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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER Iltill,Dl:R Dl]l,CAI(ATI{)N
<br />I h.sby rllirnr un,lcr Fnalty of F.jury ltur I m .x.r,pl non rhe Conreroa Lic.ns. ljw aor rh. follow B eaen ( 5€.7011 5
<br />Rtr\inc\\ and Prolcsi.n Codc)r Any Ci(y or C.umv which r.qun.s . p.mr h ..nntu r, alrd. nn!".v., d.mli\h or EFn lny
<br />(n'.ruE. pri,r ro nr i\\urnc., rL{, rcquiE\ rh. spplicrtrr lirr \ucl' IEm ro 6L s lis'Ed sd.tu.r rlk h. o. \lE is luncd puNrnr
<br />r.1h. novirio$ ol rh. C.ntr.crois I-iccns.'l Irw (Chaprcr 9, C.mmcncinB wirh Sccrirn 70{Xr ol'Div(ion l orrh. Burims a.d
<br />Pn'riseon\ C,ic) r rhlr lE n \h. s ex.nDr rheRliom ind rlD b!!i\ tur rhe rll{eJ.cnlpnon Atrt viohioiofs.crionT03l.5bymy
<br />rmlicid to.! Fflnn slbjech rh. lpplicintlo rcivilp.mlryolnd mr.than fiy. hundr.d dollt\ ($5(x))
<br />_1. ds o*ncr ol rhr nnp.ny. or mycmphy..s *hh *.8.s 8 rhcn $L comp.nsdion, slldo rh. uml,it iE (6@ i. d
<br />d. al .. oll.r.d ro. sL rs6.7lx4, Busir.$ and Pmfsi.n\ Cod. TtE cont4u s La.ns. ti* rlFs nor rpply io in ovM of
<br />rh. pfl,pen, wlb hitls oi rWoB ih.m'L ui who dE skh uort hihr.ll or lss.lfor rtDl8h hi5 or h.r owr .rnploFe!,
<br />F)vided rhrr su.h impmvetunhm6ri .nd.d orod.rd tu eL Il, hrtr.w. rh. hliuru .. irpmwmnr i. eB wnhin .E rt
<br />oI cod{rhiri rlE Ow*r BuilLr *ill h.v. dE b.nLn of povm! rld lE or $. 'ld kn bliu .r irpEv. [E pBFny nn rlE purp.e 6a
<br />_1. r\o*n( oa$. pR,p.ny, m.rclusivcll larntr.iing wirh li..'€d onr.ero6hconitucr rlr pml.cr (Sa. ?rx4. Bu{Eil
<br />afil Pmti\sinCode Th. Conioctor'i Lic.ns. Lr{ do.! rtn lmly tr, rn o*kr of |x liny wh. huilG or inrprov.s rh.r.on.
<br />rnd who ..ntx.N iir su.h pturcrs r h . Codm.k,( n li.ctucd puhwr r, r h. (1rn($hf s l-iceN. t!w)
<br />-l
<br />Jmc€nfl und.r S.cri,n .A &P( li)' rl'A r.J\tr,
<br />EQB!!8l-.c!l!!II}r:}lp!
<br />!Eet4.B r!.Utt
<br />I hckhy rlr,rm und.r p.nrxvoi |1,jltr],on..l rh.n)l[u'ni drrlrrulni
<br />_ll,,v.urdwillnui.irinrC.nrficar.ofCo.enrroS.lf.Insur.fitrwrt.Bcomlrnsarion,.spmvid.dfinbyS.ciionlTmof$.
<br />Lrhor C.dc. f.r rhc pcrlorttItr. ol rh. sort iq shich rlE p.rmt is i\sucd
<br />_l lEv. .nd will Dinrah wo.k.^ cotrlltnsarior insuB6-^., as r.quiEd by S.ci ion 1700 of rb. bbor Cod., ,or rh. pcrfomr. of
<br />rlf, qork lir whrch rlns lcrmn ir i!$ed My {.rkds omF.ns ion insrrnc cri6 rnd lx)liy numbcr d
<br />_lceniiyihar inrrE p.rlorronc. of rhc *orL htr which rhis lxrmii ir nrurd,I s llnor.ntloylny p.6.n nloyronn.r
<br />s rs r. hdcom sut .cr h rlI s*dJ c.frp.nsrion l.ws of Crlihm'a. and !3N rhd rr I rh.uld tEcore sobJcd ro th.
<br />worleA .on{r.\ i)nptuvirionr ofS.rrion lTmofrh. Lbor CoJ.,I !tl'll,fonhw[h.oDply wtrh rho* prcvaiotr!.
<br />IYARNINC !'rilurc ro scuc wr,rkcr' tunp.nsrion covcBs. n unhwhrl. md sl'lll rublccr an.nrflbls ro rimnal l[Dlis d
<br />civ'l lin.s up r, on. hundEd rhousnd d.lln6 ($l(n,(xxr, in .ridirion ro rh. co( of conf.nsaion, darue.l as pmvid.d ror rh.
<br />Se.ri()n :10?6 of rh. bh.r rod., inr.r.{ an,l r omy's f..\
<br />ApDll6nlr-
<br />UCEIIEDIONIA^IJ!&
<br />DECLAEAITIN
<br />I hcEby rm.m u.der p.mhy.rFrju.yihar l.m liena{ undcr rnvi\ion ol Ch,prs 9(6mm*i.8 *nh Serhn 70OOl.f rririsi.n 3
<br />ol lhL Busincr! dd Pmtr$iotu Cod., ! n, Iic.nr. is in illl ft,rc. lrd c,fccr
<br />lhre
<br />-
<br />Conlru.ro.
<br />coNiraucrolru;lllNc-dliDlig
<br />I lrEbyaiirmund.! peMlryotFriury rb3r rh.r n a cotrnn'd n lenlins rs.ruy li tr rhc r.rndBtu. of rhe *o.k lor *hi.h rhn Fmir n
<br />dttlcAt[DEctABArIoN
<br />I hEt y atrm u*L. p.ndlry ol p.+ry oD. of lh. followin8 d{l{d ionsl
<br />D.nrlirion P.rmnstuknos Ndrtr..iDn F.d.ElR.E!l&on: lTnk 40, Pfi6)
<br />_R.qrn.d kn.r of Ndlfr .{iDn
<br />_l cd'fy rhar rh. fed..al r.BuLrioE EBorJrry .sh.ros EnBvll @ Nn aflrli.abL b rhn I,DFi
<br />_l !!nilt rhar I h.v. rcad rhj\ lppli.arion snd (d. rhat rh. lbov. infomrion i\.oftd I .E@ ro &mnly wiln 0ll Cily.nd County
<br />onh Es .trd SraG lj*s Ehring ro h{ililnrg con{d.rio'\ avl h.Fby aurbrr. rp..rnrdiv.s of rhls Cny lnd Coutrry ro ..rd ul'on rlE
<br />ltr,!( runriofrd F,p(nylor iNp..rion proorc!
<br />Appliconl or AA6l SigMluF
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<br />D.t.:-
<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
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Reoort
<br />Enoineer Final Report
<br />Flood Zone Certif .
<br />FINAL 5/1/c")o )X.r/;i)
<br />Certificate ol Occu
<br />Notes, Remarks, Etc V
<br />Rev. 08-07-2015
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