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BUILDING- INSPECTOR RECORD
<br />DATE COMMENTS OWNERBUILDER DEI,(]AiATrcN
<br />I h.rchy lllirm trn,i.r F_naky ol Frjury rhd I am c\cmpr {tr,h rh. Cnnkr.l.r' l,'..nr lf,w lot rlE bllo*in3 rtrqrn (S.c 7011 5
<br />Bu$n.\\ r l Polc*r)n C,ic): Any Ciry or Cou.ry whrh rcqutrcr . pemir t' cdn{rucr. !lrs. inpruvc. Jrnxnsh ot q'!tr anv
<br />srucrurc, prnlo s issurh-'c. r\o rcqufts rhc dtrl*anl nlr su.h Fmrir b lrk , I rSncd (alcmnr rhrr h. ot sh. ir lrccns.d PuruMr
<br />t, rhe pmln$ns .t rhc Cnnrrucntr \ l-i.n\c'i hw lchanh 9, C.mmcNin3 w h S.ernn 70(Xl oI Drvi\on I .t lh. Bnrincs mJ
<br />Pnncs{on( 6,lc) or rhlr h.orsh. L(.rcmlr thcrclrom and lhclu\is i'rrh. rlLrd excarpron Any vrhronotS.ari,'70ll5bvanv
<br />apnh.or l'or r p:rm srbjccNrhc amneatrr t, , c,vrl Fnalry ot ft nk.ihlnlrvchtrnJtJJouus(J500)
<br />l. as owE_! ol rhc lrorcny. or hy cnDhy.cs w[h w!Sc! !\ rhcir $lc (nfrt'.tr !l!)n, *iU &) rh. *ork &a] rtE (Er@ tr n
<br />inrcRlcJ oro,lcmd ntr \dk l5&.?044. Buim* an'l Pm,cilon\ Cuic Thc al,nl.r.ttr'r L'(n\. Lrw dl)cs not q,ply o.n ownerol
<br />thc pn)tcny wk, hu,l'ls or hptuvc< rh.Nln. rl rh' d(f,\ u.h M)* hm\clf dr h.rsc ll or rhnugh hr .r hct ow. cmPi,vc.s
<br />pr,virl.d rhar n'.h impnnrmdrmnn mrc lcd.r.,lcr.d lat sh ll, k)wrkt, rh. tdildin3 or mpn,Etu rs\lli*(h'noncrtr
<br />o, romphton. rh. Owncr Bu.iq wrllhlyc rhc hrtdd dfntuvne rhlt hc.r\hcJiJ bt'ld or imF)vc rh. pn,Fny forrh. Puq eol
<br />l.r\ wncrollhcflopcny.rfr.rclu{v.ly.ontrd(tm-!wfhhucnscJ.ontr(rrsn,lrnnrdrlf,lR'j.cr(Scc?044,Aunc*
<br />!d l\tnlsrD Colc: Thc contra.ktr s l,i.cnr.l,aw ']..\ not 3plly () m.wncr ol PruJEdy who hnrlds or rmpfuvcs rhcr.on.
<br />rnJ whd conthcr ln \u(h pn)rcrG tr irh x C.trtalkJn n lEcnsen l)U^urtrr b rhc (ir ra.l,tr ! I ircnrc Irw )
<br />I im.r.md ud.r t.rn'n .B &PC l,{ihn'.,tun
<br />lVORI<En.S' COMPI'NSATION
<br />DECIABAIION
<br />I hctohy dllrn trtulcr Fcndryol ncriuryom o, rhc n,ln)wo3 delarar!)nr
<br />-lhdlddr
<br />wlllminrain a Ccnitlri. .f Ci)n{nl b S.lllnurc ntr workc6' co.rr.nsron, ar Pn,!:dcdntrbvScunonl7(x)ofrhc
<br />trrtr C(xL. tur rh. p.rfol'Mo ol tlE work tur wh(h rh. P.m[ 6 isued
<br />rhc work l{n *hth rhs p.mil Ls issu.!. My Portc6' comlEnrd ion nsuran.c fficr ail Fli.y numb.r ac:
<br />I r.nrfyrhdr lhc pcrlnrmn(.lrN work ltr rhrchrhi\ p.rmir ,r n{r.d.l drlln i cnPl,,yrny F_!!'n inrnvnrncr
<br />n, rs h h.rom ruhirr ro th. *orkcs romocn$rn,n hw\rl Cahnmn. anJ agnc rh.r lfl should bcoB \rnFd k] lh.
<br />vor(cr .omfoixrx,n ln visions ol Sc.rirn .17(X) ol rhr l,rtr* Gll.. I slull. n'dhwih .ontly w h rhrr !tuvnNnr
<br />WARNIN(; r hrc n, scurc w (.r (o rtxis rn ..v.rr!c
<br />.,vil lLn.\ trf L) onc hn lcJ rhou\rnJ d.llh lSlln|.Uxr). ln
<br />Sc.ri,D l0?(r ol rl!. hhtrGrtc. mr.r! rBl onty \ t'c\
<br />tr trn[\hLl. r l nr.r]l n hj!'.r x', .n,Pl'iyu k, dDtrrJ P.trrh.\ rtui
<br />rn. Jrmdpes a\ pnvidcd ,r rh.
<br />I hcEhy ailtm Dndcr p.nalry ol Frjury rh{i l ,m lien{J und.r pn)v6nr ol Chadcr 9 ( commncl.! w h S&rIn ?Urc) 01 l)ivtrn'n :l
<br />.l rhc ausm$ ! Prncsons C.ric. md my ltcn* i\ in tull l,,(r rxl ctlcrt.
<br />COIIII!]SIIONI,ENDING}EDNIT
<br />I hcrchy.fltm utrder pcnaliy.I !.rjtry lhar lhcrc n acondtucri,n kndo. .scnuy,nrrhe 0.rlotnm4 ol thc*o fot *hichlhis Pcmir i\
<br />r\!.d (Scc.109?, Civ. C.)
<br />AIILTCAILDLCIASAUAN
<br />I ln$y,iim und.r Fnalty ol p.ljury o* ofrh. tulbBmP dcul{ldion\
<br />DcBnrrio. P.rn v^\b.(Ds N.r rcik'n Fr.J.rrl R.8ul!ron! (Tnlc 4l). Pd6)
<br />R.!urc!i I-. $.1N"t i( n
<br />I ucnrlyrhJ rhc ltdcral r.Suhtr).\ rcSd'ling rrtrno\ r.Rtvrllrc n.r {pli.r6['n) rh( PmJc
<br />-l
<br />r.n'tyrhd I hlve rc!'lrh'\appli(aton dri sialc lh lhc {h,l.'9r.. h(,nlt'ly wrrh rllC yrr (in y
<br />rr'vcs ntrh'\ (iry rtr,l county r) cnr.r trF, r1rordrrn.c(aBl Srarc ltrw\ r.Lrnr !' htr'ld s.on(
<br />rh,vc i.nrnr,.d ',l]cnr I'tr tr'
<br />Arpliunl o.,\A.nl SiAnnlur(
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation I
<br />Roof Sheathing t/tr'llr e'M.)
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Brown Coal
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />il
<br />FINAL z////E 1r-811 4//7-v
<br />Notes, Remarks, Etc
<br />SITE-WOBK ID/SIG.
<br />,",,, /-Z' /7
<br />L.n.lcr'\ Nrm
<br />-
<br />knJ.,r AJ.ir"*
<br />^ ,/-Z-ll
<br />Ext./lnt. Lath
<br />Flood Zone Certil.
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