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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OwtiEf, AUTLDET DEIC &ATION
<br />I hcrcby onnn undq Fnah, or Frjury rhar I m.tcq, fhm llE Coni&ro^ Lk.n* hw r(, rhc lollowinS Ef,$n (S€?0ll'5
<br />Bu\iFi rnl Pror.rihn C.,&) Any Ciry or Cddy phth Equi6 . Fmil to @nrtrs! .Xs. i,rl,rot dcmli.h or Erln uy
<br />thdw. Fin to ils iruaE. .ts. rluiEr llt at'pla. ror urh Frtu h nk r ii*En t(!kBn! rh.r tE or JE n la6*d PNd
<br />ro rh. nmviqions ol E Contrcrol3 L-acnsd t u (Chlplcr 9. Conwmins *iln Sccri,n 70ix) of Divnion I oI rh. Bu$ims od
<br />Prcf...hns c{d.) u rhrr lE r 3ll is .rcq,r rlRfion rnd 0E b(i! ror rtE rlL,rd .rcr(rirn. any tioLrhn of Sdrbn 7011.5 by r?
<br />+pli.!d lo. ! Fmir subjak rh. apphclni to r dvil FMhy of no! mrc th& nv. hundrcd dollur ($m)
<br />-1.
<br />.i D*rr.f lh. Fop.ny, d ny cmpb)c. rin w.8r! s En $k o,qrn!.rion. will & tlE ktl ai dE rtalft ilhr
<br />inlcliql or oficEd for uk (S( '70,14. Busi&i ud Prra.$i6nr C.xk: Tnc Co.rdor! l-t.n$ t * do.. ml .pply lo an o*xr .f
<br />rrE F,tdy qho h{ildt or irFr6 r,EsE !,n *h &6 sh qot hiIMr or h.elf or lhreu3h hn or ltr oh c'l|lhrttr.
<br />provild tt, tuh dtFDrftdr e tDl in incd dof,.El ad rL ll hok6, rhc btiry d ir!.N|d i $ld *ihh m )€r
<br />of.onqrhriln. rlr O*n.r Build.r wil hlE tlE ttrln n of Envins fid h. or $. did Bn !oi! d, !,prbr dE pDFiy lor trE plrroc of
<br />I dn'crcnrlr und.r S(rnn
<br />D.l.: oan.r:
<br />worxsRs' (-(iirPflrs\I(rN
<br />lEg,aaauiBi
<br />I hcrchy untm undcr FElryor Frjury orc orltL,hlt,wir8 de-'larrrnrn\
<br />-l
<br />hrrc .d will minr.in r C.nitrtr or CoEnr ro S.lf'ln@ for hrk6 rnnF.ndid. a !n vind tor by ser6. lTOo of rrE
<br />llbor C.&. for th. Frlorlt[N of tlE wk for whkh llr trmjl is issucn
<br />I h,k and *ill dr! mrd,n work.6 conrFnslr io. insuhmc. ri rcqurcd hy Se.-hn l7(xr of lhc bbor Cidc. ld rh. FrronlIE. ol
<br />rh. ruk ror uhth rhit Fmir i( nsrn. My wo cr' (,trpcnsdion inruronc. cMicr ud Inlky nuhhd m
<br />.*", Sc\E
<br />".,-r*,"*, Q?S?(ft/_ebLoqltt
<br />I enify rhrr in rtE lErformrc or rlE rork for whah rhis !.rmil i! i$ucd. I rhrll n .rpk,y rny n Nn in sy Mtr
<br />$ a tD b.o'E $hFr ro ttE q,i6'oqEB.rbn Lrr of Cnafomi. .rn .3m rhn irl dbuld h.oE rubFr k' rrr
<br />so*cB comr<nsorhtr rmviiionr ol Scclion lT00 of l,E l,bot Gnlc, I rh{l. fonh{nh $n{,ly wilh rho$ rmvisbnr.
<br />WARNING liilN ro ile s*di 6n+.&dbn @wns. i uh*tul .d ih.I rbFl & srlpl.,F lo aihi l Fflla= uri
<br />ctuil lircs xp ro or hord!.d rn ldn donnR (ll0o.@), i. lddnb. ro lh. dor of drtrFNrion. d.flgB ! rrovncd ror rlE'tE]-,^l::\r$cs"r*"*
<br />I L.I!ENSED!ONrAa(1)a
<br />.,. \J \z
<br />DECIlAtTitU
<br />I lEEhy qrrm ud.r rEMlry or F iu, fi.r I m lianrn und., I'trviion or Ch4rd 9 (ftnftNr8 wnh Selbn ,uD) of Oiviti,n :l
<br />of thc Burift$ aJd Pn,fcsrbnt Cdh, &d m,ltcn* i! h tull fotc rncfiftr
<br />j"\".^-bgt"P
<br />l4r'€,A[,a^a
<br />CoNSTTUCAION LPNDINC A(:TN('V
<br />I hcrchy untn und.r Fnohrnf pcrjurr rhll lhs. n a on{rudioi lcndinB rgcmy r,r rlE l.'formE_c of lhc worl (tr qnah rhis Fmil b
<br />tskd(sN.3m7.Cr! C )
<br />L.ftt r\ Add*
<br />-
<br />AftlllA]ll)Eg"r8/$f1)!
<br />I lrnht rltinn u Jrr |ll,xlryoItr!!ryon. ol rhr f()ll,'$trrtJcclJrnrxnN
<br />Dcnn tun P$,ii[r \trso( Ndr ,n F.d.r.l R.Euhlhns (Tirlc {). l'!n6)
<br />J;ash.nor rcm)hl arc n rpplrJbk tu rhtr pruJr.r
<br />,mrnn itmr.I igE rootrplyynhr[ Cily.'n County
<br />$rbri& cFedri6 olrht Ciryrd Coumr ro.n'd upon rlErd'NETsad Srik L.Dr
<br />ubvc nEmiomd lroFny for ift
<br />\*t'tr{^ a Qla lzt
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathinq 7-11'a t)flh0t I f olel l-2-^1 .q:JtcltD
<br />Shear Wall - /r&E'in/
<br />Framing
<br />lnsu lation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />Itr'lasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enoineer Final Beport
<br />Flood Zone Certif.
<br />FINAL 7-lt'-r r l Br€?11
<br />Certificate ol Occupancy
<br />Notes, Remarks, Etc
<br />-1.
<br />or owE ol the pn,r.ny, rn cxclurircly conkcr ina *ith liensn conracroF k, mn{tucl rlE tDjd (S€. IX,r, BB,E$
<br />.,rl hllsrin Cod.: Th. Co.rEroa. Lk.n* hw dd' mr {ply ro r ouE ot pmFny *h. buildr m imprcEt tlE o.,
<br />rnd who .dtur ror .h FtrF(lt girh ! C! rxrtnli) li.uqn punMr ro rlr Cb,rr*ldt Li.!m Lwl.
<br />:::"clzffi:L'
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