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BUILDING. INSPECTOR RECORD
<br />SITE.WORK COMMENTS O\f, NDN BUII,DEI DEI'ARATION
<br />I hdcbr aflim u.dd p.^!lry ot pdjury lhal Ln .r.Efl Fom (h. Contadou l.icar t w ao. th. folloun8 r@n (5(.701 1 5
<br />BEin6 ard Profstun Cod.) a,t ( tr or Cou y whth r.qutr6 n Frn ro oNrruct. .hs. iDpror.. ddtuEh or l4ot d:
<br />strlcrue pRtr lo irs isudc.. otqr r.qun6 rhc lorli.dl lor such FrEfl b 61. a !ig..i srdmot lhar lE or she n lic.sij p6uol
<br />t\rlE FovrioB ofin (t,u*tois LFd*l trs (Chlprs 9. Com.rcrr *nh Salion ?0ol) olDndon I of'n Baind uJ
<br />Prolsn ns ( od.) or lh"r h. or sn. is.ropr rhs.from dd th. tBri! for lhc all.S.d .ioF ioi Aoy lioLtioD of Sdbn ?0ll.t by ei
<br />q,rlicair tur a poni $bjd|3 Ih. arplicor lo r ovil p.Mlry of nor mor. rhd fir. hundrcd doll6 (5500) , a
<br />I, I o{nrol thcl,op.ny. or nry.nrplo!6 trnh w0r6 N lhdr elc lomrEtualioo, {ill&, tt wolt drl rlErEdE b tror
<br />'ddrj<d o.d[s!d td sl.lsd ?o,l,t.I]@sdd Pr.l6irG cod.: Tn Codrdlor'.la6e rl$ trB mr,pPly tt d o$rd of
<br />rhr In,rEry *ho buil6 or mrmr6 rhdNq &al $ho d(6 sld *olt finns.ltor n6df or rhrcult hB orhd own.nploy.6,
<br />pr6vid.n ar .u.h mFD!ffi d. mr irdrLd or oltdrd aor el. l[ lF*6E tlE hlld'qs or in'Foro6lt is eld s'thin... ]6
<br />.l ronll]krtr tlk Ownd Buildd sill h3vc lh. hIdn ofrroving Ihar h. or .h. dd ful hriki or inyrev. U. FiFly aor dE prpoe of
<br />l. !r o*d oirh. pr.pdr, m.rcl$trrlr contradins sth l(tr<d $dfflon to.6nrnd rh. Fnid lS* 7O+r. lrGm6
<br />lni h![sh, Codc,Ii. Conu&ror's l-i..nr.Irw do6 kropplr lo & own6 oa prop.ny {'ho build!or @provd lhd@n.
<br />,nd $ho onrrds adrsl(ll projds wnh. Conrrdo(, Iic66.d pu6u.r rolh.Coirr6.loi! Li..M llR)
<br />I en c\.trrpr utrdE SNrn..l] li l)( k{1h's r.Js)n
<br />Drre._ _ O*nd:
<br />\f,oR(FnsfoMPlris Ttoi
<br />DIiCIAIAIIO!
<br />I h6dr amrn und.r p.ral) trf pdjury rt ot6. lollo$i.s ddle.lioB
<br />I hnv. lrl {ill minlliD ! C.fi'ficat. of CoMl ro S.IHM lo, $0116 .oqFslio( s F.vilal tor by Salior lr00 olllE
<br />lrhrr (-od.. lor rhc pololl@& of th. eod for which lh. panil a su.tj
<br />/2r hav. eJ will hshrah sorld comp.Mhon
<br />'Nur!nc.,
<br />s r.quicd by s<rn.l7o0 orrhc Llbor Cod., ror th. pErollMcc of
<br />llh. $ r for *tu.h rhB pcitr't i! iBEd My $0*6 otrrFrsnb. 'Butfi( .,N ,nd FI(y numbcr t..
<br />,,"," W rvd.n qf.v
<br />p,,r"!\*,,l- A),2 7 678 O SE g/4/44
<br />! rotryrh.t 'nrh. Fraonmn.. otrh. $.rt nn whrh rhs p.mtr is ssu.!, t sfilllnor mtl., My p.r$n m.nynMnd
<br />$ B b tE o'nc subjrt ro lhc \o 6 .o'np.tuarFn la$! ol('aiifomi., .nd aBR thal ifl should b.{oG rubjGl ro th.
<br />$olts comFnsrion trovisNu ofScttion:u00ofrh. trhr a'dc,l slull. ronhwnh comply eilh llNs,JrovisD6,
<br />WARNING: Failur. tu ss. $..16' comFMnrn covdasc is unla*lul. dd $.ll subj.tr 6 onploF ro sinnEl FBhB d
<br />cN,l lin.s p t. on. hondr.{ rnous d doll s ($100.0(x)). in add'lrcn ro rh. cosl or.omp.Balion. dona8.! a prcvid€d rorlhc
<br />Sdoon t0?6 ofrh. ht r C,rL. nt6d Md !trorrB r 16
<br />^-, {/( /p r
<br />DASdEAIIOE
<br />I h*by lmrn un.t r p.n6ny o i pgjury lhdr I @ lic.Nal 6da F\,tition of Chaprc 9 (6,rhd(ing with S.dirn 7000) of Diviion l
<br />of rhc B6ine ud PmfeioB Cod., id lny lkoE is in tull forc axi.trd
<br />1)
<br />*"-{/a-Lo> 3J /
<br />fsr
<br />cqllrf,lolaxl,Illrllc-4clllI
<br />I Hy a,Im und6 p6alr, otpdjury Oa rh6. ir . @nsrndb. lalding lecy for llE Ffoffi. of lh. s.l tJr $hkh rhi! pqbil ir
<br />i!!ua! (Sd. 1097. Civ. C )td.Lr'i N'R
<br />--
<br />AITIICANI.DESJAAU9B
<br />I holb arm unjd Faly olp6ju,y oo. of rh. follo*ing dald.tioN
<br />D.mollior P.mireAsh6td Norilicalion l€d@l &csuhtion! (Inl.40, PanO)
<br />R€qutsl L.tld of No{ilicnnrn
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<br />I c6r riy rn I th. lajaal rcsuldrioro rcgsding sbGros rdnovdl ec iol +plkabk lo lhi! p^rid.
<br />,A.61r, r* , **,*o rn6 spplEdlon &xl u. rhd rhc !hov. iifoddntn !.d.d l.gc ro 6mply wirh.ll cny &d cou y
<br />L/d'm.6 sd srst. L.*r Eldlls ro b{ildins confud'on, &d h@by.urrstu r.F6!ddir6 oflhn Cny &d Codlt lo dls upontlE
<br />3h.\c Mr6n.d Dropd) for Npalro_D D{Dolc - I;;:J;*:Zry_" -,.4t/*r
<br />P.m,,c'n.o.rr,): '-au4 b-wAt-- '| -
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing ?,luht Lut6t1
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Frnal Report
<br />Flood Zone Certif .
<br />tl6ttoh-t Eq3'r
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc.
<br />DATE ID/SIG.
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<br />FINAL
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