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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUITDER DElrT'AR TION
<br />I hRby rltur unde p.mlty of pdjury llEl I m d.nt, inm lh. ftnra.loR Lic.M lrs for lhc firlowin3 rd)n (S{ 70ll 5
<br />Busrs dn Proacion Ccl.) Any Cny or Counry shkh r.quiE . Fmn ro .odrud, dt6. imFor.. dsmlirh or l+sn any ,
<br />3ttu1uq Frr ro ill iw. r&o rcqlnB rh..pglicd ror sh Fmi |o nE i sis..d irdmr rh, lt or.h. i! lrasn po&sr
<br />kr tlr Foviri)B of rlE cof,t-ori Li.6!.d hw (Ct'.qltd 0, Como.inS $nh Sdio, 7000 of Dirilhn ! olrlE BurrrN .nd
<br />PmlBioB Corl.) or lhal h. tr tlr i cxmpr rts.tln &d lt bsis for lt llLscd Grdprion. Any rFldion ot Sc<rioi 701 I 5 by !n),
<br />lrFlic.,l ao. r Frnit subjdi rh. lppli.anl tu r .i!il p@lry of .ot tuE rhn fi!. hundrcd dolld I l5(x))
<br />l. a ouE ofl,E lroF[ or dl mph'6 trnh s46 arlEt $LmnFs.., wll& E*dtrddtrdrG.Ln
<br />idcrlql or o Fald ld eL (s6 70{4, BciB ad Pr.a<$N ( o&: Ilr (i'rndoa3 L.rg l* &'6 m! .+pl,
<br />'o
<br />u rtrF ol
<br />rh. Fopqry sho hril& or im[r.va $qo[ !d vho d,6 sch mrl hia.lf or h@lf or rhrerAh hn or ha o*n mpl.y.6.
<br />Fovi.Ld lhrl ruch imFrvonc!fi m ml idGrLd nr ofir.l for sL If. h*6a, llt bildins or inp.!ffi! L sld wirhin on. 16
<br />ofconplrioi rrrO!*n Builb * h64 tu hr<lnofprolr,r rhi lEor{E dn 6i hlld d h{roirlh.FnF,6r tlEFrF&of
<br />l. .s oErd of lh. I,opsly. u qclusrv.ly codE.1iry $ irn licolal codndoR lo coNrucl llE prej..l (Sr 71x4, llB'nd
<br />&d ftbftsnn ( odc: Th. ConrEtols Lica.. t-!w do6 nor rprlyro u o$.a ofpropd, who &ildr or inpmvd lhsNn.
<br />ud sho oddr tor sch Forats qnfi ! ('oddo(rl lt.n*d puEd
<br />'o
<br />rlE Cotnrr]loir Ltog liw)
<br />I m.rdpt lrdE Sa'ion ,B &Pc forthi.dn.
<br />Orr. orrr
<br />.uoali[f,lLcollf[ular]a!
<br />IE(IASAIIO!
<br />I hd.b, amm !.dcr pcndq orFrur.- orc or'h. follo*m8 tLlladioc
<br />I hav. ed will minrain 3 ( .nifior. of (nnsr b s.lf.Inlurc for *orld co,npoldbn. a p,tvid.d n{ by S*r ion l70O of thc
<br />tlhor (o<k fdrh.Faoll@(.of th."oft fn.*ni.hrh.Fnn ! isu.d
<br />I h!r..d rnl mldai. r.rt6 c.,rFNrNn iBltffi.. G r.qnir.d tt !Grn.l7(D oarlE t Lsr (-o&, for lh. Ffolrrec or
<br />:i ::-^;;7t
<br />"fffi/" % - "
<br />rl)'"1'"7 1, -,,
<br />I cfliry rhar r
<br />'h. ldfonnrrc.ofrh. sut for wh'ch rlni po_nir is i.s!.d, l.hall.or drloy m, p6.n in any mMnd
<br />$ B ro b.&n. sbj6l lo thc wod6' om,tMio. hwr oa( dilomi4 &d lar lhal ir I shruld b.com. rut jd ro lh.
<br />$d6 comFs.lo. p(tinE of SrlFn r 7m of rlE tilD. (irL l lrEll. toninnh smplr s'th rhos F,r6hB
<br />IIARNINC l-olu,. ro sur lnIG .omtEEdioo (nE!r.. 6 uhuful, rnd lhdl obF m orl,ls b min l FEt6 !d
<br />.'vd nnd up ro oE hundi.d rhou$.d d.ll6 (1100-000). rn &ldnhn ro rh...si ofcof,F.$r,on, drm.g6 a pro\kl.l aor rh.
<br />s(ri(r:1u76 oI rhc ,rbor Qxl., inrddr
<br />,,,,, J-/J -z)
<br />ltl,rtBAllot
<br />I hscby amn und6 poah, oI F)ury thal l0n liccasrl utrt 6 provGion of('hryrq I (commdcitr! $ilh sdbn 7o([)).llr\isi.n I
<br />of Ih. BNina sd ftofsiotr\ (od.. dd 'rr licre G m foll tuc. a.d clldr
<br />,.._..,^_ - u
<br />o.,. -z-ti-l/,"',"r{*V,lrt///%;
<br />cax5lBlcll0!.I$iDAiti.Ac.E|cr
<br />I hr*,) aflim uds poahy of ,EJuryrhar rhscts!coNnNiotr lc in[ d8d.] furh. Fn,ll]e. olrh.ro fo.$hrrhrhsFrmir s
<br />isu.{ (s6 109?. civ. c.)
<br />ATIU(ANI.DECI.ASAUA!
<br />I hddr .trm undd FEhy oa rEJu) om of rh. follo* inu di ld.rioN:
<br />D6mliion Pmn3-A3tdor NdiaE{i.n FaLi.l R+ublirr (l dk40. Pd6l
<br />R.q!t J l.irdof Notinuln'n
<br />I cqrih rhd rh. f.d.ral r.*uhri,B rq dn* ah6ros,6no'.1d. e! rylIabk'o rhs pnrFd
<br />I cdiayrhd I h.rc Md rhn luplrcnion &ns!r.rhdth..kr. ofomdn'i 6cod< Il|raroompl,r hallCil).ndli,unD
<br />o inrn.6 md srNr.liws Elarin! ro builditrB conidcrion. dd hd.by auhonT.
<br />'
<br />rr..srd iv6 ofrhis Cir, and Counrylo ord upon rh.
<br />H:,::ffi:"rz z//a-
<br />"^u*- ",o,,",,';/ 6ra,11 4/6rnfnon
<br />/-/3./)
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathin s
<br />Shear Wall
<br />Framing
<br />ln s ula tion/E nerg y
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />ItIa son ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL 7-{.-t?J )"<,4e @)
<br />Certificate of Occu pancy
<br />4z/
<br />Set Backs
<br />I
<br />Notes, Remarks, Etc.
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