Laserfiche WebLink
FROM :FLORIDA LIFET FAX NO. :8134435812 Oct. 11 2010 02:34PM P2 <br /> i;!) 0 3 <br /> _... ..._____. . . <br /> 1 BUILDING DEPARTMENT QUESTIONNAIRE <br /> 1 (If you have performed work in multiple jurisdictions, make additional copies of this form <br /> and have it completed by at least two [2] building departments.) <br /> TO: Building Official — <br /> "'This is a mandatory form needed for their probation.appearance; please help them comply bV <br /> filling out the following questionnaire. <br /> The following individual is currently on probation with the Florida Construction Industry Licensing Board <br /> (CII_B). Please complete this form and sign, if you have any questions or concerns, please contact David <br /> Spingicr with he CILB at 850,922.8074 or via email at david .s.pingjeradbpr.state.fl.us . <br /> This form may also be faxed to my attention at 850.617.4457. Thank you for your assistance. <br /> SUBJECT: Michael S. Lane, November 11, 2010 <br /> License #(s): CGCO59485 <br /> , <br /> On behalf of the building department, the following answors are suppliecl. <br /> 1. Has the above named contractor pulled any permits or called for any inspections in your <br /> jurisdiction during the last six months? If your answer is ''no ", you do not need to answer <br /> questions 2 through 6 nn less applicable. <br /> NO <br /> 2. Has any of the contractor's work been issued a stop work order in the last six months? If yes, <br /> please provide supporting documentation, <br /> YES O <br /> 3. Has the contractor failed to obtain permits on time? If yes, please state amount and any fines <br /> that may have been imposed, <br /> YES • <br /> 40 • <br /> 4. I las any local discipline been started or complete ainst this contractor in the last six <br /> months? YES NO <br /> 5. Have there been any serious code violations by the -e'. z tor in the last six months? If so, <br /> please explain. YES NO <br /> 6. In general, do you have any adverse comments concerning this contractor's performance <br /> during the last six months? If so, please provide hri -..• -. - its and attach additional sheets, as <br /> necessary. YES NO <br /> TO BE COMPLETED BY BUILDING OFFICIAL PROVIDING ABOVE ANSWERS: <br /> / -- J6/1 1 1 <br /> Building O cial' ignature — Date '6 Prinled Name: 1, it ,/ / .► L Icon ;e #: t <br /> Job Title: \OtL-.?Jr3 s• Gib-- . _ <br /> Phone #: � � �... ��(..� . <br /> Name of Building Department: 0 . . / ; 0 - 1 2 c (/r' i I I S <br />