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BUILDING. INSPECTOR RECORD
<br />SITE-WOHK DATE COMMENTS OWNEN BUII,DER I)DLCARATIoN
<br />I hcrchy rfUnn u&lcr p.mlry (rf lcrjury rh.r I tr r.rcnDi fn,n rhc Co kactn l.hcM l-aw tui rhc folbRing rcisn (Scc.7lrll.5
<br />Busircss md ProraNion Celc): Any Cny or C.umy whi.h rrqunc Fnnir k) con{ru.r. illcr, lmprovc. dcmlish nr (F r rnt .
<br />nructuc. I,iorlo irs Gsumcc- aho rcquiEs rhcapplicanr ior chFir k, filc o sisncd sralcmnr lhllhcor \h. n lie.scd rursur
<br />lo !I[ t'ovisions ol lll contn rorr Lic.n*d l-rq lch,fl& 9. Commmirg \rirh sccrion 70oo of Divi\h I ol thc Businc\\ rtrd
<br />Pn,rci\tn,sCodc)orllEr hcorshe n crcnpr lhcrcfrnnand lhc h.sn hrthcnllc8cdcrcmplion AnyliohrbnolS.cri.nT0.ll5hrrnr'
<br />oDpli.n fd rNnni suhj..krhc rptli.rnrlor.ivilpcixhyolnor r,drlri fivc hundrcd dollrs($500)
<br />l. r\ owtur of rh. pmpcny. or n1, c'npby.cr wirh NIEC\ os rhcir vnc .omprn\d io . *ill do rlh soA ml rh( Ntrrut is rol
<br />inrc Ln orollcrcdtuqnc(Se.rol-1,BtrsincssMdPrefc(6n{CdlcThcC,nrri.vtr(Licctr{LnwdocsnorlnJ,lyroanoNncrol
<br />rh. Dr,pcny whotfuikl\ori'll0ro!c\rhdon.mdohod*s$.hk)'lh]'ns.lforhc.lforrhroue[[horhqowncNploycci
<br />pn,vidcd rhnt such i,nprorcmnc4. nn iore cd.rolltsllhrsrlc ll ho*rrcL th- huildln8or impnvcmnr is v,ld sirhinoic jsr
<br />of.rtrplcrtr . rh.O*rr Build.r will lftr rhc hurd.i ofJ'iding rhd hc or sh. did nor bxild or nnpnrvc rhd pmFyly for lhc purtrscoi
<br />_1.rs utrcrol rhc lJro|cny. ncxclusivelycotrrdin8 snh ln ciscd .onrNtrs ro coNrnrct rhc nrnsr (Scc. ?(}14. Bu\in6s
<br />rtrd lt)fc$i,n Codc lhcContacntr s l-icci..l-rw (hrs norrlnl!h xnownrr ol
<br />atrd rho contmcrsfor suchor,jc.rqirha Conrmcr{G) li.cn$d,,trnuinr k, rhc
<br />-l
<br />am.icmpl lndcr Sccrion-- S. & P.C. ror rhn
<br />I ha.c$y rrrnnunds p.nJlry oi p.rjr! olc ollhc tull,^virs dcc[riri,]
<br />-l
<br />navc.nd willtrui iinaCcnln.rlc.icon*nr Io Scllltr\un lm snrkcs ..nrrns ion. N nrovidcd lor hySccrionl?(r)olrhc
<br />Lrhr Q)dc, foi rhc ldtunmn.c ol rhcw.* f(r which rhc Fnnir ir issudl
<br />lharrrnd{illmrnrinqork.ra(n'|xn\rri(ri'Nurncc.a\roqunc hySc.ri,n,:lr(X)orrhc l-rtxtrCodr. ntr rhcltrnrnur.rf
<br />lh. N'* lnr *h'.h rhi\ |{iin i\ s\uL\l Mts,trkc^ conDLrrrri,r Nundrccrtri.r ndl Nli.y.u rhcr rc
<br />I ccniiy rhrr in rN t[r,hnnanc. olrhc wo!k li, wl,i.h rhi!rnnir i\ tnicd. I drll tror cDdor any pcEotr i', rdy frri cr
<br />*)i\n)h.conr$rh|.rt)rhcworkc'(.orpcisrii,nhwrofCrlilan,ir.rddrgtocnrrifldrrl(llf.oncqrhtc.rrorhc
<br />sork.n conEtrs rion l)rolniotrs olSccrnr lTlX)ofrhc l-rltr Coilc.lshrll. fodh$[h co.ldy wirh rhos !rovi\nin\
<br />WARNING: Frilurc b surc workc co rl].n$ii,)n .orcrrEc
<br />\tril ,nr.' nn n .nc h nrd'h,.r.rnJ d.lldr. ,llrDrr*'.. i 'S..rn .l(176of rh. lrhtrCodc. inr.rd{ aidrnorncy\ fccs
<br />cmploy.r ro ftimin.l pcnrllEs rnd
<br />ion. drmlcs !s rrovidcd lff lhc
<br />I hcrchyotlnnundcrr^-orlrroipcrjury lhalI m liccncd undq rn){irh S..rion TlXXr)ofl,,tni(ir I
<br />ol rhc Burirrlsifrl l,rrlr\nurs Codt. ir my li.r sr i\ hrllr(tr(
<br />CA!iIB.!JEIONII!O!!I']gI]N(I
<br />I hcrhyrfnnu cr p(nrhlol F-rju'v rhrr rhcrc ( r cot{rcrir l.ndir8 lgcn.y f(t rh. Ilcrronmtc ofrhc qork nr $hi.h rhi\ |lrnrir i1
<br />isnr{l lScc lt!7. Civ. C )
<br />Lcnd.ls Addrcrs:
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<br />A.TIUCAtrLDECL'IAII9N
<br />Ih.rhylllnnu .rlrrnlr,ol pcrjLqorcof rhctulknvin8dcclnrnri(,.s
<br />Dc,mlnion Pcrmlls A(hc(os Nolili(arion lldcnl Rclul iorsl lILc 40, P.nO)
<br />-Rcqutcd
<br />t!fl cr.1 Norifi crlioD
<br />_l.cnlfy,har I hitc rcad rhs alplicrrionmd{.rcrhir rhc rn i.n ircorccr l rgr.!rocomrly{irhrllCnyandcolirv
<br />odinuccs rtrd Sr.tc LrwrrcldinE l,) huiliins connru(.rrrivcsoiihi\CiryandCornryucnr(uB rhc
<br />trh.ve nEtrlnnlcd pordy ror inspcciknlulToscx
<br />Appli.trnl or AEcnl SiEnalurc I
<br />P"-,r". *-" rp,r,,),l@s gal \$p{o \epe zfztlt<
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsu Iation/E nergy
<br />D wall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />IMasonry
<br />Pool Fence
<br />T-Bar
<br />Handic ap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />ll(h/rd -a,WtZ )
<br />Certiticate of Occu nc
<br />Notes Remarks EtC
<br />ID/SIG.
<br />Flood Zone Certil.
<br />FINAL
<br />Iro ily rhJr rhc [odrrlrcguhri,,tr\ rcg&li',8 r\hc{o\ rcfnilrrc tror xlfll(rnl. r) rhn nnricrr
<br />I
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