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BUILDING- INSPECTOR RECORD
<br />SITE.WORK ID/SIG.COMMENTS OWNER AUII,DER DEI,('AR TION
<br />I nd.by amirn undd F.all, of rrjury rhd I m .rd.pt lirm lh. ( onk&1os- Lrc.M llw ror lhc ldroMs rc;n (s( ro:r I s
<br />lrN.s !,rd fk'f*ion (od.) Any City or ( ounly * hich i.quirB r rEn'l lo mNtrucl. !hs. iq'o\., ddmlirh "i rct6n My
<br />.rtuc'ur. FE
<br />'o
<br />I't sgiJe.. .L. rcqrnE llE 4plad' for uch Fni h fik r 9ei.n er.l6r 'h, lE or rlE b lrarn puBii
<br />ro rlE FolienB oftlE Conkkrors Lrc.B.J lir ((-tu'Itd e. (omnftrns unh Sdkr T(rO0 of lrlrnln 1 ofrh. IlusinN tnd
<br />Pft'f*ions Codc)orthlt h.or rh. ir.rmfl rhdcftom.!d rhc tsris trrh. l.s.d.rorrtr. A.yliohrnr.ofsdiin701I 5bylnv
<br />iprlicant for . rEnnn lubjcls !n. applicanr ro rcirilrcnalyofnd mor. rh,n fiE hun.l,.d dolles (t5@)
<br />l. a onnqof lh.FolE!\.ornydpkrt6uirhu!A6Blh.r {kohlEdil.. r,ll& ilE\tt *lrlEiMU.6 N
<br />mrdrLd orofi..d for srl.(S( 7014. Bcrdr d PrnfBoN CorL Ih. (iftrdo.s l.k.* tA .b6 nor .ppl) lo .\Fof
<br />llE proFly qb htild! or imFn\ 6 lhson. (n who do6 i .h snl( hnrsclr or hGlf or l h^rush his or t( nw @tk,,6,
<br />phvid.n Ihakuch nnrmvmrr R no' inr*ldl o. orTaid rr .rL l[ ho$6 6, rtE b{lld!.! ofun!.o\ anor ir $ld s ilhin on. )@
<br />.f.onpkrir( lh.(r*ffi Boil& Rill ha1. E nrdd olFDvins ih, lr or !h. dil mr hrill.r imFr . fi. ,n{d) tur rn FrFrof
<br />l,6ow.d.lrh. Fopdr, dn.rchsilcl, conrerir8 \nh li.6sd .ofui.k,u ro .onitud rh. Projdr ts< 7(!{.lt*'tr6s
<br />s'xl P$li:snn((.'lhcConlracloasl.ic..scIasdo6n.lflpll,Ioso*trsotpRFayshohuildrorimtrovdrlEd\i,
<br />.nd sho cd tuls for such FrFd. $ nh . ftntdon O l(aEl ,uuunr (, rh. (nnr&1ois Li..M I !$ )
<br />l .td. Md( Sdn.
<br />D.l. Own.r:
<br />*-onxf ILr,( itnrPEns^, ioi\i
<br />DI(].^A{UAN
<br />I hdrbr .mrn undd Fun) of F)ury o.. of rh. follo* mr dR lfnr6
<br />lhavc.nlwill maim.in a ('dincat€of (-,ntdlo S.llJBur. for wolL6a .omrEn$r ion. B provid.J tur brSdton ulr0 orrh.
<br />I ah). ( oda aor
<br />'fi.
<br />pcfolllffi. o I th. $!rI for whi.h rh. Fn 6 i$uai
<br />I h.t! tnd u r ll mrrntain tr o.ld' conFel nn muruB., rs r.qut.{ h! S.nrn r 70u of lh. lrlsr { idc. fttr rh. Frdrffi. of
<br />ln. *ort fo,unEhlhisFr.rl6 is.d. My*0116 mnFrsroh iBurMC. cmi6 axj lr)licl numbs {!
<br />(.trF /'at
<br />,r*rnr.O gf]t+*tL-2Dtq
<br />I ccnrrylhat in th. psforulc. oflh. wo* fr Nhict rhis Fmil is itsu.tl, I shall nol onploy any p(srn rn any bend
<br />$ 6 b b..om. rubj..r ro rh. *ffId' c.mFrs ion htrs o r ( lliromu- dltrrhd if I.hould tt omrubJ(r !oth.
<br />{ lt6.of,Fsrx\npro\aiiNofsdonr70o.arlEtlbr(Gl..ldsll,fonh$nhs,lp\snhrb*Ir.\6irB
<br />$ARNING [.'lor. ro KU. uort6 snFsdion cord+. i! u.L$ful. rnd shr]l lubr.d & .r,rb]( ro sim'ur rxrBl6 d
<br />.ivrr li.6 up ro .m hun&cd rhrusnd d,llm (tl00.l)00), '. oddnior kr rh. cos .r onFsrion. ddas6 6 Fo\id.n nn rh.
<br />sd60 1076 olrhc l,b.rcodc. inrn6l ed drom.y s fc
<br />o.",nrI* o{ - }7
<br />DESJ.BAI]A!
<br />I h6cby omrm undd pdallyoltEjurylhal I m li.6sal trnd6 Foriion or(,llapts q (coNnocin-( *1h Sd$n xxx))"rD'.ni.n I
<br />ol rh. BusinG ard PmfdrhB ( odc, ad me lic@ is in lull Ii,..,xl.,Td.
<br />r,(o!.(hs $-" 01-05 - tl
<br />grqg 1l
<br />HD!
<br />(0liragcltall,ElllllilcEl(r
<br />I h@b, lrlrn M&r F lty of Frjrry lhsi ths. i! a coBldriion L.din8 +try for lh. paromocc .f th. ulrk tur shich rhis pnn ir ii
<br />nru.d (S( 1097.('rv. C )
<br />AITII(AdLDECIA&AIIII!
<br />I hcd! atrm u*lcr t6rit of FJUir ok .l rlE 6lh* i.s d.(lI ! ion.
<br />l).nolnFn ldmns-A3b6ror Mrrfi.dion F.dqll R.3uhnhsIt l.r0, PM6,
<br />R.qun.d ldl6 of Norili(dhn
<br />I.dt't $n rh. tdG.l rq .!nB E*idinr 6b.3or roo\ al e. hr {,lli.rbL ro lhu F.jd
<br />I rdif, rhd I h.\. .ad rhi! .pplic.r ion onl n.t. thar rh. !h'v. ,nfomd io. i! coE61 I 4,a ro comply * irt .ll Cir, rnd ( ounry
<br />ordinanc6 Md Strr. Ii$s Ehl in!
<br />'o
<br />blilding coNtrudion. Md hd.b, rothorn r.Ir6dlalirB o l lhis Cny ed Cou.lylo dl6 !!onlhc
<br />ahn.Borio.cd ll(,p.nt for itr\rrtFn purF)s
<br />rp,,. or^16,sirn.,urc UqD€ L
<br />**.n*-.",n,",, ( $l kOWt
<br />I
<br />b0 r i-D€45 rU,-" O?=O5-t7
<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 />Framing
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Mason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />uty Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />t\
<br />FINAL q\\\\f,4J41t t7)
<br />Certificate of Occu pancy
<br />Notes, Remarks, Etc.
<br />I DATE
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<br />Shear Wall I
<br />Ilnsulation/Energy I
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<br />I I
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