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BUILDING- INSPECTOR RECORD
<br />COMMENTSSITE-WORK DATE ID/SIG.OWNER BUN-DF,R DI]LCARATION
<br />I hcrcl,y llitn undcr pcMlry orrcriury rh l nnr cxcnll riom thc Cotrrracxna l-ic.n\c Ir* ror rhc ri,lloNinE tcahn (sc.70:ll5
<br />Bu\id.ss md Profcsidl Codc): An! Cily or Coutrl, whicl rcquirc\ r rnnir tu .on\lflrd. tlrcr. inDrorq dcnx,lnh or rcPn ry
<br />sld.turc. nrit k, ih tsuamc. al\o rcqut$rhc rlplicanr ra' su.h Pnnir ro ile i sEned {rrcmnr thd h..rshc is liccnscd nursuarr
<br />Io rhc ptuvi(iotrs ofuhc Conhcroi\ l-iccn\cd l-!w icturrcr 9. Ci,m,Rncin8 wilh Sc.rion 70(x) ol DivisiM :r ol rh. Btr(inc* lnd
<br />Profc$ionsCodc)orrhai hc.r\hc is.rcml, ihcrfnnn rhc b.rh nn rh. illcscdctu rpri( An!vidariorolSc.rionT0.ll.5hyrny
<br />appli.n ro.ap.rnrir\rhjNrsrhcnmli.anrtoacivilt'ctrullyolnornmrrhnnfiv.hundtdd.ll.tr(S5Ol))
<br />Lrs o$D.rofrhcpofcdy,or rycn.ycclsilhsiSc(.srhcirs'lec.nrp.f\rri,)n.Nilldorh.workandlh.{n'chmi xn
<br />idctrdcd or ofrcrcd Lr qlc (Sa r0ll. llu\i',cs rnd lhfisii,n\ Codc 1hc C.Nr..ntri l-icctsc I i'r tl..s tor l]nrlv h r orvncr ol
<br />rh.pmFny who hrikli or i'ilr.v.l rh\rm[ rnd who dm\ such so hnn\clf.rhc6.ll.rrhmuehh(orhcrotric {r.}c.s.
<br />.fcu'r{Lnotr,lk Oqrcr Btrildcr willh!\! lhc id cn.ll]trNingrhrr h.orshcdd 0.r huild or inlr'n,vc thc !fl,tfry for rhc Nrnorc ol
<br />l. i(o*nctoirhc nmpcny- am clt
<br />Pr.fcsbn Gde: l h. Contrkr\
<br />Bh. .ontr{d{forsuchpmjcch
<br />rhc Pr+cr (sd 7041,llusinc$
<br />ho huilds or nnprcvc. rhcrcon..,.1
<br />ipir
<br />l2lillA&IUAI
<br />I hcruhyrlTnDxndcrrcfuhvoln r|urvrncolrhc
<br />lhr\c dniNillnuNni n (.nill.rrc ol(ink r h Sclf ltrnrt rin so'k.re corn.f\rrnin. xs Pnrvn,tJ,nr byS..ri.r '17(xrolrht
<br />UhorC(xlc, f(rrh.ncnunun c ollhesl ln' *hich rh. nt' n I i\ i$u.
<br />l hrvc and sill miinirin *orkcri c. rtFtr\nri( nNtrhicc,nl ruqumd hySc.lnnr.l?(x).frh l- orCodc.lirr rhc Frlbnnrnccof
<br />rlt s.rk l'.r which rhn pcnnir is issLtJ Mt workch conti.nsrr ion in{mmc cadcr rd rnicy numh.r &c:
<br />-l.cnirylhtrl
<br />itr lhc !.rlnnnDnccorrhc Rork rdshich r[tlrnnn h nsucn.l shrlln rcmploy rtry ttrrq,n in trnynuntr
<br />$ r(r. bc..m suhl..r ro rhc worxer conrFn$ ion llwsotcllifornir. riJ rrruc rhd ifl should bcconrc {bjcd iorh.
<br />"o*cs.onfnsdionfovisionsolSc.rion.l?(XloirhclnhorCodc.lrhrll.fonh\eirhomnly*irhrhosPro!i.i,,ns.WARNINC, l:rilurc k, {ctrr. sorkca'.o {cnsdidr c.LcrnA.unlsrtul and \lnll {rbi.(r if ctrlr.!_cr ro ni'nnrlp.nilric\ rtrd
<br />Inr r, rhc .o{ of.oDln.hsrrnnr. drnng.s r\ pn,ridcd lnr rh.l-r/rtil/
<br />I hcdhy rftn uRlcr f,.trrlry of pcrjry rh0r I rm li.cntoal F,vti{ .1('hxfrciq (.ontrNtrcir8 wiihS.crioi 70(x)) ol Dnl\on l
<br />.i rh.lld\in.s r Prcfc$6n\ Chdc, dnd Nyli(ctrr. is ir tull l.rcd rntcllt.r
<br />caBf,rauquadl.!;xDlNclctNrx
<br />nirJlS.. .1097. Cir ( r
<br />attuclNLDlillrlBArloN
<br />I lmhv n,lii,n uMo |[trrlry oit'crjury onc ofrh. i{,lk,winE dcchBri,,ir
<br />I)cnmlirion Pcrmik A\h.(os Noiin.atiotr rrdcril Rc.!uliliirN ( Iirlc40. Prrr
<br />l.cnilyrhrr I hr\cr.rd rhL\
<br />di',m.r\ an,l Srrro I xw\ rchr'
<br />ioi{ndsdcrhir rhcihtrc nri),nhii,r i\..'rc.r l.srelocotrDlyLrirhallCirynndCourly
<br />hcrchyaurhni2c rtn.{mdrivcs ofrhh City ond Coutrry ro.ilrd uPon rhc
<br />ihovc mcnrioncd lropcny nn i'
<br />,\Dnliunl orAAcnlSignntrn ^ilil(
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil
<br />l
<br />FINAL <d>qltp tLg
<br />Certif icate of Occupancy -l - I {Jt /
<br />Notes, Remarks, Etc.
<br />I
<br />I l..n\.('Lr!s: 1.i.. \r Ntr nlrr
<br />lr r
<br />-l
<br />ccniiyrhd ihc lcdcBl rdgxliln,ns re din8 $lEsosrcmv0lrrc nor {plicabhr, rhisPmttl.
<br />Forms/Steel/Holdowns
<br />lt /t at1ar-u-,
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