|
BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNN:R BUILDI]R DELCARATION
<br />I hcrchy atfinn uDdcr pcnrlry.f r.rjury rhrr I trn crcmpr tum lhc Conlra.ro^ l.i.cnsc ljw ntr rhc fullosirB rcr! rscc.7{)11.5
<br />Busirr.$ ,nd Protcsion Cdc): Any Ciry or counry which rcquncs n f.nnir h (o.sifl.r. olrLJ. imFiirvc. dcmohh "r rcn:tr ,ny
<br />{rucrurc. priorro irs is\rMce, dso rcquires rhcapplicanr for nEh lEanir ro filcaslgncd darerEnr rhlr hcor \hc is licrn\rtl nsu. ri
<br />r. !hc t'roririrs .f rhc ConrBckn \ l-iccnscd lrw (Chaprcr 9. Connncrci',9 sirh Sc.rb. 7(xx) ol I)ivi\ion :1 ol rhc Btr!rr\i Jnd-
<br />Pn)fc\stunsGde) orrhor h.orshc iscrcnDr rhcrciofl.nd rlEh.si\ tor rhc illqcd crcmoriur AnyviollrionotSNri.nT0il5hlrn,
<br />3pnlicr.riorrp.irnilsuhjc.rsrhc.ppli.rnrt,rcivilNnrhrufnorfrtrcrhMhchnndrcddoll6(1500)
<br />l. N owtur oflhc pmpcnr. or mycmploler wilh w.8cs,s lhct blc $nIcn\alion. *ill do lhc sork and thc nerm i\ ni
<br />i cndcd or ofi.r.d r(n elc ( sr ?(!4, Busincs and ttonssions Co,lc: thc Conrmckn s l -k.n* tl* do.\ nor lprly lo an o}ur or
<br />rhc pmpcn, who 6uilds or i.lll'mss tllB)n. flxl sb rl(B \uch wo* hiDs.lfor hcsclfor rhmugh his or h.r o*n cntlil'Dtcs-
<br />providcn r[al nrh nnroKnrnrs dE hol inrddcd or olIcrcd fir sah ll howchr. lhc boik]ing or inpmrcnEtrl is $ld ,irhin onc ]td
<br />or con{lLri. . rhr O$ mr BuiUer uill h.\ c rhc hudc. ol lmvitrE lhar he o. rhc dil rbr bui}d or nNrorc fi. pmpcny ror llr NOoc of
<br />t.r\osncr.lrhc|l)p.dy.anrcxclusrvcly.ot.crnrgwirhlicctr*d..ikr.(trrtocon(rudrh.r&jccr(Scc7114.1-Itunicss
<br />!M Pn,h$i C.d.'Th. ContKk, s Licctr\c I rw doc\ nor {'plyr. ono$ncr ofpn,pcny sh{,l'uilds or nnptulcs rhcrcon.
<br />r Nho coorr..l\loi r.h lnojccF wirh r Cont,.krn r liccn\.d prr\u'ir k, rhc C.ntri{tr { LBtrsc l-rw)
<br />I n crcnrnl undcr s6.-li(
<br />Drt. O*ner
<br />lVorRXi. (\' Cr )lllPt\SAl'lcN
<br />DECIAXAIION
<br />I hcrcby trrfirm undcr peElry ol pcrjury onc ol rhc folbwins dc.hftrion\
<br />-l
<br />hrvc afrl will nrn rir r Ctdificalc ol A)n*nr h Scli l n\ue fd qorklrr .on{knsat idr ns lR)vdcd ror by Sc.rion l7([ ol r hc
<br />Libor Codc. lbr lhc l)c forimnc. of lhc work f.r whi.h rhc ,.mir ir irsucd.
<br />!4i.vcrndwill nri' ain workos c.nrr.n$ i.n in\uran c. rs rcqurcd hrsccrn,nJT0ooi ihc rtrhitr (ixlc, l.r rhc Nrronntrrc.r
<br />rnc work a.r whichrhttErmil is ksu.{. Myworkds cohpcnsdn,n insurrmc .micr dri rnicy.rnhcr m:
<br />^Jo
<br />(fuha,D 9t\'<-
<br />bAtilc @443a
<br />I ccdil-v rl,n rhcpcnanrunc.olrl[wo'InnBhi.[rhispcniri\i\\ucd.I\hrIn.rcnrd.]rnr_
<br />si lo tRlm shFd ro rhc wortcr .ompctrsrn,n Lws olCrlinmia. md ngdc thri ifl \h.uld lrrom subjrrr rorh.
<br />wo cr'onrri.nsdbnpiovisn,nsolSc.rionlT{Dofrhct-a}itrC{xlc,lshnll.fo hwirh ..mtly wilh rhor Uoytions
<br />WARNING Fiilu,c ro scnrc q cs conrEnsaliur covcnsc is unhwiul. trrd shall subF-l .r .nrrlorr ro riminal r.nrlrt! !frt
<br />civil rinc\ ur lo orc hundrud llNusnd dolhr ($l(x).000r. in tkldilnnr lo l[c cost ol conEnsrlion. dtrnqscs r\ r0vidcJ tur lhc
<br />1i"il'"''
<br />,."**.r* R. , ,,*,
<br />D!!E ,h1+y,,-**{
<br />.CAISIBUCIIONIINDINCrIIiENCI
<br />I h.rchy afimridcr p.n lry.lt)rrJur! rhri rhcrc is !.otr(ru.riotr bndir8 lrcDcy fr rhc pq ntm$Ec olrhc *ork f.r whi.h rhi\ pnnl n
<br />irs&d (Scc .l(rr7. Civ C )
<br />AIELIIAII.DES/I{IION
<br />I hfr'by.iinnundcr l)cn.lryofpcrjurt onc orrhc rolk,s sd&larrri{,.q
<br />Ocnbunr P.nnn\ Asheios Nolifi.rlbn Fedci l Rc8olarion\ (1nt 10- Pfi6)
<br />-R.!uircd
<br />Lcfl .r.f Ndifi .orion
<br />l.c'.rrrhrrrhrlcJcrrlr+uhrii)ns ro!r'(li'r! rslr{o\ '. hvrlrc tror imlir blcn' rhi\ Fir..r
<br />rbvc nEnrioncd nDltriy for instn-.-r
<br />ADDIi(anl or Ag.nl Sitnaluro @ ,",-'f nk
<br />Set Backs -TForms/Steel/Holdowns
<br />Erection Pads I n
<br />UFER Ground lz i/tO/t{ rt tr74/
<br />SLAB Floor )7 'r
<br />Su bf loor/Vent/lnsulation /,2/./1//E -7
<br />Rool Sheathing ./al iihi
<br />Shear Wall ,I
<br />Framinq m-7 (r'y l,,|s)u
<br />Drywall iztq,'Z/tr.L14
<br />Ext./lnt. Lath
<br />Brown Coat ZJ*. - . V72 i//9..1&q\
<br />l/lasonry lrA,f
<br />Pool Fence -
<br />T-Bar
<br />Handicap Req
<br />qeputy Final Report
<br />Engineer Final Report
<br />I
<br />FINAL 7/"//4 .
<br />Certiricate of Occu pancy
<br />Notes Bemarks Etc.IIrcrcby.llirnuMcrrcnrlr!of!.ruryrhdrIrrli.ctr*\l!.rpn,vnidofChxtr.r9($nftmnrBwirlSc.tDt7fX))ofDivsiot.l
<br />of rhd Ilusincs md Pmfcs\bns Cnle. tud my liccr{ n ir iull iorcc rnd cttccr
<br />Dkno
<br />I
<br />Ma
<br />lnsulation/Enerq v '/Ot1 lf ,W
<br />Flood Zone Certif .
|