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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />UFER Ground
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq
<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 />Enqineer Final Report
<br />Flood Zone Certif .
<br />/n\
<br />FINAL 5-7t-t1 G
<br />Certilicate ol Occupancy
<br />Notes, Remarks, Etc
<br />OWNER AUILDEI DELCARATION
<br />I rEEbr .rrrn usr.r FEly , ncriur, rhc I m .knni rDn rlr (bdtut,F trd* Lr n, rh. aollotE! tr$h (St 70!l 5
<br />Borms nl Pr,r6\nn C,ri.)r Ary C y d. Coury ehrh tulurt . Fn lo Lr'tr{ur. .lr.r, .mPbv., rb nrh or EF! sy
<br />nd.rm, t*dro iB n.uih^., rL{ Bturcs rlE +pl.. ntrsu.hFm b flLt r'sn J nd.trnr rh{lrordEnh(cnsd pN.d
<br />b rlE F.vLr$nr or rlr ConrE-'i({'! Lr.n<J t4 rchrfld 9. cl mLh3 wnh SarM 70(I) or Drv'rxt I ol
<br />'rE
<br />BUir( .tl
<br />Prncsrrnt Corlc) or rn trorih...r.m,r rhGrhon rxl r hao( tur rh..lbrc,j.r.n{{o. Any riollrr,n ofS&1!n 701I tbyany
<br />rmlkrr|,tr.,Em({hj.ir!rlrlppl!.dn'.uvrlFulryold Etrc rha I rv. hunJFd dollr (ltoor
<br />_1,arowmrolrh.FFny,(xmycmJ'loyE!* h*rtrtrrrh.r$h.on{xh\ib..wdlr,i,rh.wr*.^lrh.{ture!Dr
<br />i.rcdal ni oiiEd ntr ab (Sc 704,1. Burms u.l Pn,rrsi'n\ Ccl..: Th. cnnrrd i l-kns ll* &Er mr .p/y trr o owmr .l
<br />rll F,Fn, wb h,B! d !qh6 rtrft[ ul phr &B rh unt hlncll dr lErcll or rlE u8h hn ff ls orn .nl'l,]tci,
<br />lnrvrL\! rh,r !u.h rqF rcmdt ft rr d.dhl r oltc'nl r,x st l( h)kE, rl* h{tllu3 r lrF,Erd ! $ll rihm om trr
<br />ol Nmpl.ll,n. thc Owrcr Bliltr will hlk rlf brnLn ol pnrvtr8 rh, lr or $. drl fr{ turll .. mtflE ih. rroFny tbr E lxrirF ol
<br />L aso*Nolrh. thFny. im.rrhFrv.lylrrnt rnr rrh l,c.hrJ coniGro^ k, Ltrn{rucr rrE ftucc' tsc(. ?044. Bucms!
<br />PDt rqhCoi.:1h. Co rltx \ l-(.n\. ljw &xr rn rpply ro .. oEn$ or pn'IEny w,vt I'u rus or mpn,ur rhcmn.
<br />wh' u,dL! ltr skh F)rdt r h. (dr&r.'rt!) lxcnsal p{^IEr n, rlr G' rxrd'rL..eue)
<br />I rmcrcmJ unlcr Selnn
<br />wollxFlts' coMPFNsaTtoN
<br />lrEcldlArla!
<br />I lrrchy altum unn i rxEltol nc.j(r! om oarlE iolk'wnt J€lr.rr,m
<br />_I h.v. .,n wru m,nr.b . ( cn rft.1. or Cone.r k, S.ll'lnruc n* hrl6 dmpcnq'rr$ IF,vr,6l tu t'y Sftrbn l7m ot rh.
<br />Llr" Cuk, ltr rh. F rm. ol dr srt fd rt.h rlr Ff,d ! arEi.
<br />I h.v. .d uill dhr.h *ork.n omFrtrr$n usnrd.. f. i.quRJ hy Sel$n l?(x, oa rlE llh.r Cr{., nr l,r Frfollia. of
<br />oE xrl rir whih rhr Fd. s B&l My wdt6' oqFndsn utol4. rrmr .,n tDli., Nnixr e:
<br />PolEv N!frrxr
<br />-ErpG!.
<br />-
<br />Ic.nfythd r rh.IErfinnuB! ol rh. *o r.*whrhrhtrFm Ftru.tl.Itnllftn.hl'by.nyFB)nr..,lMffi
<br />i' rr b h.$m sutrFr to ilE qrts'lrEtE.er Dn L*r of C.ll,omu. rL! r!ft rh, ll I rlN! h..oE rut'Fr h rlE
<br />k,.i(.B' .dhFnrslr'n pmrrons of Salnn ITOJ or lt. Lf,htr ari.. I \hau. bnhwilh co,nrly wih rhos tr vlbni
<br />w INntc [ritu( t, s*ur u,r*.(' u'mp.nrdk'n ..v.nt. n unh*tuL f] dull biu M drploFr to sinri l Frts ra!
<br />.,vJ llft. !t i0 nr huLlEtl rhrgd d<il6 t!lm.Un), m .llrrn h rk cor ol eortE.uin dm!.! ! Fovrl..l ldr rlt
<br />S.!r[n.]076 ofrh. Uhor OrL, mrcc{ tnl ilr'my r licr
<br />LTCE$ED-CAMIACIqE
<br />DECIdEAIIONIh.Eby rirnud.,FElyolFr}lrythdIoll( nEr unr.r Frvri'noforF( 9(Nnft 6!w n sd$. ?uD) ol D'vtrnn l
<br />.( rh. Burm$ . Pmrcs!.nr Con.. .,n ny lI.nr ! tr rnl n,!t arl .llcr
<br />CONEIBI]IIIAN.LENDIN{i.trgENCI
<br />I h.Eb, t,ltn udt r Fn.lry o( FrJur! rhrl rh.r. tr . dr(uliln ktrluE a!.tuy ntr dF Frflmc o, rlr frtl I *nthihn Ffln tr
<br />uleJ (Sd :109',7, Crr. C.).
<br />AIfIICAII.DEIIJSAIIa!
<br />I hdrl,y llim trtn r lEn.ly ol Frrrry o ofrlr l,)ll,wot rkthr.trr!:
<br />Ocnkn[ptr P.rmh-A{hc(os Norili.artr'n licdc'rl R.3ulf,r('n" lTnl.,lO. Pd6r
<br />R.quKn hr.r ol l'lddi.irn
<br />I c.n'lythd rh.l.dcr ESulrlxr FSar,jrtrS .\rEnor rcn,!!l x. mr rrrl.rhL bth! PnrFr
<br />I Lcnrryrhr l hlvc rcsd rhB.t'!lrd
<br />nnllMBci. Sr.tc LrurELrry r0 bn
<br />.lbr mntr)rJ ptuFdy ld orFtr.n
<br />,nntrhdr r trcolK_.r.I ryre n, Lon{ly *dh all C(y.d Coully
<br />mt hcr.hy rulhrrc r clrcsni tr!!olrhtrC yrtlCounryt'cntnuF)nrh.
<br />Qrcrio* r,rrtnr slrm
<br />\ P.mlrft Em(trin l
<br />Stx /n
<br />,/ilvlNil
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />L.trlir Arltrs:
<br />-r.f,S (
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