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BUILDING. INSPECTOR RECORD
<br />SITE-WORK ID/SIG.COMMENTS OWNER A!ILDER DILCARATION
<br />I hd.t').,Imu*Lr F. yof Fjur)lhd I a.\m[x nsm rlE CodrxloB L(m t!tr lnrlh.adklrryllen(s<7(,.r15
<br />B6'n6! rn ProIqrF. (irl) A.y Cny or Cou,ry *tEh ..quu6 . Fhn io co'rnrud. .lro. 'mrd\. dnnnsh or kFtr .i!
<br />rNdEeFnt itr Bttm...L rcqlrd rh. +ltd tMikhFm b nL. si8ftd rdclM! rhd lEor nE ir licoE d plBd
<br />ro 'h. Fovaod .r rh. ( nntd6a. Li.d!.d t * tclqrq 9. (imddin8 u nh s.d ion 7(xx) or Dn nbn I ol rlE B$in6 ..d
<br />Profsio (.d.)orrhdhc slE ! ctmd llE(non. rh. ia6 tur rlE.lh.d ddnp'hn AnyvNhionorS.dion70115b) lnt
<br />dpplrcdt ror ! Fhi subJrt! rh. rpplicdr ro ! civil p.utty ol.ol horc rhr nr. hundEd doll6 (l50ol
<br />L a oNE o I lhc riorEny, or my cmployG wilh war6 nr lh.i sn. compostion. vill rlo lh. *ort md lh. s!ru.l@ ii m'
<br />inhdar or ofi(.d fin sk (sd 7044, Busin6r dd PFf6roN (idc lfic (iJnrralrois Lic6:c l-ss &6 nor .''ply (o an o\nd ol
<br />rh. Fopdy whrl!il&.rnq 116[Eor.udun dE $ sr,d h'm3.lf.r hsFlfor lhollh ht o, h( ds. mrlo]t6
<br />p.ovil.d rhd su.h imrn)rdHrs r. mi hrdrLd or olk litr uk I ( ,[)$ 66. rlE t( diq or i,i{nn 6d i sld q ilhin or rw
<br />of conplcto. llE (,$ nE luilk sdl h.!r rlE hrdn of rovqr lhd h. {. +. dd rcr hlld or 'trq.\! dr. F)pdi, for rh. FrFr or
<br />I. ao!ffiolrh.Ftrtdy. m d.lrir.ly.odm.rdS trih l(q!.n Ndrd66 ro.odtu.r rrEFFlsd 10r.r. &!i!6
<br />ind hokn Co& Tn. ( onkrro.r Lk6$ L.n &6 mr .!p\ ro M o$.a of Fopd, ulF trrldt or hror6 rh6@n.
<br />rnd wL onr*l.id o.h tmlc<r3 triih, coir.!.ro(i) li6!.d E&d 'o rh. con.i<r.i. l.rce I.$)
<br />I d.rd{i uods Sd1n,n
<br />l)rte Orner
<br />woru<Fn-s (ontltrNsAlloN
<br />ulgdttllg!
<br />I hqcby lilim und( pcn{llt ofpdJuryon.oflhclirll.s'.! 'jahirN.r
<br />I h.vc rn sill mhrM r ( ci!ar!|. olCoB6l to S.lf-lBur. lo. *nt6 mhFEslhn. B ForxH Lr by s..lo.:rrm orih.
<br />l,bm Co&, fm
<br />'h. FlollM. or llr Nit for $ hth rh. Fnn 6 is!.d
<br />*s;;.d*ilrnnnrrin *0116'.onFdi'n 'Nnrft., d Equr.d ID Sdkr. !70o of rh.li$.('.d., for
<br />'h. Ffo.,llsc oa
<br />ld $hkh rh6 Fmn i ie.(L My *$16- snFdhn 'Burffi. cmir an poky numtEr ,.
<br />.*,., !.tP/ t1\ Jnr J_b' iaLv4ol't''a''r-(-rs
<br />I cdifylhd inrh.rnfonn.n..ofrh.worl for shi.hihir rdnn k i$u.d I shall not dnployrny p6so. i.anyn n(
<br />5 a lo h..oE. sbj.d to lh< worl@ .lmpssdior LL of ( rlif.mic !.d tsr thd rf I nnuE td.m. .uhj.{! to th.
<br />$0.16' onF l ion ForBFE ofs.ci6n 1700 of lh. L.nrr ( cle I ilEU.lonh{nhcomplys(hrt s rmrbioB
<br />WARNINCT Flilur. ro su. $rk6 omFaiir. erds. n u"hrtuL i'd slEll $bj.rr D oploF ro dihindl FEIb.ndNrl fu6 up io oE tunrn.n rho@n<l rt,ll&s (tloo.fi,Ol. h aldiro ro rlE con of comrE!.rnri, d,ms6 a Fo\il.d for rh.
<br />slclFn !076 otlh. l,tnr ( o<L 'niFd tnd monE) s 16I (13
<br />Ll(!t\$ED (0trl-Ad!I!)a
<br />ot:(lJBAtl(,!
<br />I hdcby amrm ofrl6 nadlly olrErur' th.l I m licdB! untid F(\ ki.n of(lupla t {conrmd(m! trrlh s(1ion Ttxr) oaDivirnln r
<br />oa rh. ausi.6! ann PR,f6iiore ( od.. md n, li.d.c ir in tull ftn.. Md .lt<r
<br />g Qi\r q-
<br />9-1o-r'7 YLP
<br />cQNtlBl](IlaNr[tollclcfll]
<br />I hc.b, rilm !nL. Ful, o f Ddjq- rhi rhc. b . olEtu.lnn krlns 4fty for rlE Ffolrre. .f rh. tr orl f.r $nkh rhk Fni ir
<br />isu.d (sd 1097, c'v ( )
<br />atlu(6lf[lcljaalla!
<br />I haq arm uni6 p6!hy ol pqrury oft of rhl lolloq ins &clmr hrni
<br />D.mfiion Pdmtu-Astnro! Noriaf,srion ld6.l R.IlldhN (Ink 40. F.n6)
<br />R.q!n d tnrd of N({'fkdnn
<br />I .d,h rhd rh. r.ridll i(lllLrbE rcErAinS atBror rm^.1 r. mr ESlEabL ro rhB F$Fl
<br />I cd it thal I lEr. rsd rfin q'plnlnon and nar. rhrr rh. .hn . rnn,mlxon i3 .dr-r I r{r( t, romtl\ tr nh .ll an} lnd aounlr_
<br />ord'.anc6 and Srarc IiN! r.hr,n! h hu,ldinE.orelrucl'on. {rl hs.hy lurhorr. Efi6ddn6 ofrhir ( iry Md ('o!nlt lo 016 urnn rh.
<br />rEre n'or otrcJ fl,1(r\ li{ nrrrhl
<br />nrr,,..n, o. n*"r,.,un",uJ
<br />6or L,,tr
<br />9--q.q
<br />i /.'1 t?lLtv 3Ll
<br />Forms/Steel/Holdowns x t\3 ill/1t
<br />Erection Pads x Ltt 17 l,[u i4
<br />U FER Ground B /q a M/3f
<br />SLAB Floor tu t1 l,lU tc
<br />Roof Sheathino t1 tn
<br />Shear Wall tlb t
<br />t'i t37.
<br />Framing )n
<br />ln s u lation/Energ y
<br />qrywall.E x)./tnt. Lath ty)
<br />-Eirown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handica p Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc.
<br />DATE
<br />Set Backs
<br />Su bf loo r/VenVlns u la tio n
<br />/tNtvl
<br />1n lt+fir'ltyl ,trNlfl
<br />')b /t't
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<br />tywyl o.," ? to't-7
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