|
BUILDING. INSPECTOR RECORD
<br />SITE.WORK ID/SIG.COMMENTS OWNEf, BUII'ER DELCAN NON
<br />I lrrcl,y dtun o.d.r p.tulry ot p.rjury tbd I m.r.ir$ rmm lh. Contm.lon Licns Llw lor il! toUowhr Ersn (s6.'7011.5
<br />Businc$ !d Ptofcsnn Codc,r tuy Cny or C@nry *hih EIIIE! . Fmi ro onrM, .116. inpmE, d.mlnh or E .! e!
<br />nedE- Ftr ro ire isu,e. rts E{uiF. rrr +plamr lor slch F.nir t.r 6L. s&rn srrr.rnr rh.r lE or sh. ir licn*d pw @r
<br />lo rh. pmltk ni of rhc 6ntB.ror'! Litnrcd L,w {Cnnprd 9. ComBnS wirh Sdtnn ?Om of Divnion I of llr BuriE t .trd
<br />Pmfc\ri'.r Codcrd rhlr h. d dE n.&npr ihdtfiom !n rh. h..is lor lh lllcS.n c.r{xion Any viohbn or s(li.,n 70.1l 5 brr.,
<br />rmli.. for a F.mil subl..k lh. apPlictnl lo ocivilFMllyoftrol mrc rhln l-rvc hxndr.d d.llG (itoo)
<br />l. a owEr ord. Fop.ny. tr ny.npbFs *ilh w.Bca s llEt $b onllrNrbr. will {io tlE wort.d ttl driE 6 fln
<br />i c .n or o,Lrcd for sL rSd.T O,l4. Blrirc$ rnd Pbt .!nN Codc TIE Coffi \ Li..E l,r dca 'bl .p,ly lo u o*E ot
<br />rrE FlJEry *ho hlil.& or irt oB tlEEc rd slD &a sh brl hi@r or tErslr n rhhuth hir n hcr own.nproy....
<br />p.6vid..l rh{ su.h inlmvtft.r: s d hrad.d d dk rd sb. ll lDl.c, llE hriBiry c irrNrEd i Fld *ihin m F,ofo'q'trin dE o'rc BuiB, wiu llE tlt habr 6f FovlE du lE M srE dn mt h{ild or inlmE dE FDIEIy for tlt puFs or
<br />-1.6olE
<br />ofthe pmFny. uncrclusiKly.o.r,erins wiri li.c.*d contdoN
<br />'o
<br />L\mr d rrE txij.r (sc 7o+1, B6'Eii
<br />!d Pif$m Co,r. TrE Cont-rof r La.rE L.* &H ml +nly b r o$F of pmldy wlx, buikli or inpmv.. rh.m(
<br />rn.l *ho d,nrmB tor iu.h pnr..k *irh r Ci,e.rdnn liLr.$d l'usu0nt lo lhc Conlrelor's LtcnE llw).
<br />I rd ci.mpr uod.r Sdlaon_
<br />-C4- 1 L)ct1 "",,\k,
<br />IECIJAAIITIB
<br />I h.Eby u,Itrm und.t p.nolry ot InJury oft of tlE folbwinB &cLnri,ns:
<br />_l h!v. d will n[i.r,i, r C.nifr.ic of Consn o s€lalnsrc lor wort6' mdrEnsdio., a Fovii.d fd by Sdrbn .lID df llE
<br />lltE C.d., for rlE Ff(,ffi olrlE dt rd rtth tlE Fnn i i$En
<br />-l hlw ind *r ll minr.in mltcB con{Ens.riu in ul.[_-c. .. rqliEi 6y lnrion 17fi) ur rh. trbor A'd.. lor E Ffoljrecoa
<br />lhc vorl for *hi.h rhir p(mi it is{Ed M, worlsr' co.rllc6dioi inru.!tu. ctrEar lld Plty rumh.r el
<br />c.rir--
<br />-l
<br />Mrty rh.r i. th. p.rltrrmr or tlE rort fd vhth lht F nn t nrEd. I dEU ml .r{,L,, .o, tEmn in .ny @rcr
<br />$ s to b.&c {bj€t ro rh. workda compcndion hB of Ciliromtr. rrld .88 rh{ il I .hould bcffi $bFl lo lll
<br />ert6 oriENraonpr.ai.bc of Sarion l7m6t E llrn Cod.,I.ldL fodh*nn @rply rnh lbr pmvnbN.
<br />WAINNC: liiluE ro sm *odcB onp.6{io. covcn8. n unhqtul. lid rhrll .ubrd h .npbyn 16 diirnd Fonil !n
<br />cilil nn.r tp ro om hundrd
<br />'hous.d
<br />.!oll, (tl@.un). in dilnbn
<br />'o
<br />dE @€ or ory.Er.lior d.tr!3.! .r tr6vi,.rl tor rtr
<br />sdrrn 1076 o, rlE ub({ c!d.. mrdn.nd droffy r,c.s /
<br />^,,4:J-L9e2l ^nuW
<br />IEIIJSAII{,IN
<br />I hcEby olfrm undcr pcMlty of Frjury rhut I am liu*d udo Fbvii,n ot Ch.pid 9 (onrBirS wnh s.<iio. ,un) or Divi$n l
<br />or lhc ABir$ rrd at$t6iiB C.d., .rn my li..n- ir in tull foN rrrd cfi6r
<br />colrrBucru!.tBDMc-dcEdqr
<br />I lEEby silrn onLr FMlryorp.rj!ry rhn rh.r. is r mnnrudi'n tndnr8 r8croy lor llE rrcrfttrmh-'c 6f rhc k',k tu *hi.h rhs Fmi n
<br />h\ucd (ss.:1097_ cir c ).
<br />AIILICANLDECIdBAIIN
<br />I ts6, .fm ooL, pcodry ol r..gy 6E of ri. follrwiq d.rlrnr.ns:
<br />Dcmliri'. P.rmjs.Aihcalor NolifErl,on Fdr.nl Rcruht hns (Tilh 40. Pan6l
<br />-tcqunc!
<br />Lrllcrof fioririlriotr
<br />I (dity rhi rtE ll{.01Eglldi,ns EBaJinS r$c$o\ rcrmvol$e mt aprlt,hlc lo rhi! rn,j.rr
<br />I dilyrhd I IEE r.d rhs.trltri,n url n.rc rhr r,E,tint inromdion i'.tu I $rd lo onply sirh .[ Cny lnd Counly
<br />odiMm* sd Sl.rc Lavr EhrirS ro building cotrsrtuc1ion. .!d hdcby rtFria r.F.*tuiftr ofrh. Cny !n Counrt to.m6 upo. llE
<br />!t vc ftnti,rri ln,Fd, for isF<
<br />A ppliGrr o. Aa.nr siBuru
<br />z
<br />n,a1-/7-9ap)
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq il,/tr ,Jt*'. t/,1 'r4?n
<br />Shear Wall t
<br />Framinq
<br />lnsulationi Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Beport
<br />FIood Zone Certif
<br />I
<br />1/.cla ]L*;{i a1
<br />FINAL #
<br />Certif icate ol Occupancv lr(
<br />Notes, Remarks, Etc
<br />DATE
<br />Erection Pads
<br />l!-.=':i
|