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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS owNER Atlll-DliR lli:l,( aR noN
<br />t h.r.hy .ll!fl urkr I'.MI,,'l Ftp.y lh, t 6.r.n{ h'n rh. (itdr&nr' lr.nE llr ntr E folb*D! rrqh r*(- Tlrll I
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<br />nru.ruN. Frrt) rrs r!u!M. !l$ Rqut.i ,h. .mlrrd ntr t&h lxrnnr k! I 'k ! nlh d n.r.nrtrr rh:r lEnr rlx s l'..n{!l ntr{.d
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<br />Pnnc.\rnF (idclo!rhrrlE or\ll. r.(hnr rlEckimrndlhc hrls lttrrbc dllcScJ .rcmlri('n A yvidrlon.fSccrirnT0ll 5hvanv
<br />lnplRs tnr r n nn \uhl.ett rh( llPnl!(lnrrr rovilF-mlryrr ior ni(.rhln tiv. honJr.J JollJi\ls5(l)l
<br />l.n leftr ol rrr nn)Fny. d dv.mnlry(( lrh *.!c! ri rlv s)k $.q$err w l& rtt k*t rrn th. {ndB 6 n{
<br />d.nj(\.| .r.liceJ n, eh ( S.r 7()44. Au!tr( ..J Psn6.r,n. (irL 1 h. (i).ir-(t \ l.r'd* lre &B B, rlrly ro rn .*Er or
<br />rhr Fliny *lr,h k.r !t!FE rlrmr. !n lh &B.rh sxt hrmcll or lERlf or rtB'u8h hn d lrr oq olYlbr(1
<br />rovrkJ !h,i \ud|nli'trrdr s ri ,rrd.!l i, ofidtJ n, qk tl. h'KF. rh. tturltr3 d lqn'ENd a i,u *nhtr txr Fr
<br />ol un{ .rhn. rlE ()wrr Bun d *,1! hN llE hriLn ol l'nyurS lhlr h.ort F Jd dn hr! ,, lriroE IIE FlFnv n, rh FrF(.1
<br />-l.
<br />r\o*hrorrh.t'n{f,riv. rmcr.ns,(lv.onrri(tru f hl' rpnrF(ris.r 1(!l. ln^m\\
<br />,nl Ihnc\r{('rlc lh. Contrrtr'. Ltcn.. Lrwn(f,{ nor{dv rn inu}n.r lI!|Ii'rr *lv, htr'l.l\ 'tr rmllrt{\ rh.r((
<br />rnJ sh, 1od,rG l(tr {kh F,l.(n}ihr(i)ntrlrn\) lr.ik'l t' {'rd n)iri ConrrLr, \ l {rn{ lr*l
<br />tloRKERS', ( onlIENSATION
<br />DE('LARAT(IN
<br />I lrr$y rllnn' uhJd Fnrlryntl]crrtrr) otr. Irh.lltl[,w$!Jr([nnrnr]
<br />I havc :n w'll rumau r C.n rlarr. nl (i!n{d n, S.lalnruE l(tr *oltcr' unFner nn. at FovrLd l(, t v S..r r t'(r,olrh.
<br />Lrlrr ('n . ttr rrx Flttu. olrlr Hrt ht rtxh rlr Fmnr r rnr.l
<br />f[hrr. *'lltu'd.h*rr N\u!.J hyS(ri'n \nxr ol rh. l:h" Crir.. l rlElrnrllfur'or
<br />rh. ktrk l *hrhrhrFmii ir 6(hl M! tolt.u omtort0n hluih. (nar .nl F,lE, .unh.r G:
<br />Il*'-s;
<br />l|''"'"-*'
<br />e 7t;l
<br />qotcttt ( - t2s(..p*. /i- ltr- l?
<br />l..drltth, r rh. Ilrlolmr. ol rh. u rt l,r}h.hrh!Ffl,n n !rkl.l shrll nn .nlnh! rnv rErq'n rn rnt n nrr
<br />!' .r n, tm'd llhrrr r. rlE vrl.( oqinnr$n Lr\ l Crll,rnru. mJ 4G rhr I shrul! h.1om rutljd h rlr
<br />qnkoi .onlfnqri'n |ttrrsbn\ ol Strrrtn !71{r d{ ttF I rtrx (irl.. I \hrll. Lnhw{h r-q ! * nh rh,e fn'vri'nt
<br />WARNIN(; l{rlurc n) aut klll.n d'nnnt $n $F83. ,\ trnlxrhl. rBi shnll $lirrr !n.nrll':rcr k,6n'nal FdlA rnl
<br />Sr!rtrr, x),-n !'1 rh.I 'lrtr
<br />( (i. tr .rar trl trn{Nv\rit\
<br />("D6- l0- tn
<br />rEctAEAIl{tu
<br />I trEby rlt !m !hr.. Fn l,olFr,tryIhd I.m Lnqj udq ln,vun. r(luF.rI(( rrnr.8 wrh Serm 7u$tort),tEiD r
<br />ol rrE Burr( nl Pn'L$m. (iri.. ut ny l..n< r ntull l,N rnl.ltdt
<br />K;::o(-C:]-a
<br />,D- l1
<br />lttl{?)
<br />, hrh! rrm unt r Fdl y or Frrury rh. rlrr ! . Ltn{Brnn kntry .r.Ny lq rL Frfi,rlIN ot rli h.t tu r'hrh rhtr Fmr a
<br />'i.u.J tS(.. !09?, Crv. C.)
<br />APPLICANT DICLARATION
<br />I hdrtt.flim usLr Fnrlt ofFrulr om.l rh. h,lh*m3 d('brotilnt
<br />O.dnnrn PcrndG^rt'. o!|ilr kiiln likr.l Rc8uhtintr I lik {r, Prd6,
<br />Rcqurcil lrrnr.r Mr'tu{nn
<br />I.(n,l!rhrrrh.lillJxlr.3nli[n\rlrnlrn!r\hn',\(ni,irlJ'., 'l]l'l(rhl. r' rl'^ |n",..r
<br />l.! ty rh.r I hlEuJ r hir .Pf lr.rnr !
<br />,hlDB.r,i Sr,rc lf,rirlrr,l3 ll' h{rllh!
<br />.h^r mdrffJ nn{.n! nn msttriiln |xrF
<br />rln..rhrolf, , !r.(rr,(nr n,nr!otr.(r Ii!rfrr'(otr,fht'rh rll( rrrrnn(inrnrt
<br />.ondturr)n. dl rrr.hr rtrrhr,rrrre! ot rhr ( iv sntl C.unrt r).ntI trFmih
<br />\ppli. nl trr,tffnl Sicn{b(
<br />--'Sd t1/,/ LC (-
<br />o6--/D-lcr
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />S ubl loor/Ve nVln s u lat ion
<br />Roof Sheathing L-n - tq .)@/o,
<br />Shear Wall
<br />Framinq
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enoineer Final Report
<br />FINAL 6-/7-t, al '.,sfr, /o1
<br />Certiticate ol Occupancy
<br />Notes, Remarks, Etc
<br />\
<br />Forms/Steel/Holdowns
<br />Flood Zone Certil.
<br />I rm.r.n,fl x'rl.r s.(rN,'
<br />lr$n.r
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