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BUILDING- INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS i)r\ Nl.t lrl ll Dr. R lr r.( rk \ l r(r\ I hqlty rmrm un& Fr.[y or pdjury rllr I madF nb6 rlE Conlr-16 Uc@t s f.rdE folb*i,a ren(Sâ‚¬70]I1. BdilB td P.ol6lion Cod.) Aly Cny or Cou,ry *hth r.qun6 . Fhit lo conr cl, .lts. inFove (brclalh or @.r ey st!dur.. FDr to iB ilsJeq dlo r.quir6 rhc @plt&r for suh p.nDn b fik.3isn d irddFn rha rE oi lrE a la@.i F $a loth.FoviriodoftlECor.eld.Lie.dL.w(()ry6LComftingqnhSdiotr70mofDirishnIoflh.BEiIBDd. PrDt6riotu Cod.) G rlEI lE d llE i q&F thd.noE rd rh. b.rir for rh. dk{.d qoFion. Any viobtion otsEiion 701 L5 by lny r .pplicet aor ! Fmn Nbj6E rtE rppli.u o ! .iril p@hy ol mr hoE rnd ,ivc tu,xlrdj &lla, {tt00) _I. 6 o*c of rlE FoFty, o. o, @plot6 with *.s6 s rh.t $1. emFadior! will & ln. *dt ad r& ni.tc ! Nr inldrd.d or ottd.d for sb (Sa.?044. lt6itB mi Pr.t$b6 Co& T1l. Co, t.rl 't lJdB l,r,&,6 d +ly ro E ow of rhâ‚¬ FolEt, * h. bilt d inp!6 rEaa. -d *l$ dE sh q,l hitult or h6*ltor rtrcusn hi! o, hs oM mplo}!6, Fovi<Ld lllr s.h inEormll c bl idd!.!.d or ofir.d for di tl hos!6, th. hurldnE d i'npNGi(fl i! $ld *ilb m ]d orconpkio& th o'*G &iil& wi[ h.E tlE hldar olFwilB rk rr or lrt dd or h r nrsow dE ForEty er rI.E Frpor.r -1. so*Eotlh.FoFty. EachliElyco r..liry rih licdE rl codrxlm to ordfld llr Fojel lsr.7044. BBmB .nl hsGe@ ( o&: l-h. aonlr..lol ! Lic@. hw d6 mt q,rly ro u o*nd of proFry * ho bril& or anF$r6 rh66n. dd stF slntrr lor Mh FDi-l! shh r Corhlorlr) ltdE dFj!6'otlECorr6rdrLirut s) -l m.rmpl unds S..lion-. t] &,'a turhsltdrn \.u-BrljrLllltlI-)\lt!]-l llt!r.!-8ll!!.1! I h6$y .mm undd p..ahy otpsjur.- oE otlhc folh* q &clg, n)6: IhIradwillroi.inr(dificd.ot(oMitos.la-laurcforwldt.on,pasrion,6Fr\i:Ld6rbyS<rio1?00otrlE ,lhor Cod., tor rh. Ffo':14. of tn. $ort for rnich EFnn i! iqcl _l b!v. rnd witl fuiotlin wort.q' (fiFB.rFi i!!llfu., a rcquiEd by S.ni,n l7()0.f rr libor Cod.. for tll Ffffi. oa rlE Nrr aor $hih rh; Fbi b i&d My *qtd @6F6rio, ilMm. ..06 dd polry nuhb6 ,.: Polry Numb6:-EIpi6: I .diry thd ir llE FfollMc. ol th. worl for *hich thi! Fmn i! ilsal. I iEU ml dploy ry Fen ir 6y nllG $ 6 ro heoc lubjer lo thc,qLd'odFlrrion lt*i orc.Ifomir !d ed rhi if l lhodd b<6ffi &l*{ io 'llerl6' oeF!.rb. Forai8 olsarbn l7o0 of rh. Lbd cod.. I .h.ll fonhwitt .omply virh rh.s Fo!i!i)E. WARNINC F.ilur. 'o cu. mrldi .omFqion or6{c ir unL{'tu|. &d ndl $bj.( E dlplo)q lo aihintl tala.nd cnil fu6 up ro oE hu.t.d rhourd dolh! tlloo,o(x,), in ddnhn b rlE oq of cohFn$rior d! sd B povidat lor rh. s61iou 1076 otrh. L.tq co<r.. t s.n &d.noftr'! f6. lJcEltEDrqlra4;rla DECI'IAIIOd I hqdt dfto uldd pa.ty of Fjury rnd I m li.a!.d u!d6 provilioi of ch.F6 9 (cohnl@iir *in sdio. 7000) of Dn'iJbtr 1 ol rhc t$!in6 ind ttof6i@ Cod.. in ny ltle it h tull toR.rd.lEd. Lic.B.(-l!$. Lr.e Numb.. AfIIJCAtrLII(IIAAIIO! I hrlhy.fm lndd Frlhy ot Fjury om of E ftllosDg {k lrnio8l DqDlnirn P@iB^ltdd l.aorifrcnion F.dd.l R.euhbN ('f nh 40. P.n6) R.qun.d L.{d of r.kriftrbo -l cal ily lhar th. f.dsd rc8uLroE rcBad'n* abcnos llmr.l d. d lppl(abL ro lnE F,J..l I .d iry thd I h6r. ran rhi! rppli.lion !d 3r.r. rh.r rh. .bor. rnfoM b. i cotrd I .ara ro onnl, wii oll Cil) d Cooly .d'n*6 and Str. tr$ Eljuu b t{i .boE lmrion d !,opdy lor iGtEliod codrudio( rn k*ry lurlniE..rreirn6 of rhn C r dd Coory to ars uF. E .\ppli(!rr or AE6rl Sirn.lur. lA-#Ap-P4 \WP?X* tJhk Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loorA/enVlnsulation Roof Sheathi ng Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif. FINAL //r.?/tol,,7 Certificate of Occu prn"y 7-r Notes, Remarks, Etc. Set Backs Brown Coat (OIIIAI,SIONIJIDIIC.AqENI;I I hatby.rm urda Fn.I, ofpfjury ln lh4 t ! sdMri L.din8.edy for rlE pgflfuc of rlE rrt i', stEt fit Ftri a is!.d (sc 1097, civ c) L.ni.r'r Nn _ lind6 | Add6 -