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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG. <br />Set Backs <br />Forms/Steeli Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVlnsu lation <br />Roof Sheathinq <br />Shear Wall <br />Framinq <br />lnsulationi Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL !/t,./ttt .*Ahr <br />Certilicate of Occupancy <br />Notes, Remarks, Etc. <br />OWNBR BUII,DER DEL('ARAT!ON <br />I h.Rhy rltirn rnkr FMlr, rn Fllury th.t I r .lcnyi fnrm !h. (llllr*ioF' l.r.n{ lrw k, rh. n ld*r3 Erin (h(.7l).ll 5 <br />Bu{ cs aLt I'tu!.s$ n Orlc): Any (-iy or Counry *hrh rrqufti r Fmd !' (.nrtur .lr.r. !6pn'v.. & ,lFh.r RTJr st <br />(RJK.In, r' rr{ F\uft. rko 'rqrr.r rh. qDlimr |,tr \o(hlr.rnn r) [kd qsnd ir.mnr rhd h.d.lr 6lncn..J la(lnr <br />b rk pr,vrk)nr ol rlr (-,'nhrnx r Li.ns.n ljs (Ch. cr 9. C.mml ! r h S(rrrn 7(rlr.t l)rri'n 1ol rh. Btlr{t:nl <br />P.nc(imr(-,rLr,trrhrrlEorrlFtr.rchflrh.r.fnrnatulrh.6rntl,*rhc!llc3.dc\.mpl!)tr.Anyv[hii'noiSelr,n'Otl5hvrnv <br />rp?lKanr,,r!Fmn sobj(rk rh. amlxrnrt'.drrln Dlry.ld frtrcrtun I't. hud^i &,||fl rs!ix)) 'I <br />_l rr *rcrolrrr pn,Fdy.,tr ht.tr{*,!.t! q hr.!crarrh.ni'k..nyEnqrr,..* l (It rll *rrt lil rlt < iu.FB{ <br />dcntcd oro,,.r.J ntr arl.(S< ?t4a, Bu\oc$ .trl ltoltshns (\rlc: Tlc (hnr(rt'r l-t...lr**rr Tri,(,rdrrrol <br />rh. F{rdy *ll, t Js tr rtn,€\ rh.6{ el *h ll1.r \uh rvt h'mtll or h.rt,r or thn,!!h hr nt hc. oY. .nlhycc\. <br />pn,vrlcd t hdr n( h mDn)v.trnh N nr lncoldl or ollird 1.tr qk ll, h)*.rq. tE tr ltr3 or uqnxtrrd tr $U *ihin , m y.i <br />ol dxr!)lrr,n. rlf ()*dr ,lu ld wdl h.k tlE hmkn ol F'rm3 rhi lr rh. J! nn t[lll or mtn,F rth ln)Fny fttr llE I'u{$e ol <br />l, !\orNr I th pn,lr ny. ur c( lusikly.odn(l r! wi h l'(.a{n ( odB.n,6 k, u}.{rud I lr lr,j.\r I S( 7ora. Aurtrs <br />ml hlklsr(iiL:'Ih. (intr.rr'\L'r.ns.liwd(.r n .frlyr)!no*ncr lri{.dywli,bullJtortrhl'rrvc{rhcr(tf,, <br />rtul Bh' ( rn(ril,tr{khrir*(rre h4Conr,rn,(o h.'ktl rnriunr h <br />'h. <br />Cudnclq s Lr.n{ lf,er <br />_l r.\.m0r urxlcr S.(rN'n '"'PoO/et <br />I h r(hy Jlltrtrr utuicl,rn.,lryol Il(rju,y <br />I h.rc rdl wrllrMrnr.or (.n,lir{i. o, ConEnr t, Scll ln\urc kr wnfk.rr co.qrn{ron. r{ nn,!d.d hrhyS.di)n t7(xr l rl. <br />Irhn C(xlc, Lr rlx Frl.lllfr. frh.*o tu,whrhrlEn(m r trlo.J <br />I h!v. rBl *nl nrrn(.m *orl.ri L smFn\xri'n m\urrftr. 2s r!.qNcit ht S( I i6 l?lr) or rh. I jlir (iri., |,tr <br />'h. nc.iirron c .r <br />rh. wnrk n{ whrhrhr pcrnnt rs run Myworkcn'comFn (,. m{trlR.(uf,t nl Fn.y nuarh.r xc <br />I enrly lh.l n ilE rrh'm'Lr ol rh. *ort 1,tr $hf,h rhtr lrrfrr F !ru.l.I sh.llrn cmeh!.ny Frq tn..ynaFr <br />!' In, tiroE rxhFr b rlr s*tdi omtEneti'n l!*!ol ( rr.mu, r.J r3Nrh'( 'l I rlxrkl h<oft {hF!r brh. <br />*)rr.* rohFn\nrk,n ln,vFkrnr .l S.lrbn lTtxl oI rh l:trtr (lilc. I {dL n,nhr h on{ y * rh rh)r F vnrrhi <br />W,\R\lI(: l.nlu. r, \(tr'. \,trkr'\ (otr,|in\, ts,n !o\.,,'rc A trDh*1,,1. ,trkl \llll {,h,crr rtr. rtl!)ler t'.nnntrrl rMlrr\ a,xl <br />ivrl lrnc\ up n) om huBh.J rlr'ui:'rl d,,llrF I ill.lxllr n rnl[.{r t, rlt .o{ ol .oqxnern,n. JrnB3.{ ar nr*rl.J l(tr llr <br />\r!r!q to:. or rh. Lilr,(,x1.. tr cR! rn("ar ,€oOtd <br />I h.Rhy rlhrmunl.r FMIryol !.rrur, rhj I rm lrn<.1ud.r FrM{ l (lu|id 9 r!.llwE-'r! *ih S(riln r(rn) ol Drtr!'n :l <br />r rrR lr'i{tr.\\ rnl liir.$ntrt (iil(..r1nrv ltrnr{ ! r nilln !.. rl.ll.(r <br />la!$AlJlflANIE$JNC.AliElfI <br />I kr.l, rrlrm u'rLr Fn.ky or F ,ur! rhr llE F . LlnrBlrr l,rros .a.tuy n, rlE Frrolrllhr ol rh. *.tft ht *tf,h lhtr F m! ! <br />r$ql (S.(.Ir97. Ci! C ) <br />al8lEAar.llg.aEdrl0N <br />I h.rd',,lir ud.r Futr, ol Fr!,! om ol rrE r!'lt!*r! LkiLtrri'n(: <br />Ixmrl( r,n l,.rm lAtlEnol Nd llrrln F.rLr.l R.Sulrr ir( r1 ! k .{}. Pdn6r <br />_Rcqutr..l hn.rol Mr (dlnn <br />r.Sul.i$n\ rgmnnt rsh(dr\ r.nrnrlr'.,xi {'flr$k n, rha InrF <br />\ rpplf,rrnnxnl (ar. rhrrrlr!h I rrrtn'(nnd <br />flB 1,, hu,1 tr,g Londntrri)n. r,rl h.rthytrurh,nr. r.|{.r.nr,rr.\or rh'\(\r <br />DI tlor,o ,46/<!t7 <br />COMMENTS <br />Pool Fence <br />lhl.:-