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BUILOING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNN BUILDB DELCARATION
<br />I 1116, .rfrs urt , Fn ,ry or Frrry our I m .r.npr rinm rh. CoddM trft h* lor rlE folh*n8 B*r {S<.mll 5
<br />aL$n.r( .d Pml.sn Crn ) Ary c y o, CMy rhrh r.qur. r Fmn b $nqur. .la. ihlmv.. d.mlrrh or EFtr dt
<br />irftrlr. Irir lo nr tnmc, aho EqoE. rlE rpplianr lor och Fflnr ro filc a shi.d lrd.dr ihn lt o. .lt a licr-d FBlr
<br />to rlt FBbn\ ortlt Contrrq r Lt.n$d Lr, (Cn+rs 9. Colmri.8 ,nh Sdi,n 7G) or Divirb. I or LIE BuiEn .d
<br />Pmfc$$ns Cod.) or thlr rE orslE B.r.npt rlE fmm,nl E boii for$. rtk!.d.rdnprion Anyvinrtionofsa-lbn?01l.Jbyotry
<br />.pdkrnr lb, r Fm, {bFrr tlE rFlad ro r .ivil FDh, of br Nr rh.n nv. hrErr.d doll{! (slm)
<br />I. a oeEr or rtE FoFny. 6 ny cnlbt6 *(n B.8d a lh.n sh oqE dion, ri! rh l}. rvdl .,n dE ffi 6 d
<br />htod.d oror.r.d for .L (Sd.?O{4. BliiE$ Bnd Profsio6 Co<t : Ttr C.drcroar Lkdk trv ds d, +rlt ro i owEr or
<br />rh. F$IEry rls hir& r irPllB iEG4 .rn *h, d6 qtt vnt hiela r lt&j, d rhhrSh his d h.r ofl.iPtrF6,
<br />oovidcd rha rEh ntrrcmnrs e mr idcdi.d orofi.d ror sL lf. nosE rlr t{irriry or 6rmrm,'l i $E withh oE Frormghia rh ()lE Build wil, lrE dE hr&r or Fovila dr lE d tr dii d hrild d rrF(e l|t FlFry ftr dE Frpo: ot
<br />_1. row6 6f rrE FoFry. u.r.h'iv.ly.d&r.lins wirh li...rd.trdon b odrud tL Foi-i (S.. ?Ltt4, ButiHl
<br />rd Msin Co& Th. Conrrbir LenE t * d61er +ply ro md*B of ,,oF ry sh6 buildr 6r iopmEr rh.r6n,
<br />rnd *hr onflElr f.r $ch FoFclr with r C.nt lonn lirnsd ljlrurr to rL Comxrd . Lt.M Lls)
<br />_! a cE.rpl lr*lc. Sari
<br />l).le ()vn.r
<br />IllBliESr-cQilfllilarM!
<br />IEII.A8AIII]N
<br />I rrrt.ht ]l InD u nLl.r F rlry of FrJrry om of rlr k,llo$ 'nI drlrnrxntr
<br />I hrE rrld *ill midi.. Cdirdc ofco.-nr !o s.lf.lnlm ld *ql6 mnp.Nlhn, 8 FlviLd ltr brsclbn l7m or llE
<br />Liboi @., le rlr Fdollrre of th. rql tor whi.i ilE Fnfi i! isu.d.
<br />I h.E rd *ill Ninrin {ortd onlP.Mlion i6u.c.. s EquiEd by Strriotr l7@ ofrE lrhor Cod.. rd r,E pdf(rlrlN or
<br />lh€ *ort for whih lhn Fml is isu.d. My qnt6 otrFr..lior 'tr\l,le! cuir.d poliy nlnbs e.
<br />Polic, Nunrb.i_EryiE!: _
<br />_l c.n,ry rh4 rn !h.lE formr. ol rrE s.rl fo. rhah ihis JErm, n nrucd. I rh.ll not c,r{,loy any rE66 in u, tunE
<br />q, dblr.r st'ial i6 rli wri6 @hFnsrirn l"at olcrlifomi!. rlI*c rhr if I ftrld tEor sdF b ilE
<br />wo,t* mqEB{ionrmvkio of Sdlion rrm of rh. l,br Cod., I stull. fonhwnh omply wirn rh< rnvnioi!
<br />WARNINO F.ilurc ro suE wrim' oqE.eri)n oEt! n unL*,ut &l ihll ilbFr - o,pkiF b dimirr Fnlii.r'd
<br />.ivil nrcs up h orc hhdEd rh,u$nd d.nlEs (4100.0(r)), h lddnio, h thc con oI conFnsriotr d.m8.s ar provilcrl tor rh.
<br />sd.n :1076 of rlE tlttr cln . iii.d .rn .rlrmy s f6
<br />Dn: Ab.Idd:
<br />ucrNsEa-q,tdrxalfus
<br />DECIAEAItrI!
<br />IlErhydrrnu.r|tMltyofFjurylhalIomIsEnudcrFoyni{,n.fch.rls9lonftkingBirhs(rbn7{)@)orDivi$n.l
<br />I rlF auri6. !d Pmr*.b.s (.d.. .td my l*.e n in tull roN.rn cfi6r
<br />LtlM CLs:-
<br />qNslarcuqt.tElD&tiitiIlta
<br />Ilfrbyofrrmu cr Fmlt, of Frlury rhor thcE is ! onrMrio. ttuliry .r.ry for rhc F.aoll1lle or rhc mrr for whkh rhir p.rnir ir
<br />irsd (sd lo9?. cir c.).
<br />Arfu!/trr.DEtutaItt!
<br />I ha.by ,tu unrkr Fn.xy ol psjlr, ok or l,l iollowing deLrllion!:
<br />D.tuliri,n FrdlrA.llns tidifrdi,n tu nl R.8uhon! {Tnk d0. Pd6)
<br />-i.rtuiEd
<br />t!lcrof t*rifrrlr
<br />-l
<br />.diry !h.l rlE ftncml EslLtions Ea.,nin3 .{Eskh rcmrvll re E, {rlrAk ro rhir pmrd
<br />-l
<br />d'ry rh.r I IEE Ed rhir .fi,!-. on rd d!r. rhi dE lbor intotrdi,n ir Mrrr. t .rE ro orplt wnh Ciy Ii Couiy
<br />ordiBNr rn Sbr. Llr El{hg ro buildins .Miialbtr dd hd.!, drbr& rcF*nlrLiEr of lhir Cny ]d Counly to 6lq uron tlt
<br />.trE cnrinEd pmFr, fa iBrarhn pqps
<br />A|4ticul or&6lSkrluE
<br />P.mrlR tim. (prlnl):
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf looriVenVlnsulation
<br />Roof Sheathing )fl$ln qv
<br />IJ
<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 />FINAL g 4lb bfvn,^.*flCertiticate of Occupancy lr
<br />Notes, Remarks, Etc
<br />Rev. 08 07 2015
<br />UFEB Ground
<br />-71'261")
<br />Shear Wall
<br />Flood Zone Certif .
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