\ BUILNING. INSPECTOR RECORD
<br />coSITE-WORK DATE ID/SIG.
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ma sonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL l-3- za x,I4{. jd,
<br />Certificate ol Occu pancy \J
<br />Notes Remarks, Etc
<br />o -E,F-.2t--/a .1
<br />OWNEI IUII-DER DEI-CAN T('N
<br />I h.r.hy r,rtrn utui(r Fmlry ,n pcrjury rh, I m c\cq, rn,m rlE (!)dr&nF llos L.* r,tr rlE n'flo*h! r.:$n rsd 70!l 5
<br />8unncs\ 3et Pbt.$n,n ctic) Any C y or Counry sh(h rcqrkr 1 Fd kr .o.{tur, .lr€. imln)E. &frrsh.r EF! ey
<br />nN.Nr., Irrnt' nr !(utRc. elw, r.,tuurrrhcaml(rnr l'tr ruch Fmi r,',ik r npnc,l (srcmnr lhll t r n\c ! lkcnrd Fuaur
<br />rr rlE F vNon\ of rrr (i'nr*r, s l-r.n*l tjr ((lu .r 9. O'Ilftrm8 * h S&rx,n Ttlcl o, Drrtr$n :l o, rlx Buqm({nJ
<br />Itol.$inr (ql.).r rhrlh. tri slr tr.\cE{i rtmlr.m.d rh. h..n ntr rl* rl}r.J ckqrDn Anyvri.tonnlSarln701l5hy.ny
<br />{tl'canr ftn {0.6n suh^r( rhc sptlic,nrr) r.rvrlFMliyol n nrc rnu liy. hufrl^J tlourt l!500)
<br />-1.
<br />i! o*erotrlE F,Fny. or my.ny'L)yer *ih *.!.\.r rlrr qlL umpodri. * drrltat!drtr{dGBftn
<br />d.nlol or fi.rcd l!tr srk (Sa.'7()44. Bu.e(.nd Prni(oN (dL'Th. O'dr&roit tr.nc kBdxrni{d,bro*rrol
<br />rlEFIdy rh) t{'Ui or nln,Er rlrN,n, rr wll d*r nkfi *nt hn(lr o. h.rcll or thn,!3h hc or hcr own .i{'byc.\.
<br />pNyrld lhi .uch rrgownls c rr do.krl o.ofi.r.tl ntr qh Il. hrw. th. tr .,!V or lrIn,Erd N s *ihn {r F{
<br />oI$n'pkr$h. rh. Owdr Bui!.. *d h.h r1r hlnLnifrrrvry rh.r lror rlE dn n hr!! or [tnE Ur F'rEr, tu rlr Fl.Fl(or
<br />ro, rh. |tsp.rry, rm.(clu!r.ly.o nlrint wlh l(.n-d ddraron b onsrN rtE Imi\r rsa.70lt. Burrs
<br />l\,16 mC,ilc In.Conrra.Ltr'\ 1,,..n\.1-a*J,B iorrpllyr{ anownrr rl p0pcnt *ho hu'lJ!or mpn'v.\ rh.r.on
<br />"hl.odrrtnn!hhlh)r(r\*nh.(imtr.rinlr.n{,lpurn'rnrr,rhcconkr.rtril-f,.n{ljs)
<br />7
<br />a & PC ntrrhtrroiL_-=.=4sezz4-,x ,,,"2J hn,9 fficquuni raJuL!tr!&!rar C
<br />I h.,.hyrrntrru .rlrnrlry.rp.4urv,,m!,rrhcInlh$trr3trc!t,dk{r
<br />_l h.!. ul *rll Dtnr.u r C.n irt. ol Coner ri' S.ll-t.lur. t,tr *o cr'Nmlxnid[n..r F)*Li Id bysrt n 17m ofrh.
<br />ljhr O{c ntrlh. FdnrltB. ol tlE xnk lor whrh tll Fdt tr st*J
<br />I hltc rad *,ll nu'nr rm *orks! (,mFmrr nn murrftc. rs Rrtnu.J t') S(r tr,n l7(l) ol rlr Ltxr (irll. (itr rh. Fnortuncc ol
<br />r hc work ntr wlkh rhtr lxrmn ,! r\ud M, workrn' $n{rntr r)n $orn. rarr ul F,lr I ilnh.r ,c
<br />-l..dnyrhrr
<br />nitE lErlorrE-'. oltll $or[ nn rhrhthr Frn ! tr\u.J.I lhrll n, cr{'l,t 1nyIEe,n
<br />'n
<br />riytunmr
<br />$ ai r,lr.conr ruhl.(r t, (h. wurk.r'crmpcn.llrr kw!.1Celrltno, rtul+r.. rlDr 'l I fi'lu h.rr,m luhrcr n, rlE
<br />$dcr' .t'q$ur$n F,vK$n( ol Sdr Dn lro(l ol rlE trhtr C,llc. I rlull. l'{ h*! h .ompl, pnh rh){ pn'vr0ni
<br />WARNIN(; lailu,c nr $u. *o .i\'.onyxnerrr.s\.rr8. '! unLrroL rd thrll rlhFr s.trl{lklr€ t,6m'Ml Furs r.d
<br />Uv'l lin.\ u|] I' onc l,utr(l'.d ihlrNnd dollrl r!l(Xr.(XxrJ. r(ln rn n, rlr (o{ ol .otr{tn\.rnn, drn
<br />S..r('n 10r_6 ol rli. Lttn (ir].. mr.r.{,fti domy'\ n$
<br />Y"".zll /t^.t g d-
<br />IE(IASAIqN
<br />I h.rchyrllnnunl.rp.nalryolp..Juryil'! I !n lktrwl untl.r Ftrrtr('hrlCharrd I krmftN.8 r h S..ri,n ro(l(]) ol l),Ytrrn r
<br />o! lh. iu{ft( .n-l fi$rcsnns C,rlc. n,nylr.nrrnlull,,nrc,n.lti.r
<br />calslElrx[ruElDulilcElcr
<br />LrEl'y rlrim udcr F ly ol Frju,y ir rh.rc r . (m(B_lr,n Lnju! .s.B-'y rd rh. n rl.mrc. or rh. w'rk ntr uhrh rhis Fmil n
<br />ntk! (scr. rgr7, (rv. c )
<br />/lPfl,tcANT DfCt,\R TION
<br />Ih t'J_ xlltrnuBlcr nctrrlry "l O.ru.y on. ol rh.,,'ll,,w'n3 Jc.lxrdn,n\
<br />I).m,lix,n l'.rsrs a\tr(o\ NonlrrikD Ir.J.rrl R.3nlar()n\ I l l.4rr. Pr 6)
<br />Rcqutr.J Ir(cro, Ndr,i3irrr
<br />_l.cnny lh, !h. fcJcnle8ulrr$nr r3rdb!.ir(.r rcm,rJ r. nn {Olr 'Lt,rtuI'n,Fr
<br />rt$v. rk rrlrdl lln)n ny lu u'rFdb.NrF'<r
<br />l)pln$l or \s(nl SirBluft ,7 )4
<br />Set Backs
<br />L.Bld ! AJdrlr: _
<br />rh! I lu\.(.drh6itI,l(r,n{r'rl$r.rl, rh..'htr. tr,1!nL(,rt '\(!'t.!r Irtrrn,!f'dy![hrll(irr_!'tl(1,unrr
|