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BUILDING. INSPECTOR RECORD
<br />SITE.WORK ID/SIG.COMMENTS OWNER BUIU)ER DEI,('ARATION {
<br />I hew .rm ond6 Fdry of Fru.y lh! , m ddrpr nln lh. Gl{lct@ l,ic.M l,* for th. lolb*69 r.&n (S< ?011 5
<br />BBilld ard ftofoion Co<k): Any Cay or Cout{} *hi.h r.q!n6. Fnn lo 6dM. .!c. up.oE d.tuliri or rqn &y
<br />n^cr@ Fif,lo i! !.ll'e..t EquiE 'lE.p?li.u! tu$.fiFntro fik ! !8'xd iIdtur rhr lEor lli b ltdE d F^au
<br />$ rhc FnvilioN of rtE Co.tractor'r l-icnEd lrw (Ch!pl6 9, ConmtrinS *irh Sario. 70110 of Dilnion a oflh. Bor,B ed
<br />Pmfdiof,r Co&) tr rhn lE or rlE i uanF rh6.fron ud rh. bBB tor rh. .ll.gcd d@Fion a.t viol,rio.oasclion 70!IJ by uy
<br />!0plictr for. pd6n $U.ri! rh. .fploll to . drn p.ot).f Dt mr. th& fir. huid &lld (tJol)).
<br />-1,
<br />d oM6 oalhc F.Fny. or my mploJc wilh \.{6 6 lh.ir sl. compqsnion, c .to lh. {dt dd 0E dME i! Bn
<br />i, qxLd or or6d for et (Sd.7O4a. BGiB 6d PrDl6eB Cod.: Tr. ('Mln.loi! l.t* Ii$ d.6 nol e9ly lo u otrn6 ol
<br />rrE pllsd} ltD huitt ( irFo\- tlsq rd sL &E rxt w* hitrll or h6*,f .r thmuah ha d lE om olplolc.
<br />ForiLd rhd kh imFDtglEfu ft mr idad.d d olT.nd tu sl I[ ls*6s. dE h]ildiq q iisoy@ . Fld $ihh m !6
<br />oror'pkiol! rh. O*G tuitdq ]ill hlvc tu hridr ofFlring rhd h. or ft dn m! bild or in+.o\! th. EoFq tr l& pliF& of
<br />-1,
<br />a o*c of 0E FoFrn s .r.l6it.l, sdrdbs *nh hqE d .o dc io odM tlE FoF (S< 704,1, &.dB
<br />!d PlDtsn Co.!. Tt. Conlr.clo. . l-ic.M hq &6 mi {lply lo 6 o$'n6 of ForEty *ho huild! or impbv6 th6on,
<br />a.d who.olnturrforluchthjcrwnhaConira.ro(rlic@.dpuBudrorh.(onr,lcroirl-i(cetrB).
<br />_r a .rdF undd nrl .i!F'T"i
<br />,,,",: I f ,v{2}ttl
<br />I hddt .mrd un tq FEnl of FluD om oaih. aolloy'oe dEldrioB
<br />I h.v.sdsill mrnrlina Cdin..trof ColEr ro S.la lBur. for workda conrp.n$rb.. a Fn!id.d for br sdioo lTur ollnc
<br />bbor Cdlc for ih. Ffrlrlffi. olrlr $!rt aor vhth llE FBn k ie.J
<br />Ih.\..ntj siu mli .h *r*<f, conrp.Ealhn 'curanc.. s r.aun.d b sdi.n i 700 ot !h. I jh)r Cod.. ao. rh. Ffomdc of
<br />rh. "ork tur *hich thi! p6oil is suqj My worl. - comF@rio. icuran.. .mid dd lrli.y nu,rhs sc
<br />_Erp16
<br />-l
<br />cd,ryrhd i. rtr F6ffi. of th.mrl for $nkh rhir Fnh i"! is!.d I nEll ftn dgh) uy F$n n x, oeE
<br />$ B ro haar et*al to rtE urtd'conFudbn k\: of C.[rom!r. !d rsE th, 'f I ]bould tt .ft $qd lo tlE
<br />*0116 onpqsl ion prcvnioE orsdion ! 700 orlh. l,bo. Codc I thlll, fonhn nh smply tr nh rhor povilioB.
<br />wARltlNc F.ilr. ro s6. wdrr6' comFdion .o\cnt. iu uhwtul. ard ihill $bj6l d dplolq lo cinin pdshis ud
<br />dvil fin6 up ro oE hunLd iho@d &rlla llloo.O(x)), in to
<br />'lE
<br />oi otafp.t!.tio., d,"!.e6 E Flvir.d aor rb.
<br />sd.n 1076 ol lb. L,hY Code iddd Id
<br />D.,e t/'Ll 12.ttl ^
<br />1 ..-\)/ //,-h
<br />I h€r!}.rl'r0 u.{tq F tyoIFrur} rhd I Flrbio. of ClrF6 9 tNmmins I
<br />'lh
<br />S.<l.n 70m) of I)n nion l
<br />ol rhc ll1Btr,6s.trJ l,!nl6sn,ns (bd..ud,ny l(o& is in lnllnnc.mdcll(r
<br />SIIII8UIf]QTi.LEIDTdGIGEICI
<br />I h@by rm.rn undd Fnllty o t pajury lhd lh6. i! . o[nrudion Endins asdcy tor lh. prfomm. of lh. woit tu which lhii ldti n
<br />i$udl(S€.lca7, Civ (')
<br />AIII.ICAdI.DECBAAIIAN
<br />I hcrby rItE u8l6 p6.Xt of F,try oE ofrlE lnllowirg .L.baioB
<br />t).@ltion P@ir!-Atbard Norilicdio. F.da.l R.SuhioB (TnL 40. P.n6)
<br />-R.q!t.d
<br />t-drq ot t{.ri6.in
<br />-l
<br />.Eri8 rhll rfiG f.d6!, Esul.lioN Esddins 6bdG movd dc ml .rplic.hl. ro lhn Fljal.
<br />-l
<br />cdi6 rhi I hnt qd di eDlklrbn rn d. thr E .lDrr ilfon bn u c6dr I .gE ro orpt vnn rI Ciy dd Cou,riy
<br />ddill,lE !n suc L.E Ehi@ ro^'ld@ @dMlrE in hdt,, .urh..e l+.s[i6 or t: ciry dd coun, ro 6rq l4o. rrE
<br />rb6v. mnroi.d Eopcty for dgqaEn pupord I*--..*^-*."*7) =l,li)- -D.,. '/21/;-' yt1
<br />p.rnr,Err.rprbo, /' J "' P1.t,r, rtt,tl'!q--(
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<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 (-\r-o\.sr /,L't/6^.)
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL (a\ro\..\Mtks
<br />Certificate of Occupancy 7 \..7
<br />Notes, Remarks , Etc
<br />DATE
<br />Set Backs
<br />SLAB Floor
<br />Subfloor/VenUlnsulatton
<br />L.tul.r'r^r 16: _
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