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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNEf, BTIIIII]R DEII'ARATION
<br />I h6.by ,rtrn uidd po.hy .f Fju.y rhar I m .ranq ton rh. (nnudoc Lie L3" for th. lolkNiu r6Fn (S< 70r I 5
<br />uum6s rnd PNf6ion (-cl.) .t (-ny or counry *hi.h Gqtrtc r rEnnh (' .otrrdcl, !llo. imrrov.. dinoldh .r rqEn Mt
<br />sndu., Fir'. ns isue.. &. r.qunB th( 4flrst ror tu(n IEn lo fiL . rsEd 3r ddd rhd lE or sh. b hcdsd pomdr
<br />k th. FolinrB ol dE contdois l-i.d!.d l rs (Ch.pr6 s, (-ommfti.r \ nh S.n Fn 7000 or Divilirn I of rh. tiu.in(s ..d -
<br />Pr.lsions Cod.) or rhat h. or sh. B c\dpr lhr.frod dd rh. b.!is f.r lh. alks.d malprion A.r \ iohlion ols.(i,n 70r I 5 br u)
<br />.I,ph.dlorrFni$bj.il!rh.rptlicanrro..i!rll,.nahlolnoinor.'hDnvchundr.ddollesltt00l.
<br />l. 6 o*m oflh. Fopqrl, or mr cmphrG wlh tras6 B rhdr $L Fn{dM.[ $ill Jo rlE $,rt ti ir rn{1 r. s mr
<br />ftdrbd orolldlil lor sk(Sd7(}44, aNinB d ltr.f*nrN(ird.: l1l. Cont6cloir I ic@ lls &6 n, 6r0ly k, d .{n( oa
<br />th. tmpsty s h. Iliklr or nrgorE rha@ -d r h d!€ kh *r* h'ms.lf or hdxllor rhrcuAh hr or hd o*n mpk'tc.
<br />proriLd rhlt ruch nnForaFi! e ml mlqnol or ofiqd ror el ll h\6t. ilF t[llii* r in9.sffi i! $H trilhn o. y@
<br />of.ompl', bn, rrE o*F Blrldd will hrv. tlE hati of p.ovins ,u h. or sn. dd mt boirl or nqro\r lh. plopdy fd ll! FrIr4 of
<br />l. sn$ndorthcFoFny. o.rclBiv.ly conlra.lins *ilh licsed co mdo6 rr.odrud rlr p.njd (Sd 7044, ftlinN
<br />ind hrl*6 co&: Th. ( o.kd.r'3 I-i.o3. Ir$ {to6 nor 4ply b M otrld ofpropd} rho &nlde or irrhlcs rhddn.
<br />ud qho onrtur lor !!ch FoFr snh i CorrRlo(r) ltdE d plEutr nr th. ( onn rdi! l.t.Ml^l
<br />I er\cnF !niq S.cln'n
<br />lxl. lrrne.
<br />\r()Rr(f tls (()ntPF\sart(lN
<br />otg.Aaarla!
<br />I h6.h! dmd trndd pdalry o I lEj,'D_ on. o nn. foll)tr in! d(lddr'ont
<br />I h!r. di sill mint.in r cdirEd. oa(bnst rn S.lf-lBu. tu tr0lt6 NmFBdion. a Fnr'drl tu b sdk .l70o.f 'lkL,bor Co&, for th. pdfomMc. orrh. $orl for f,hich th. pcml n isu.d
<br />I hav. .nd vill mlinrain *0116'(.mFeiFn iNu6(..6 r.qun.d b s<rbn 17r[olrh. t]ir (-od., for !h. Ffomuc. ol
<br />thc wo,t Iff*hichrhBpdn't ! i$ucd My$ork6 .omparltioi i.surM...mi. ,x! policy numb6 6c
<br />fohc) Numbd lirpncs:
<br />l.difyrh6r inrh.r.rntrmrrc.of'h.worl tu shichlhis p6nit ir isu.d. lshlllnot snploy y p.rs). ina.r mond
<br />$ a h tE$m ut'J.Cl ro
<br />'
<br />h. trlrle conFa?iNn !r\! or('ilirofrid, ed .gd rhd rl I sh'uld E<om. slt'jd lo lh.
<br />*0116' .omFvlion FlrahE olsd i]. r 7m of rh. lrhr (_uL. I Jdl. fonh* nh comp[ s ih rh- ror sr6
<br />$AtrNlN(; raiturc lo su. rorks' cohFulion cordale i. urLnful dd !h,ll subjdr m @plord ro dimiEl Fuhies.lllj
<br />cn'l fin6 up k, oE hund.d lnoosnd dolla (tl aLi(l((n, r, rh. !o( .l .d.'m[.s .r prn cd tu rhe
<br />sdri)n 1076.frh.lrhtr rirL hr6d rd
<br />DECIAAAIjq!
<br />I Hry.rm und6 p.nlhy or pnrurr rh.r I e li(qr.d unds F.rtion oi (rldpr6 e lcommd.in8 f, h S.dnrn 7@0) ofD'vi'on 1
<br />oI lh. &!iN md Prol<ioN C.&, rn iy li.ce n m tu loc td drftr
<br />,.'"*,rrr",C-)0
<br />".,., 7 -// z),.,**.*,.b.7 .5'7r'z/
<br />GZoL z)
<br />(a!frBur11a!l,E!Dactc[!!]
<br />I hcchy rftm un& Ftuhy of Frury lh, itE. ir r odtudbn lddn8 !g*y lor lrE Ffrtuc of rh. *dl tor tr h(fi rhi! Fni b
<br />isN.d lS(.1097. Civ C.l
<br />AITUSITLDIig.AAAIA!
<br />I ndq.rn rndd F.h) of Fjur' oE of rh. follo$in3 d.rlm'ions
<br />Dc,hhDn Pdirs' 3b6ror Norin.l b. F.&r!l R.*ul,li16 ( , nk r0, Pd6)
<br />- .Rqun.d lnr6 of N<iifrclrnn
<br />I.drrt$d rh. Lddrl r.luldiotrs t+adin8 ab.rrosrm al d. Bn a0dic'hk lo rhf pojdr
<br />I.61ifythd I h.\c.Blrh6oppltdo!ddrncihd rh. !tir. 'rtorndion 6 conal I {raro c.mpb qnh.tlC yrndcounrv
<br />ordinnncs ed Srile ln\srclnt codndn.n. el ho.b\ rurhrriT.rqrcddn 6 otthn Ciir ud Coumt (. ord uF,n rlE
<br />ah1\. manonat lt)p6r) f.,/.Hr\t,rriri rnr rro r \i(ri!
<br />I(mrnd n.n.(prinr):1pw /t-u/(5 ,,nJ -// -t )
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />ln s ulation/E nerg y 7lt7 lt7 ,a4E(/))
<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 Final Report
<br />Flood Zone Certif
<br />FINAL -il 17 l/7 .{4ln v)
<br />Certificate of Occupancy s-'
<br />Notes, Remarks, Etc.
<br />/zt/.
<br />L/L/.,U A--",,,. 1 -// -/7 LA
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