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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE OWNER BUILD[i DIiII'ARATION
<br />IhEclrlmmu.{tqFul}olp6jut..rhiIm.rnnFttr6rh.(\r&1ou-LkGtuforlh.folhsi!tsl!e.(sd70.!I5
<br />BGina .d P.ol .n Co&) any chy or Cldt $hiLh r..tuc . Frr lo sn!ruci. .lE, itrer.rc dimlii' or Ep.n or'
<br />rM@ Fir ro n! i!.ltrq &. Equn6llE +plrel lor {ct FEn to frk ! t's.cd ''ro!d thi E or rlE it liGE d FlN.,r
<br />lo dr Fo\iio6 ol rli co r-16! Liccd!.d t e {ch..rd 0, (bmffiin8 rnh s<rhn 7000 ot D'ralFn 1 olrh. Bsin6 md
<br />Pbf6io6 ( o&) or ih.r lE d ilE E d.npr tlE fron rd tlr ts! for rh. dLs.d sdp.ion AtrJ_ !blr!io.of sdion?0rI 5 bl e}.
<br />lpplkoi f !Fhirubjd!th. rrpliel lo ! ciul p. hlof ml mc ll'd 6r. hur&ald.'ll6 (uurl
<br />L a ds.d ofrh. F.ltn), or my.mpLr6 $irh $.*6 N rhdr rn. comp.netrcn. trilldr ln. {(tk t l rh. ttul@ 6 Rr
<br />ilndxrdl o.oild.r] forsLlSE 7(,rr. Buil6 Md Pnrcss'oB (ixl. lhc( ofuicro.s Li.d{ li( &dn.r iml,_ l(, so*n6or
<br />th. rmFny s h, tlildr or DFo\c rhr6., all who do6 3u.h q!l( h n.(ll or h6.lf or rhreqt hisor hE osn.'npl,))6,
<br />Drulid.n th su(h im,rorffis & ml htddcd or orT6ltl n,s! lf. b*'cr, rhc trildi.! or mFo\dnd irvrllsirhin 'ncy@of.ompldion, rh. osn6 lloilld Rill h,v. rh. h(kn ofrmri.s rht h. or rh. d ml hiu or improv. rh. ImF! tur rh. pnln* ol
<br />l. N .$nd of I lE trctEly, e .r(lBiv.ly co rrlin[ n nh licaEd conrrrclod ro 6dtud rh Fn).d lS( 7lllt. lnllitrG
<br />&n P$fsir ( o& lh.ComGr.is Li.d.k* d.6 Rn qllltro uorndof proFnr. srrc buildr{r nlror6rh6Fi.
<br />5nd rtn cod.rr3l ruch rmj.(s *nh a Cotrr*io(,lf,6E dFqu lorh. codmd 3 tkG lr$)
<br />I m .(mF und., sdb.
<br />DESJTATA!
<br />I hd.by amrm undn FnrhroiFJrryoneoilh. folh\in8 Jcladbns
<br />I hav. ud s 'll ruinlr'n n Ccn,fi.r. of Co6mr b S.lf-lNtrr. f(r Mrtds .onrposatt'tr. s rorid.rl ltn hy Sdr i(nt l?00 o f thc
<br />l.bor ( ode nn rh. F,onmcc orthe sort fo, rhich rh. p6n,il ! 'i$'d
<br />I h.!. a l s ill mrinr.in worl6 comp.Nlion iNumft.. s ..quncd l,y S4l ion l70O o I rh. lrtFr ( ird.. rn I h. pqlo.ruc. of
<br />rh. $rrt aor $hrh thi. pdmn i! is.d M, s.rl6 comFcdFn iNurm. c.ro s'd Fhc) nunb.r r.:
<br />I cdil thlt inrn FforroKorrh.*ort lduhkfirhrpqni ']6r.rL I sh.llmt mphran] ps$noi.! Imnd
<br />$ a r. tr!.@ suhr<r ro th. $.d6 onFrE ion l$:of(iln)m(.nd rsG rha if I should lrcom 3nhF! ro tlr
<br />sorld' NhFeri)n lnn !e6 ofSdion l70O ofrh. uEr (irl., I Jdl, f.nh*ilh smplr s nh rbr Fo\ nhm
<br />wARNlNc liolu( ro Eu. sorkd'comFBdhn cord*. ir unl.trful. od sh6ll suhFr M mpb)d ro rimmil FuhE and
<br />.i!il nnd ur, !o oft hundrcn rhousnd doll6
<br />sdrio..1076 af rh. lrbr(od.. int6.n d.no
<br />D.l.:_ app
<br />*f;:l:
<br />I heby rmrn u.d6 Fsrlly or Fjury lh, I d I'c!.d u.ds,roenr.i.l( hq,rd 0 (offitrinB silh S<1r.7(lU)) orDir tio.l
<br />of ih. B6iB od Pml6i)6 (-od., ad my ltcB n n aull ao,c d.fid
<br />CAIiIAUCru)U,E!II!CJGI!(I
<br />I hcby dfiirm u.dcr rEnihy oI FJury lhn rhqt B . connnd{n lndins .gdc, for !h. p6fommc of th. * ork nv $ni.h rhL tEinn i5
<br />ku.d (sa 1097.( n. c )
<br />tand.'r Nan'.
<br />AttllllNLug,Aaarla!
<br />I h6dl.t ,trfr und.r F.x y or lEqlr. .R of rlr folhwin8 &lldFtri
<br />Dcmhi.r Fafrn}Arb.lrd Notrfrd(n F.dd.l R.Bul,ihr(T l..10. Pd6l
<br />R.quEd ldlq.Ith,tui*
<br />I .drfy lhd rh. f.nd.l r.suhl iod r.ssding stEsnu .m\ !l trc nor ,pplKthk ro rh6 pol.d
<br />I cdi6 rh,l I h.r. ra'j lnir d,plrcalioi {d slalc rhd rhc ahr\. infomar trri Lr .ond I .*re r. .ompl]_ \ nh lll ( iry rnd ct'unr v
<br />ordin.nc6 and Slrl.l,E! Ehlru lo ttrildins c.tulrud'o..,rJ h(ch urhor,. r.Fdrtnarn6 ofrhE (ir) s i(i'rnr) nidr6uFnrh.
<br />rb.{ m6nnn.tl n',pdr f.r inrpqtDn purpo\!' .l J /
<br />App,r(. or^rm,shrr,ur.- f\ /t-{/L, y'-L(*-1> ,,*
<br />pmi,rn.nrrDrrn,,: t|-i t cha<l lq 4(r,'
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathinq b/b /t?l) rb
<br />Shear Wall
<br />Framing
<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 Final Report
<br />Flood Zone Certif
<br />FINAL 7/n /tt iltilyl
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc.
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<br />ID/SIG. I COMMENTS
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<br />Subf loor/VenUl nsulation
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