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SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loorA/enUlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulalion/Energy
<br />Drylvall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ma sonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL I :vPtREu
<br />Certificate of Occu an
<br />Notes Remarks, Etc
<br />"AMco45''Tf 7 RiT7iTK'VlP"
<br />BUILDING- INSPECTOR RECORD
<br />OWN}:R I}UILDI]R Dl:L('ARA TION
<br />I hdd, amrn und6 F.aft! of Fjury 'ha
<br />I m .rdti nsm rn. ( od,NoB Ltre lls tu
<br />'h.
<br />folbu'ng
<br />B6irs &rl Profstun Cui(): Any ( iry o. Courrr- \hich rq!t6 a Frnd to cotrnrud, .lrs. ioprolq danoliln
<br />(tuclu.. Frtrro rri is@c., .k Glurc rh. @9lrcdi ror ru.h Fmn t, 6k i risncd rdffir rhd lE o. slE u lEd!.d
<br />ro tlF ForBhE ofrh. Codr-rd! Lt6!.d Llw (CtuF6 e, Comchs w Sation 7000 of Divi.ion 3 oarh. BNind !.d
<br />Prcl*ions Cod.) or rh hc or th. n qdB fi6c{r.n ed th. b6t for th. dle.d 6dFhi. ,{., virlsiotr oas<tion 701 I i b.! st
<br />',plker tor . Fhn lbjdlt rh. .t?li.ain 16 . .ivil FuIy ot rcr mE rho fi!. hu,xlr.d &ll4 (1500).
<br />l. s otrE ofllE EDFly. * hy srplo,6 silh *ds6 s rlE! it oEFlriotr rin {b tE rqr tn $c curE i! mt
<br />idqtd.d or olld.d aor $! (sa 70.14, BailB ed Pr.faDN Cod.: Tn. (b rdor'r Lic.E t!* &6 ml.pply lo e o*E or
<br />th. pnFty slE tlikl o. inFo6 0E@( aj $tn dc rdr f,ort hif,Elt or hs*llor ttNusb h! d lE o*n @pk 16,
<br />prDvll.d rhd Mh inFwajEb c sr i d!d.d or otuqj ror sL. If, howwE lh. hiildins o. inFaaEd is eld *ihin m )d
<br />olonpkiotr tlE Or*c &r b "ill IEE dE h'iri o[FovirE lha lE m JE dn d hl'U iryr.c rh. FDFi, foi dE F,FE or
<br />l. s ouM of rh. FrrEry. m.tcluiv.ly cor rcrin{ *nh lic6*d contraclou ro.onerucr llE rre.,cl (Se 70.14, 8$n6
<br />,rd PDFss Cod.: Tn. Conrr&r.r'3 l-i..e hw &6 er .p,ply rr, o orrd ol pr.Frt * ho buil& or inro 6 thdon,
<br />Md $ho ot Et. tor Mh p.trj.:lt qilt. Conlro.1on3) lic6!.d pussnl l. th. Conlr. nsl,icd*ll$)
<br />I mcrdp( !r& Sd1hf,
<br />)!0&iE8tijqut!rsara!
<br />DECIAAAIIA!
<br />I h6.t'r amm lndd Fmnt or Fjlrr orc ofth. nnhsms d-l-atio6
<br />I hlvc ind *rll uim@ r Cdia(d. olcoosr ro 5.lr l@. fr! tr$rl6'c.mFdr( a pr.\kjd fot b, Sa-lirn:r700 oarh.
<br />l,E Cql.. tr lh. FfotMc of lh. sorl lor *tkh lh. Fmit 6 isql.
<br />I h.r..nd *ill mrinlrin *o 6 .onp.Mrio. iBu,e.. B r.r]ur.J try sd' 6n 1700 of th. Lrbor coJ., for rhc FfomEncc oI
<br />,"":" jl"YE)|Y;;)1"'-H;:
<br />,.,,,.,..,",* qe h)F4 ETts,(c 34:l&
<br />I ccnify lhal in thc Fformnc. otlh. wort for which thi! pnnn k $u€d. I slEll nor snph) o) F$. in in) moF
<br />h 6 ro lt$ft stirt ro E rqrd .onp.tsdnn L*r of(Uifodia u q.r( rh,l ifl ihoukl bcom.lubjd lo rhc
<br />s6rL6' $mFerio. povtsiom oas..lion .! 700 df rh. L,ah" Col.. I $all, fonh* nh cof,tly vnh &'s FDritioB
<br />$ARNlltC Fnturc b s@ "orka omFMion $orr. b mLsall Md shdl subid u arploF lo ominll po{16 ud
<br />.iril n.o up lo om hun&.d thoN.d dollm (tlfii,Inlol,
<br />'n
<br />adJ ionf rh. coi olc.mp.dion, d.,r.B6 B lrord.J ror rh.
<br />!id.n r07o ofrh. kb.r ('ode ddd.al rb.rO tIc l, ^
<br />_,,. &.5a- tz ^,,*", NLUIu(ErslrlaMxA(f,la
<br />DE( lr{frtoN
<br />I hdrty iflim und6 FEhyof lqjury rhd I an I'cquoi lndE pmrision of(nrfls 9 {coo@ins *nh s!<lni 70m) oaDhi.hn I
<br />.a th. llaiN dd PrcfdioE Co&. td ny !ic.c i in tull foG,n.fidr
<br />E /oo12?'l
<br />,-)tt r-?
<br />I h6!ty lllm undd Fulry of Frju, rha rha. i! a coil(rudioo lddnE .gocy for rlE Ffollrle. of fi. *orl tor $tich lhis Fna a
<br />is!.d (Sd. 109?, Civ C )t,116rNd.
<br />attu(3tlDfoJaalto!
<br />I ho&y .IIm lndcr poahy of pdjury onc of lfic rolb*in8 delMiotri:
<br />D6N'lnN. Pmns-tub<rG Noliar..rio. r'.dd!r R.suhr6G (TnL r0, Pd6l
<br />Ra$r.n kxdofr*ilftdm
<br />I .diry lnd th. Ld@l rc*uhnrN G8-d'nr at 116 romrll&. n{ qDlt.bk t rhE F,F
<br />! rhn I ld. iad rha rprltrrrcn rd s!r. rhd th. .tn\ c
<br />'naonndrrn
<br />ir.ofl..i I rlr ro ondy tr nh .I Cnt . (nlnre
<br />Dd Stalc Iis! Eldi+ ro t!'ldinrr nn. arl ho.h!aurhorn. rcF6dtrr'v6 . f (hi ( nymd ( olnry b 6(d ull)n th.
<br />'. mmrn'n d pmFn, au iBpdrn
<br />Appllr.nl or AAdl SiSnrlur.
<br />Pemnr n.mr I print l:Plrn, t $-tr'r't
<br />Erection Pads
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