI lhc follo*ir8 dNlarnrnnrs
<br />-lhovc
<br />ondwill mntroin u Ctnifictrrc or Consnl to Scll.l.sur.lorqo.kcc'cor.p.nsario.- 6 povided ir by s..ri,,n lT0oorrhc
<br />tjhrr Co<lc. for Ih. tdf.ioancc oI thc work l'or shi.n rhc fnnir i\ i\suql
<br />PolicyNumhcr:-
<br />-![""niry rUr in rr," a,t"rtuncc ol Ihc work rd *hi.h rhit r^-rmir is issocd, I shrll nol crnpby rny pcrsotr rn any .rnncr l'o .s lo bco'f, sbjL{ ro
<br />'hc
<br />$o cs conrynsd ion l.ss ol calitu.nitr, a asrcc lhl( ill sl.iuld trconr suhjcd rorrr
<br />sortcr conll)cnsatn F,vthnsofSc.rbn 3?00o1'rnc Lahr Cdc.l shlll. nrnh$irhconrplyNirhrhospnrvisions.
<br />WARNINC Fnibft i, *.ud workcrs c\)mpctrs[n,n ..v.ragc i\ u lawltl. n d shdll subjccr an cnrtloycr io o'ninalpcuhas d
<br />.i\il hrc! uf kJ onc hunlr.d rhru\rnrl doll { lSllx).(XX)). in addfi( r t, rhc co{
<br />u,&Frert
<br />n. d!mc8 * eovidcd fo h.'
<br />Sccrion 1076urrhc t-rhtr ctdc. inlcrcsr rnd !lktrrEy\ r!':i.
<br />1l>o l&
<br />\0"
<br />DT&IAB{IION
<br />I hcahyrfll Drd.rpcrdlryofp.rJurylh.rI rr lrcnscd trdcr !ro!nn olChrprci 9lcnmnEncirrg $ith Scclion 7(n0) ofDirision:1
<br />oI thc Rlrincs.nd Prel!$ion\ C.dc, xnd n,y liccrsc i ir lirlllnrcc !fflcffc.r
<br />CANSIN.IJEIIANII'IDIIC.>N.(;.I
<br />I hcrchy ltfirm undcr p(nalryoipcrjurr rhlr rhcrc n r con\rrucliD bdira o8.ncy nn rhc l,.rLrnbi.. orrh. work tu uhich rhh p.rmjr n
<br />i$ucdlse-. 1097. Civ. C )
<br />A}IIIIANIDEII,I3AIION
<br />I hort y afim undcr pcnlhy of pcrjtry.nc ofrhc aolk,NinA dcclararions:
<br />Dcnroljrion Pc nirs Ashcstor Notill.artn F-encral Rcsulrli(,.s flillc.l0. P!n6)
<br />-Rcquted
<br />Ltlcr of Notilrnrhtr
<br />l.cnili rhut rtc fedcrll rcsuldrioni dg,rdihg Ntrdor rcmovslrrc ornnpli.ibhio lhn[onrl.
<br />tu(.n'ryrhr I hrh rcrJ rhrs rpplrdr rnd {arc rh. rh. .hovc innrmrion h.omcr I osre lo o'nply *irh ,ll Cny a.d Connry
<br />zc rcprcrnrariv.s ofrhi\ Ciry rnd Coonrt b cnr$ qhfl rlf,o'dinrrccs !trd srarc ljws Ehrin8 ro huikiin8 coNrdcr,on. md hc#Ejllilryi
<br />ahnc,tunriuned nmpcdy finnsN.r on lurto{\
<br />1n*,n".,.. ^*",,.,**,.(."]).r, ug v \/\
<br />J"*ir*.,..rca,,,, ?A!r- L\6NJ
<br />>olK..
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq
<br />Shear Wall x
<br />Framing
<br />ln s u latio n/E nergy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />N,4ason rY
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Cedif
<br />tl
<br />FINAL z rrz//{ -.-vvD
<br />Certificate ol Occupancy /7- 7e
<br />Notes, Remarks, Etc ,t)
<br />rleo",o '|-ot d2- *" i I 1T.JI
<br />7
<br />-l
<br />hrvc ud *illmnirrain *orkc^ co'nr^-n$ri{r! insunncc. as rc{tuircd hySccrion:17(norrhc lltxtr Codc. for rh. pcnonmncc ol
<br />rhc sork n which lhht--rmil i! i!\u.i Mtsork.n .rm|rnsarim ir\uBtr.c.rd.ra Fni.y m rhcr nrc
<br />kdcis AddrB.
<br />-
<br />I
<br />--r------
<br />=
<br />=
|