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BUILDING. INSPECTOR RECORD
<br />SITE.WORK (r\r\tk Bt Il DtRl)tt ( \R \ r ri)\
<br />Iid.byamm!nd6 p€n y olpdEry rhd Im.rdn nom th. (nnlracrod L'.ft* t wforrt folhrinr ra$n ls(70ll5
<br />&trh6s dd Piofsion Cod.) Any City or ('ounly which rdtuns t lrmil lo co.slrud. ahs, '.rpio!a ddolilh or .qEir uy
<br />srtudu.. Fnr to ik isum.. 6!0 EqunG $.4ipli.m! lor so.h
<br />'lm
<br />lo fik r t'sn il3rltod rh,, n€ or slE a li.da.n tuNMr
<br />1(' lh. Foyan,6 ofrr. Co.krtor's l-ic.B.d l.* (( tlpi6 9. (immdins snh sdrion ?0O) of l),rBi)n I ofrh. ttutrns and
<br />PofBrn.s ( o&) or rh{ lE or nE s (@F lhs.6oh.!d $. b6i fd rh. .lks.d .t@rrion Anr v$hbn of Sdirn ?0!L hy a.l
<br />.rolElnl for . D.mit subids lh. ippl,.6m ro t ilparlryofR moE rhe fi\. hunl'.rl d..llas (15u))
<br />l. s o*r( ofrh. F.Fly, or my.nployG $th s!s6 s rh.ir komPdsalion,sill&lh."ortdld'tEsu.1ur!,l
<br />idsrd.d m or(si lff sL (sc 7044. BsiB xJ Ptol*ioE Cod.' ln. Codrerdis l-rN L.w do6 ml +Dly ro d otr nd of
<br />rh. F!F} r ho hilr d nstiE iIEEG rn *,r' dE sh *ut hr,elf or hd*ltor rtrcush hs or hc o*n mpbls.
<br />F.vid.d rtd tuch EF rEr6r ft d -rarldl rofisql6r rl. l( hr*6s, lrl t!'U4 or inqD\ffi it sld urhd (* )d
<br />of Nnphi6( rlE ()f,ffi B{iljs *iU lnw tlE h(rn of FoviE rhi rE or !i. dil rcl ttaB or lprcv. ln. FoFy for tlE FlFa ot
<br />L s o*E otrh. FlFty. m.r(lEircly co'nrdhs s'nh li.o!.d co'rrdo6 h $drud llE rrJ<1 (Sd 7o{'l t}&n*
<br />sn ProEsimQrk Tnc Codrrlori Lt.e t *.kE mr tpply r. d os.a of FoFnv r h. burl.tr or mPor6lr6Fn.
<br />lnd who $ddr. fd 3Eh F!F13 snh. ConBlo(t) lko'sj F6d ro rh. Codrdo.t Litu lr\ )
<br />lrnc\r rt{ r rl.' Sccrit!,I &P( lir!rhsre,n
<br />Drt. Oxrr
<br />\a (rRxItls' a(|ntPEl\s,\Tlo:t
<br />DEclflall.llq!
<br />I hRby amirn unrl6 ,.mlty of lEt!ry on. ol th. fi,lkr*'nE &.1 .itr,trs
<br />I hlv€ dd uill mimrL a a.nific5rc of CoMrl kr Scll'lBurc for f,o, k6' onFsrir, s Fovid.i fff by sst n'n l rlx) of thc
<br />I.trn Codc, tu rh. Ffolrm. of rh. so for$hichrh. Fhn ir Bu.d
<br />I h!r. rnd r ill n.imlin mrt6 comFqrio. rqrs( 6 r.quldl b, Sal ion l70o of rh. t h.. (-oJ., for th. lqfolrrrff. ol
<br />rh. *ort aor whrch lh6 Fnn B iqrd My *o.k4 cooFMion iNurN. ffi lri lllty numb.r a.:
<br />c*- Elak trL{* .\
<br />,r*rn*t , l"l cl rtrl t^r7
<br />,-t 1Ar.e,- r-l l/ lL
<br />l .diry lh.l rn rh. p6fo@fr. oarh. wo ror sh(h rhis tcmr i isu.d I dBll noi mplor lnt P€vrn r d, mdnd
<br />$ s ro bcom. rubi<t ro th. f,orkd' ampqsxon la$ ol Calii.mi6. dd ssrE lhal il I sh,uld hdoIn. ubjd to rhc
<br />{o 6 comFMrion povilioD ol s.dtun r7(U .r rh. trbor codc. l tldl. fonh*iln $mrly *irh ttbs PNvisioN
<br />WARNING t-rhE ro se qolt6'omFsltrn coro4. s unh*6rl..rd rttll ,ubld e qnpk lt r.6nni l Fshis d
<br />.Ail nn6 ur ro oE hondr.d lhound dollrR (llm.Ooo). in k'n ro rhc coe r.omFMrn,.. drh.N6 6Ir.\kitJ fir rh.
<br />Code inrsd !.d dlorrEy r rd
<br />I I
<br />DECIdAAIIS!
<br />I hqltr.,Im ud, Fqh, of Fjur' lhn I @ I'cd!.d u,r&r Fvti,n ofct Fd Itcoffiins sith.rqrion 7@(r) of l)nBir,I
<br />.l lh. BsE id Prcldb6 cod.. d my lic.M ir in n:ll forcc txl.fi<r
<br />al<
<br />^,.1/zltr
<br />c-3a Li
<br />(a!flaucuqxl,Idllllcic.Elcr
<br />t h6.hy arm undd FElry of pojlry thd rhsc i! ! cod{tucli.n LndhB .gdcy for lhc Fro.rM.. of rh. *otk for sh'.h rhir panln i!
<br />$u.d (s( lo9?,cft c )
<br />AIII.ISAXLDICI.6AAITA!
<br />I ho*y rltrn uo&r Fnthy ol Fiuy oE of fi. follo* us dala.r Nm
<br />D(mlirion PoIil^rh6r6 Norinc.rhn F.dd.l R.*!l.ri.N (-rnb .10. Pur6)
<br />Rdluncd I.116oINorilicnrir
<br />I .dit rhd th. f.da.l r.suLrlt6 r.srdrns 8hdo. ,mrn r. Nl tpglrtbl. lo fiir Ftj.r
<br />I.dit rhr I h(.. rad rhii.ppl.dio. {d r.r! thd rlE sbor. infomldion i.otr.( l.SEloomPl}snhaUCnrMd(ou t
<br />ordinoc6 ed Stltc Lle s EllrlE to tuldos co.$rudio( dld h@by .ulhri, rcF6srdir6 o f thir ( ny ud Codry
<br />'o
<br />dr. lpon llE
<br />ilh!. 'Ddr'6.a1nmdv f.r nt*t,-^dI
<br />^,,*ff:ff;*Kbzra- t?"''%'. *,. I I zt / t 1
<br />e.-r,*-,.rp.rno,5kvevt U6,i2quc2 ?'
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation 1
<br />Roof Sheathing r-v"t7 WP-M
<br />Shear Wall /
<br />Framinq
<br />lnsulation/Energy
<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 />FINAL 3-lo 't-7 JJtS>+,Gh
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />I DATE ; ID/SIG. COMMENTS
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<br />Drywall I
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