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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER Bt'ILDER DELCARA'IION
<br />I h.r.hy rftirm unJ.i p.nalry ol rErlury rh.r I o cxcmpr fmm rhc ConrncroA Lkcnr. Ln* f(, rh. foll.,$ira rc2$n lsc.70ll5r
<br />Busincs lnd Pr.nsio. Codcl: A.y Ciry or Counry which r.qunus i trcmir ro cotrnrud, altcr. inp'ov.. ddn$inh ry rcI{n in,
<br />{ru.ruE. ttrin r. irs hsuan.c. trho rcquircs thc lprli..nr lur such pcirnit ro lilc ! risncd !'.mir rhtrl hc or shc is lienscd l)Unumr
<br />lo lhe ,r,lisions., thc Conrrrct, \ t-i.enw, liw (Chercr 9. Co.m.ftin8 wirh Scctiotr'7(iD of Divnion :l orrhc Burincs ,trd
<br />Pn)fcs\i,,is Codc)orrhd h.orshc iscr.mpr rhcrciomand rhcbasis tu lh.rllcscd cxemflnrn Anyvn,htionolScction?0:ll5hyrny
<br />lplTic.trr,ora Fnnir subjcchrhc &rplicror ro acivilpcn0lryoinor ho,crhM nvc hundrcddollas (551(,)
<br />L as owm or rh. roFny. or m! cnllorrcs wfh wagcs ss lh.n $b c.nrFnsrt'n. will do rh. work 3nd fic (ulw i\ mr
<br />i,rtcndcn or orcrcd Inr Mt lsa 7044. Businc$and Pmfe$ionsCodc: l'hcc.nra.rors Li.cnsc Ijwdocsnor alplyroanown or
<br />rhc prur.dy wh) btrilds ar i'npross rhcto$n- okl pho des su.h m* hi'n\cltor hc$clfor rhou8h hi(.. hc!.wn c'nPbrc$.
<br />pmridcd ihar such imformnh ft to, inrc,rldl r or.ftd for $L lf. lnNcrcr. lhc hoildin! or i'4mlcmnr is sokl Bithitr one )cu
<br />r ol connhrnn. r hc os ncr Bu Js wrll hla 'tr hurLkn nf,rmvins d.r tE or shc dil d hlild inpmre rhc pmpcny lorrlt lxqx,*or
<br />L$'
<br />fi].r. ^ ""'*oi ,* n-*r). ,'h r\.lu.trcry.,tr rr! rns wirh li..tred (nrrcr.6 ro o.(tucllh. tx,ii (s€ 7(l{a. susircs\
<br />' nnd Aorssi.. aollc. Thc Conrrucrori t.!.cnsc t.atr docs nol antlyro anowncr ufpropc ywho buildsor imnrovcs rh.rcon.
<br />xntl slr mnrru.r\l(n \uch prcjccrssfhr(_(nituchln li!ci\.d tu{riN ni (in .x.(tr \ l.i.cn\.I-rs )
<br />(r"",]Itti['i
<br />I hcR.hy rlli, trr un,Ldr D.nnlr) ol ltqr.!f t olrh.lr) h,
<br />lhrvcunl$illnuinrrinrCcniiicrrc.lCoNnrbSclll \urc frn ltrnko! ednrNnslri,n,. rs rtro!i,ltllnnbySccrionST(xrolr[.
<br />l.rb.r (inlc. lor thc t.nnrnNncc ofrhc w.rk ntr *hich rh. Firnir l\ i(\!cd
<br />I havo rnd Rill nri rir wolkeu conpcnsarnr iNur0nc.. us rcquircd htSccri{ri l7(Xrofrhc bhor Codc. lbr rhc Fnnrmi.c of
<br />rhc work lor which rhh pcnnir is irsEd. M y *orkcB conlFnslrn,n in\trdc. .aftici and Jxni.y N mhcr ac
<br />l..nilyrhar itr rhl !.rfonn.mcofrhc *ork l.r whrhrhi\ D.irnir is isu.d.I shrllnor rnllluy.nyNri irrnynunnct
<br />$ slo l'.{.nE suhjcd ro lhc sor\ss coDFn{rnnr b*s orcrlihnir. md rlnc rhd irl sh uld bccom sbrcd r) rhc
<br />sukcm conEnsrrion prolisions nlsccri,r]?00oirhe l-ahn C lc,I shJl. ianhwith.omfl
<br />WARNIN(; Frilurc r. surc wo.kcs' conrJicns.rbn .orcmec is ntrlowtul and \hall s
<br />.ivil fincs ut ro ok hundrcd rhousnd dollir ($lur.txx)
<br />"",". aeE(
<br />I hemhr rfinnrndcr pcnalry o f pcrjuiy rhri I am licctr$d undcr t,mvisiotr ofChxrrcr 9 (.onntun.in8 qilh Sc.ri.n 70Gl) ol
<br />ol rhc rlu\inc\\ lnJ Proac\\i,,nr Cod.. md ry li.cisc h in lxll f.ra .fr, elfccr
<br />CANEIAUCDANI.I,dIIIIC.ACENII
<br />I hc^_byrllt uMcr D(nrllyoancrtury ll rhcrcns consrtrri,,t lcndir! ilctcy lot Ihc lLrlbnn0n.c olrh.work tr whi.[rhk lrrNir is
<br />issudd (SLr 1097,( iv C )
<br />AIIUSNNLDICLAEAIII}!
<br />I tueby ahinn undrr pnahyolpcrjury one oflhc lnlhsins dccllnrion\:
<br />ocmlin,n Pcrmirs A\b.ios Norifi.rnnr Fcdcr.l RquLri,,ns (Tirlc 40.l,an6)
<br />Rcqrircd h cruf Nolil(-dtiotr
<br />I cdrilirhnlrltr radcrnlrcruhrnrn\recartlinE arh.no\r.Nrrlrrr .rap|li.rhlc r.lht Pn,lccr
<br />I ccnil.yrhrr lhrr rud rhn r iul is.orccr I xgrn h conflt wirh rll( iryr
<br />o'dinJn.r\xna Srrr.l r1v\ rcla(iis r
<br />ohorc Nniioncd lropcny tnr in
<br />Appli.onl nr Aecnt sipnol
<br />P(rmil.. nanr (Drnrlr:l)
<br />v
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Roof Sheathi ng
<br />Shear Wall v
<br />Framing
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<br />7uly/b =-4@_crt744d )
<br />lnsulation/Enerqy 7
<br />D_ntwall 7Dd *. qllltl Il.-^iler,) t> . ltll l8 r""ltreulr2l)
<br />xt.&rt. Latn It trl
<br />rown Coat 4lLlL8 1i 7,
<br />lVlasonry UI
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL tc,l tol({ T ionnarl
<br />Certif icate ol Occupancy I ul \--.-..2
<br />Notes, Bemarks, Etc
<br />-
<br />Erection Pads
<br />Flood Zone Certif.
<br />7/, )
<br />I . nJ.,',. ,lJn . .
<br />I
<br />=
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