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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNNR BUII,DT:R DEI,CARA'TION
<br />I hcrhy rlll'n, uni.r p.naliy ('r p.rlury rhar I n crcnll, fmm rhc (ijnrractn\'l-iccn\c Lrw t)r rho nnk,wtrr!.cinnr (SN?o.]15
<br />ansircs\ rnd Ptufc\\i(,n Cd.): Any Ciry or Counry *hich rcqtnc\ r Iannn l. ..n{rucr. trllcr. in,)rt,vc. dcnxri\h or rgritr rny
<br />{ructtrc. |Iiorb nl issuancc. ol\ rqunc\ ttu al icmr for \u.h Fnnir ri lllc r \i8md d]r.n*nr rhnr lr or nr n li.crscJ Puruatrr
<br />t'ro{!r{iotrsC.dc)orrhI( icorrhc is.rcn, rh.relionniJ rhc h!(is for rhc rllcScd c\.mP(n,n nr\nnrri.nofSccrinnTllll5$yany
<br />rnfliranr inr u lcrn,ir \trbjc.h rhc rmli.rnt ro r.irilpcnaltr.l nd Dorclhrn llvc hu r.ddollrrslS50Or.
<br />-1.
<br />rs onncr otrhc roIany. or DycnlPk,re\ *nh wqcs rr rhcn sb..nwns.ri.n. silltk, rhc klrt ird rhc nmNrc i\ nor
<br />in!.' crl oroflctud fd sft (Sd.?04-1. Businc$und tunassion\ Codc:'l hc Conkdor's t-icc.sc t-ow docs .or aPply t, m owrcr of
<br />lnc pmlcny $lx, huitk or iqnovcs rtEd)n. r wlFd,ts\u.h$(lAhnnscllorhcrsellorrnroughhi\orhcrowncnllno}acs-
<br />Drovidcd ihar su.h inrrcicmnh rmmr inredcdoroficrcd f.rsk lL k)*cvcr. rh( triklin-A ot in{'mlcnrnr t skl *irhino,r }ur
<br />nf.o trlcrion. rhcOwncr Buikld willh.rc rhc hKlcn oftovinS lh hc or stu dil ior huild or irn[ovc rhc |ntpcny l'ot lhc ruryrxc 6f
<br />t. r\ owdrr ol rhc lr)fdry. dncx.hrsiv.ly.. ncrirs wirh li.cnsc,lcotrlrrctnshoiiru.r rhc t,ojc.i lScc ?{x4. Bu\irus
<br />ind F\nf6\a,nC-.dc lhrConlrucxtr s l,i.cn\c l,rs,l,r\ norapfl!t, ino$ncroftrot--^nywho huild\or imF)vc!rhoc.tr.
<br />trtr{! who .onrrr.r\ lar nrh ltr,).)..rs*irhr (l rNrrrt lrcnscd !trr{(nr r,rld (-(,n!,r.ntr'\ l_(r \r l_r\)(
<br />-l
<br />amcicnpr !trdc, sc.rio
<br />I h.rcby rfilnn unds Btully oin rjury nrc oilhc {oll,'{in8 dccl.raliuN
<br />-lhrv.d
<br />willmiriinrCcnificsrc.lcon\cnrhsclfln$mI{rworkcrscoDrpctr\inon.asFovidcdforbysfrri 3T0Oolrhc
<br />rjbr Cod.. r i rhc p.rformma of rh. so nn snich Ihc pcnnir n isud
<br />Ihxvcrnd*ill'nxi',in*orkcrs.. rNn\ari.n nruirtrcc, r\ rcquicdhySccrion.lTlX)olthcLnboiCodc.lorrhcpctlhrm crol
<br />rhc work aorshich rhi\r.mf is i$u.d Nly*orkBs comDcn\lri,nr iNu.rncc c8tricr,kl |i'li.y nu'nhcr irc:
<br />l.cnlfyrhd ir rh. p.rhnNmc oflhc uork tbr +hich rht ncrnrir k iso.d. I \hall mr cmplo, uny pcno. in uy nrnncr
<br />b asrohccoN srhjccr r. rhc *olkc conrFns i.n l,wsorc,lllamin.,trd asrelh,l ir'l shotld t$.m {bicd hrlrc
<br />*ortc6.omp.nrllionpmlkiomofSdrion:l7L)0ofrhclnhrC.dc.l$ill.nrnhwirhcorylywirhrhos|)lovhionr.
<br />WARNIN(;: F lutu t, s.urc Eorten compctrsltion .ovcrrsc is unh*tuL atul shrll suhj..r drr cmPloycr lo oninrl Niahts rnd
<br />rNil lnr\!prootrchrdr.dlh.u\rfid.lhrr(SllX)l[x]). n llili,r ro rtu .f n ol .f s.lion. ttrnt8cs as t(,ridcd lnr lhc
<br />S..rn,n :1076 ofrhc tihr Codc, intc.c( and allorrcyi lccs
<br />a
<br />I hcrcbyaltirm undcr p.nslry nr Frjury rhrt I an li.cn{d und.r provhim otChlprcr 9(.onmn.ins wnh scdhn 7lxlo) nfDivi\t l
<br />ol rhc Busircssnnd Pmlcssioos Codc. nnd myli.cr* is in rLll ror.c kl clncr
<br />Li..nsc class:-Liccnsc Nlhbd:
<br />Drler Conlmclor:
<br />CONS'IRIIC'I'ION I FNDINI: A(iENCI
<br />I hcahy liirnu.dcrr.trrltyolpcrjLryrhrrh.rdi\rtoiidcri' LNltrr!rgcncyr'orrhcPcrronmk.orrhosorki'rwhi.hlht|Ern,iri\
<br />nrucd (S.c 3097. Civ. C ).
<br />ATILIITINIDII;I,IBAIII]!
<br />I tErcb, dninn undcr pcnnlr, ofpcrjuryom ofrhc nnbwi.s dcclirariotrs
<br />D.ft)liri{ P.nnii!Asb.stos Norilicorn ljcncrrl Rcsuhriotrs ( lirlc40, I)rda,
<br />Rc!ur.l lxrrq ol Notifi clli,,n
<br />I..nifyrhar rhc f.dcra I rc8u lar ions FSo.dinS ostEslos rcfr)ulare mr lppli.$lc t, rhis pmi.l
<br />I ccdilyrhd lhNc rcdd lhi\rpnlicxrn)n d i rc rhrrrhc abvc i f.nnrtiur ncoficcr I
<br />ordi"ancer lnd Srolc L.ws relariq ro
<br />Dtx,v. mflbftd |)n,p.ny lor insncct
<br />coi{to.rtrni. xl hcrch!nurlrtr
<br />\ppliunl o.,\,lrnl Sixn luF
<br />Co!trryro crrcr upon rh.
<br />A
<br />Forms/Steel/Holdowns 7-30-lr X'YJlu)
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulationi Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\rlaso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil.
<br />FINAL ?-/(-/g r.//.Ja afir)
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc.
<br />Set Backs
<br />I
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