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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.OWNER EUILDgB DTLCARATION
<br />I h.rch,.lrim llLr FMiy rf Frju.y rh{ I n ckrt, rmE rlt a,flr rF Ltqc 1,,lq rL lolL,*r! Ea-r lse roll.J
<br />Buinc( r,ri Pn,L$Bn C\rL): Any (lly or Counry *hah r.quEs . rtmr ro rnn{ru.' r(. in{mvc, &ml$h o. Ep.r rny
<br />{ru.tur., Ilfttr rr ns nrue.. ano rc{trircs rlE rpnlf,.nr n, tuch Fmir k' rik a n8kl {d.mnr lhd lE or slE 6 |trEsn Fmur
<br />t, iri F)!!onr ol rlr Conrturd'\ l-kn<rl lrw (ch.rrd 9. Co.mEos *'lh Sdr,n ,000 ot D'virnn I orrtl Buitr$ dJ
<br />Pnncsln! C-dLrq ihtr r.,tr ilE s.r.q'{ rlE fmm.rn rh. hr.n tur lh. .lLrd.rcn{,bn. Any vhLr norSerr}n?0}I5hy.ny
<br />rpfl(2h' n,rapcmn \ hjer rh. irpn anr ro.riv,lt}.mhyor n tuftrhd,rvc hlnJr.d d.lla! (l5l{r).
<br />l. !\ .urcr dl th. E ll<ny. rm cr(lunEly cod.r.r mr v h ltrc.etl (i, r&r.^ t, ()nntur rlt F)Fr lSd. 7llra, Eu\Bs
<br />.il lh'l6rrn C,xL thc Conkatr'r l-r.r.. l-r* .ttr\ ft aptlv k, m nund u, t'.)IEdy who t uildi or mpn)v.s rh.rco.
<br />rnd wh, (nrBr(ntrsu.hF,lccrrwrrh 0Conrr4b(n lNnscd punurnr (,rh. (irtr&r'r Lf,.ns. Lrw)
<br />Iamckm u r.rS(lir .li.&PC lnihFua'n
<br />TAAf,Ef,SIAUIEUSAIq!
<br />DEI.AEAISB
<br />I lr .t'y rlltrm und.. pc.rlry oa Irrrnr) or rfrh tull,*o8 Jdll,rr$nr:
<br />-l
<br />hlE .,n r rll EhrM . C.d ra.rrc oi Con-d b Sclr-|.{uE tr kit6 oiFner$n, !1 tn,v .d r(tr by S-lon t?q) ol ih.
<br />L.lw (oL. fG
<br />'lE Frf.{ll$. of llE Hrt l( $lBh rh. Fhir n $Ed
<br />_l hrw.Lt *,ll mlnr.ln wortcn' .ohlE.s.rir inrur.B.. $ Equld t'y Scrion 17u) ol rh. t rbr cek. nr rlr Ffiro ol
<br />Lnmrrri.rn inlurh. lfir ui lllxy nuhb.rd'
<br />,t,..1r-v "E€vx*.,s
<br />y.,",*,.,*,,qZzqbsG t,p*,, t -zo -)Lzo
<br />-l..ni,yrhlr
<br />rnrh. D.normr'. ofrh. *orl l(, *htrhihn [f,rm tr srucd. I shlll n.( .mrhy any p. onhinrmrnrct
<br />a' !r h tEenm .uhrcd k' rlx ktrts urmp.nr.tin L*( ol Crl .m!. .rr .!ft rh.i I l th,ultl h.{om .uhrlr ro th.
<br />s'*(! ('iIEnqrrr |lnn rsn\ ol Seibn .u{lr ol ilx L{htr (iri.. l \hal,- fodhw h !!,rl|}ly wirh th's nn'vn[n\
<br />WARNIN(; ljfilurc io $rurc wor*c( $nrnqrk]n (ov.n8. ,( unlr*rul, .ntl rh.ll rubF...r an mrtot r b m.l FMIH.nl
<br />dvrl lirr up t, om hudr.tl rh,usni JoUr (llll).{Xt,). m 1 ir !! rlr ({ ol (.r{Enqrion. t!M!.r ri Pftrut.d for rlr
<br />s(r$n llr)16or in l2h, c'rL. d.r.{ jrl dr,my'r 1..s.
<br />X",.oq -r-?sr1 I
<br />UCATELCONIAA!:IAApgcrdSarlo!
<br />I lEEby .,rm uaj( p.Mrt (t F,rr'y rld I rh linrtl ookr lhrlnm or ch,ain 9 r(,lttrEln8 eirh S.lrhn 7&x)) or o'vni'n l
<br />o! rrE Eusr$.rn Pn{clrsnr CqL-.rl my licnr ! D lllln,u lrl.rf&r
<br />(ci4 tozllgc)
<br />Xr""Oq-r*Zolq ,"",*,."GbLD €^1 DF ,n\C
<br />(0NIIAIJqIONIEIPIIIiTGENI}
<br />I lEEhy .lftrm unLl,En lty ot p.riu.y rh, thr. ! . dr{Brp. Ldh! t!.rt fttr rlE trtt(|le-. .l rtE Btl for *hrh rhN Imd r
<br />r.ud (Sd 11D7. c,v. C.)
<br />AITLICANID'CIA8AIIO!
<br />I hd*ir.nir unb. F.!ly oI Fri'r, or or E nrb*'nr rhLdnnr:
<br />rtfrnnm Pcrnrg^rlrsror &ri&rrb loLri RcsuLrt,ns ('r k4, P,r6)
<br />R.llu!.{ lr((rol fld i.rrr
<br />_l ..nrfy thi h. lcd.nl G8uLfur.r ESadrnE.rh.ios Enrul& n{ qt'lMhL b rns ImFlr
<br />l..nly lhr l hrc ru'lrhF.ppli.!rxn, ul (ic rhrrrh. ah,v. ' l.3r.chcomnly* h all(iiyand (i)uhry
<br />slrnrk{r .nd Sr.r. lj}r ElatnS n, t'u rll rnf .or{to.r[n. ul tE .l'y rurlld. rF.td..v( .f rhr C y.il(irniyb. (rlllnrlt
<br />itinT m .md nn,Fdy ft, o.rEdrr
<br />(Appli.sr or A16r sirEruE te ml ,-,.6n'l -2c/f
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Su bf loor/VenV ln s u lat ion
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />,I
<br />FINAL 4/zz/,2 .*furl )
<br />Certif icate of Occu pancy
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />-1.,ro*rrolilEIn'Fny.orN.mll,r<\eih*rS.\irrlErqlk(rm|xntrron,al&'rlludk.^lrh.dNr@nrnc Ld or.liaRd ktrsL(Sr.7l}44. Aurm$ rnJ Pr .(ion\ (i!.L: rh. Ci'nrr.cttr s l...nr br .lcr n .orlyn,r"Pftrul
<br />rh. FrFdy *h, tr io. EirrE rlIltu. t n *h, &xr uh s,t h,n{.ll or hr<lr or rtmr8h hn m lEr {wn.fltpLr.1
<br />0fuv d.n rh:t erh mrn,wftds & tr{ dorldl (, olliyrJ t, sk la lr'tr\q. rh. hu,IrD3 or nlh'r.mnl R $U *[hh on. Fr
<br />.l ofttLr[n. rlI O*n.r Bd k*dlhM rlF trnln ol InrvDB rh]rlror!h( Jn ftn htrU or rtmE tlr FnFny nrl'r ,Irlrr ol
<br />2Aro rpE z
<br />LEh. Numhcr:
<br />Irtor.is Adlr.(:
<br />Ext./lnt. Lath
<br />Brown Coat
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