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LDING- INSPECTOR RECORD
<br />SITE-WORK DATE COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />Subf loor/VenVlnsulation
<br />Rool Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handica Req.
<br />De Final R ortU
<br />Engineer Final Report
<br />Flood Zone Certil
<br />FINAL /ol1ll8.-dAi r '9,/
<br />Certificate of Occupancy
<br />Notes Remarks Etc.
<br />OWNljR BTIILDER DELC R TION
<br />I hcrchy nfinn trndor ,.nrky r)r p.rj!ry rhar I m ercn!fl fror rh. Contr.r{,a I ic.n\c t,r* 6! rh. lbllosins rctrv'n (sc.70.ll.l
<br />Bu\inc$ rRl Prulcs\ion 6dc) Atry Ciry or County whi.[ rcquft\ r tcnir k) .otrn d. rlrcr. infiov., de Dli\h ,tr ruNtr ]nJ
<br />nru.turc. IYtunr ir\ issuxtrcc. rh{ rcquircslhc appli.otrr f(, su.h Nnnirki l]lc r sisncd I{crrnr rhar }f.rdr i! lr.nscd tur\ua r
<br />r. rh. r,vi\ions olrh. Conrracrais l-icctrscd l-rs (Chrfr.r 9. Annnsncing *ilh S..rnr 7(xI) of Divnirfl I of rhc Bu\incs r d
<br />Phrc*ion\ codc) or rh h€ or \h. i\ crc'npr rh.rtro rndrh.l{rhlorrhc0llcScdcxcmpri.n. Anyviolario.oisccrion7o.lI5hyrny
<br />trp,,licrtrrl,trLpcrinirsuhjcclslhc rtplicrnr h a.ivil t'ctrnlr, ofnor nntrc ihii nv. huidrd dollar (S5m)
<br />-1.
<br />as o*trd ofrhc rtur.ny. or m!..rtl,,ytcs *irn slgcs as rhct snc .omnctrsrtirn. will do thc $o,k ind thc slMrum i\ ml
<br />inrcndcn or ofcrcn ior elc (Se 70.14. Busircss.trd Ptufc$i.ns Codc: Tlr coftndofs Liccnsc tiq dl)cr o.r,pply ro atr orrc..f
<br />ihc pmlf,nt *tn hnil,4s or irylrDtcc rhcNtr. lRl who d,f,s \u.h lolk hir\cltor hctrcll or rhough i( or h!' oun cn,!i,'ycc\.
<br />lrovidcd rhal \uch impmvcmnh m nor inrcndcd n ofcnd for slt ll howcv.i rh. hdildin! or nhrrovcnrnr h r.U Rnhh otrc ,rtr
<br />of.onlpLtn& rlf, owmr Buiki.r willhrvc th. brrdcn ol lmving rh,r tE or shc di:l mr hiti or iq,n$ thc pmFiy for itE puqn* of
<br />l. rs osns of rhc nmll.ny. am crclu\nrly conrracr ina wirh lic.nscd contr .ror to con(Nd rlE pmjccr (Sa 7ll1,1. llu!rc(
<br />lnd P$iisiotr Codc thc C.nhcl.f\ l-i.cnsc Las doc\ nor xntlyro inoNtrcr oinropcnywho builds or improvcs lhcrcon-
<br />trnd aho on nrcrs ior such rrcicls $ith r C.itri.(tr( t liQnrd pur\unn' n, rhc Conkrrtr \ l-iccnsc lj* r
<br />I rrcr.n,pr un,l.r Sc.ri,,
<br />UOA(E&):.CAUITNIAIIAN
<br />DECI.ITIAIION
<br />I hcrcbt.mm undcr rcnal'r of Frjlrr onc olrhc followins dccl0mtions:
<br />lhrvctr will'tuinrrinaCcdiatrsrcorConsnrn'Sclflnn,clornMkcnco,rpcflsriotr.isrovidcdlorhrScctnrn:l70oolrh.
<br />tjtxtr Orlc, ror rhc pcrforf, [Ec of rh. work for *hi.h rh. lx nir a nsucd
<br />I luw lnd *ill minllin workcrJ comrrctrsolion insummc. ,r rcquircd hy Scdi.n :l7(x) of rh. bhor Codc
<br />rhc wort r,t which rhisFrmil is nsln M,workcF ompcnsarion insurdncc.!ri.r od lblicy nunbcr ml
<br />C,"i",
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<br />PolkyNumb.r Eirircs:
<br />I ccnili rh{i in rhc pcnbflumc olrhc work for shich rhk trcrnrir t issucd.l shallnor cmfloyanype6o. innn, motrB '
<br />sr aslo rr.o'rc subjccl to lh. wor*Lrr .!mpcn\ n,i la*soicllilornn. md lstoerha' ifl rhould h.com \lhJcd rorhc
<br />s orlcr' conllEnsarion ,iovisbns or sccrio. l70o of rhc Llhr Canc. I shlll. tunh*irh comply wirt rhos !rcvhion\
<br />wARNING: Flilurc lo scurc slrkcm om|xn{li.n.ovctugc n xihwrul. atrd shdll subj..r rtr rntlur.r k, rinirr} Ftrrkts Md
<br />.ivil fincs up i'.rc hundrcd rhouqnd dolli^ (Slu),tx)or. in rddiri{ b rh, co{ of.o.D.n\arnr. d.mrlcs 0s prcvidcd lor rhc
<br />sc.rtrnr 1r)74 onlr l-nlrr (i c. i rcr.{ rnl xnrtr f, v'
<br />',"," 1,-tB-\5 ^n,,u",,,
<br />Io
<br />uL.ll.!ll-\-!t\
<br />I hcrcny!ffirn undcr Fn0lryolr.rjuy thnr l0m li.cnin uM.i piovhn,r orChntrcr 9tconrmncing wirh S.clirn 7fiDl ofDivision l
<br />ol rlrc Businc$ dnd Ptuf.$ions Cod.. dd f,yli.cn* is in lull lorc. ald ctr(r
<br />lto b
<br />!ONSII]JCIIONIINDINCIIiINCI
<br />I h$chy affirni uidcr Fn lry otpcrJary rhrr rhc.e n ! coNlni.li.n bndir8 a8cncy tor rhc pcriornrancc olrhc work f(r shich rhi\ p(mir n
<br />i\{rdrscc 1097 Civ C r
<br />AT]LICAXIDECI,ASAII!]N
<br />I hmbyammnndcr lcnuxy ofFrjury oE ofrhe follo*ins dccl rtions
<br />Demolirion Pcrmih-Asbc(os Norificdion ftdcml Rcgulalions (Tnb 40. Pd6)
<br />-Rcquned
<br />Lcllcr of Nolifi calbn
<br />I ftn iay rhd rhe icdcral resulation\ rslrdins osb$ros rcmval arc nor appltablc ro rhn pmjcr
<br />-l
<br />cerlily rhlr I harc rcod rhh ap!,liolion lnd slutc th.l lhc atnvc inrdrtrrion h.old. Il8re rooN,ny wnh ol Cny lnd Counry
<br />.rdidamc\!d Srlrc LawsEhrin8ro huildiq constfld nin. Md hcrcby rcF*ntarivcs olrhn Cny and (tuntylo cnls uBnr rhc
<br />ah)rc mnriomd l( I'crty aor irs,rctiotr
<br />]\ppli.onl or /\Acnl SiAtrolurc I t8
<br />ID/SIG.
<br />SLAB Floor
<br />x,
<br />Lard.,', Addr!:
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