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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE IDiSIG.COMMENTS OlVNER ATIIT,D'T DELCAR TION
<br />I rrrd,, rmm tr.& lEulry nf Flury rhd I m .rmF tld rh. (-odr-oN' Ltmr t $ ad rlE fi,llotrilg rlen (s( 70ll i
<br />Brhc .nl Profdnn Cod.) Any City or Colnry $hi.n r.qutr6 i Fni lo oniru.1. ths. impior( &molirh or ..td ,
<br />rrudueFinlons isue.., lko,.qun6 rh. mDlr&r f Nch Fmir ro nkr si*n.d $d.lMl rhdlEor3n i!lic6u.d,uNMt
<br />ro rlE FovihB of rlr (-o.k*ktr! Ltrdrd L.* (Or'rd e. Conlffilns $ilh Sd$ 7OI].tDr'.Fn 1 of rlE &BinN tnd
<br />Pm fdi.ns (id.) or thrr h.orrh.6.ror, rhscftom! rh. tEsn f( rh. all.s.d dop'D. antriolatonofsdM70115 b a.'
<br />aI,lliclntlorrp.rnnrubjar!rhcappliorrrororilFuhyotnormr.$nn\.hu.dr.ddoll&(ti00)
<br />L s orF.rrh. FrFdr. or my.mpl.)6 rrh s.s6 s rh.n rn. mmp.Bdron. sill& $. trrk 8*l rL 3ldu. E mr
<br />inlcrj.d or olTr.d for slc (Sa 701,4. Buir* dd holBrioN Cod. 'l'h. Contt.rot'! Lk.M L* &6 not $plylo in oqrs ol
<br />rh. rhFly *l$ bl&or nrFor6tlEotr rn rhl d6shf,o h'm.lt or tdllor rtFuch hE q h< otrn 6n9h)6,
<br />Forid.d rhri rlch mFlEci! c mr d6i.d or.rldEl irr sl lt tr*-(, rlE tUldry or inF$-an B $ld r ih6.r !*
<br />ol'ennpkn'n, llE Owns t uiBE uill h!v. d. trd.n ot proviqr lhd hc or shr dd er build or in9ro\. th. F.pdrv aot rh. plrpos ol
<br />l, a ou6 oflh.,,opdly, m.rlBiv.lyconrrdrs sirh l(tu.{$lnsdonro codfl.i th. FmF.1 (S(. 7OrJ. Ilshd
<br />vl l\oftsim cod. Ih. Contriois l-i..M L!$ &B ml .+'plv ro o$n6 oapr.p.ny shr r'!ild! or imprcr6 rhnon.
<br />ond utxr co'rr*r ltr such rmF! nnh. Co,rraro(il lrdE d p!6ud kr rtE c6drror! l.EmE lrr)
<br />I dn clc nr unJa Sc..ri,,n
<br />lrrr. Oinff:
<br />WORKERS' CONIPTN.SA'! ION
<br />PECI.ABAIIOtr
<br />I ha.bt .firm und.r tco.h! of rtrjury onc of lh. tollon ss d<l6nird
<br />IhlE,xlqilltuinrrinrc.nifrar.of(-oGarr.S.l{.lEUr.fo!\!.td.onFtsnnn.a pnn xLd aor b S<rion 1?0o o l lh.
<br />trtx{ cod., lor rh. Flffi. .f rh. r ort fd rnrh rh. F6n i ie.n
<br />I h.r c and * iU msinlain sorlo' conpcaqrnrn Eurrn... !r r<tun.d hy s<r n h l7(xr r, lh. Lh.r Cod., fo, lh. Fforru.(. or
<br />rh. u! rortrhthrh. Fnn ir eid Mr$oltd comFrai n ieffi.cmE 6dplt].uhtqr.,-- €Q/r/",,2 1'e fr\g., 42?J/-,-<-- , ,
<br />1 e.". o5;7ta2/11],.t,,t", o y'4-J
<br />I c6ri[ rh.r irrlEFfotmeof rh.trort for vhahihit Fri ir BNaL I.ldl.or mplo! rN Fen in!n) rmF
<br />$ a ro b.(m $bi6l to th. Nmt6 otr{tuhn bs! oacdifon4 dd.*r rhd ral lrFuB t<.m slt d io 'lrsort6 comp.@lion pmvisionr ofS6ln,n I700 ollhc l,hor Code I dEll fonh{irh cDf,plt wirh lhos prolnionr.
<br />WARNIN(i [rjtur. ro $@ *!116 coniFldi,n oln r. k uLwaul. ud shnlt ]ubi.!l u aphF lo dimintl fErhi! 6nd
<br />crrl fiB ur ro oE hund.d rhosnd doll, (tloo,om). m .ddihn ro ih. con of .onFNiiotr dlnusd a Foril.d lo' rh.
<br />!fL( ! ltr !r r(\
<br />Ihd t mmunddF n!.rFjurylhi I m licoE d !td6 Flriti,n offtrpt 9($nffiiq$nh S.dhI 7lr(D)or Dn [i,I 1
<br />of ri. 8618 ad ItotBrB Cod.. dd my lk.B ii in lull forc. d.fid
<br />,.^.rr- 4-32^"4) b/t?-
<br />I hq6y .fm bd.r Fn t! of Fju.y Ur thd! t . odr<lb. tnd,g rgfty tu llE Ffotu. olth. *dt br r'iih ihb FDi a
<br />is.d (Sc.1097, Civ C.).
<br />kndd-r\m.
<br />AIII!(AN[DDOJAAUO!
<br />I hdr+,y otrrn lndd p.nihy .l Fl!r) onc of llE [i] llos in3 &. hraxon\
<br />Drmolltion I'l.mils-AstElos Nolincation l'.d6.1 Rc3ul8l n'nr (ThE r0. l'dl6)
<br />R.qun.d tdrd ofridiftdM
<br />I cd it lnd $. t dGrl Egrldiod ,!*rdiig Et ror rm\.| a. ,ol +dt$L lo lhi pNi6l
<br />I cdit rh.t llw. r.d rhir lpplicltion md !rat.rhd thc.tovc iilomniri i!.ord I rtE to comply*ilh rll Cny lnd Counly
<br />.rdn.nc6 and sr.r.litrr . boildin* coBrrurlron. 0j tFrt. rqr.grdn 6 of thi! ( nr_ Md ( ounly r(, 616 ut n rlE
<br />6tor. 'EltuEd tropqrr for
<br />"'"d7y'ltr'Apllk'nr or Asmr Sir rru'r
<br />s (oy
<br />--\
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing ro l2aln tyt ll4
<br />Shear Wall
<br />Framing
<br />ln su lation/E nergy
<br />Drylvall
<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 />FINAL ttlt lrl )tl11L{
<br />Certificate of Occupancy I
<br />Notes, Remarks, Etc.
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<br />Flood Zone Certif .
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