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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE IDiSIG.COMMENTS OWNER AUILDER DELC RATION
<br />I h.r.by rfifln undcr Nnrlry ofltrjury rh.r I Mr crcnUl lionr rhc Conrtt)^ Li.ctrse Lrw lnr rh. n hqirg rcrsr rs( Tnll 5
<br />Bunncss aRt t'rolc\\ion Cdld) ny Ciry or Counly shich rtqonrr I ltmir b con{tu.r. rlr&. inlltrovc. demoli\h or rcI[n rtrv
<br />srucru'c. pri,nb ir\ isuriEc. rl$ rcqtrires rhc applicmr nn n'.h lrnnirro lilcn sisn.d {rrcnttrr th.t hcor +c is liccn{d Puru0trr
<br />h thc f6vin ns ol rlE C.nllackn r l-iccnwl L.w lchnplcr'r. Coor^-Dcin! sirh Sccii{nr 71XX) ot Di!i\n,n I oflhc tln\incs rid
<br />Prolt$ions Code)or rhd hL orshc iscx.nfl lhcrclromrnd rhc hsn nrrhc rllc-a.d .rcmPrn'. A rviolili{rols&ri,r70:rl5 hy0nv
<br />rpplicrnr rd rFnnir subjccls thc urplicani tu rc,viipcndlryoinnr mtcrhu filc huidrcddollm (S5d))
<br />l.!sowrcrolrhcproFdy.ornrycnltl.yccswilhstrscsrsrhcir$lc.otrrNnrsri(,i.$illd.rhcworki rhcsltrrh i\n
<br />i' ctrlfrl or .ffcBd f.r slc ( S(.r(|'|,t. Blsifts md Prorc\\bn\ C.d. The Contucttr s Lic.trs li* doc\ nor llflv ro rr os mt oa
<br />rhc prcpcny who t[ilds or inrEoes IlrB)n.ofd *h. doc! such *ork hnnsclfor hcrcllor rhn)uBh hn or [q ostr c'nrlt)vccs.
<br />prt,lidcdrh.r su.h i oot!'nnk rc to inrc' ulornFcrd turat lf- h.*dcr, rh. huikhry or i'qrR*Mrnr is sllwirhin.m )ttr
<br />ol conrplcrion. rh. O*M Burldcr sill h!rc lhc hldcn of Foving rhar h. or shc did nor hnild or nrpmtt rhc !DFr, fttr rk Nqr* ol
<br />I. $owncroflhc lrolcny. o'ncrcl!\ivcly.onk rirrBwnhlicenscdconrrcktrsro.on(nlcrrhcpnjccr(SLt.7O!.Bn\incs
<br />rd FhfLrsion Codc lhcConrriclrr'sLi.cnscLou(iocsnoriPplyt,diownctofn.orxrrylvhobuildrorinrprcrrsrhf.oi.
<br />and who coiihcrs rff snch pmlccls wilh ! Cotuactxl\) li.cnscd Nnuinr ro rhc Cufudors l-iccn* I rsj
<br />a &PC l$ rhr rcJ{n
<br />Date: O'..r:
<br />ulrBxEllls)nu[rrAuu!
<br />DII:IAXAIION
<br />I hcEh!rfft ruidcrFrilry.in.rjuryoncolrhcfolbwiigd..hmri,,n\
<br />I hrvcr sill nD inrlin a Ccn ilicarc of a,n{nr t, Scll ln{rc tur sorkc' i co rlicnsiion. rs Pr,!id.dforbvSc.rion:17(x)nlrhc
<br />txbor Codc. for rlrc jrrfomlncc oirhc work fr thich thc Nnnil h nsiLal
<br />I harclnd willDainiai. sorkcrs conErslli in\urrncc. r\ rquircd hy SNrion .1700 of rhc Lihor (il(lc- tur rtf, |[rlonrutc ol
<br />lhcwork,nrwhi.hihisn.nnxishsNdMyworkcncoDPrn\xrbnilNtrrtrccqricrrnnpolryouD$crnrc:
<br />t\rivr n !{rC lL J 'LA'>
<br />.,*. 91!fl!UIUJCo t q3 5\
<br />l.cn'fy rhrr ir rh. p.nnrmimc ofrhr $ork lia shi.h rhivtrmir i\ i\\uctl. I \hrll tror .nlnloy rt P.'\on ir rnv nunmr
<br />$ rsri hc.onr suhicd n,rhc*0*.6'..nrNr\rrion ln*r ol Cxllririir dd igturll rill\htrldhc.otrE{:hicdnrrhc
<br />*orkcr\ eomfc.q(iotrF'!i\i{)n\.fScdion:1rrx)oirhctrhnCodr.l\k,ll lodhwirh conPly sirh rho{ Frvi\i{'ns
<br />IVARNIN(| llihrc t, {.urc sorkc .ompctr\arion colcrrlc i\ unlnslitl. rftl \hrll nrhi.cr .r cmnlorr h.ri'niMl lrmlrk\ an(li
<br />h oN hrndrd rluranil dollrs lsl(x),(Xl0). i'r d i(r k) rlN co{ of.onlrnr ion. dr mgcs ns lroviJ.(l tur lh.
<br />Sccli(nr 1076ofrhc ltrbrCodc. i crc(rndrkrkj sfcc\
<br />6lt3l ts
<br />I hcrchyrlltDUnd.r nctrrlrt ol tu prr rl r I nu li.rn.c,l pmvnionoiCh!fld 9(.onmrmiry $ilh sccri{n 70rr0) oll)ivtion l
<br />or rlie Ii\i'tr\! xtr,l tk'lesriox(inlc. xrd rrv lncr\' \ n ln l lnr.c nd(llc.l
<br />c3q 113
<br />B ,-,.,.,- COcr. Co..sjw*i0
<br />g}NEIAUCUQNTENDIIC.trCINII
<br />Ihctohy rfllnnuMcr pcNlryotr.rjury rhd rluc is 0 mnslrucrion kdin8 aB.ncy for rh. lcrfom tcofrhc sork for shich rhis lsnril is
<br />issucd (Ss 109?. Ci!.C.).
<br />AITLICANfDIII,ABAIIO!
<br />I trEhyarmund.r |f.nhyolpcrjurr6 ..rrhc loll.qiredcchralnrn\:
<br />O.m,lirii,n Pcrfriis Ash.{ns Noliiicarn,n F.dcral RcStrhrions (Tirl.40. Prn6)
<br />_R.q!ndd L.rld oi Nolifrlrion
<br />I colilyrhrr lhc Ldcrxlr.guldioDs E8nrdirA rs6(no\ rtnn,val dc nor ltlicrhlc k,rhr l(lJ..r
<br />#;:l:rhd I hrvc r.rtlihr rflrl.rrio,:'nd {r1o rhi rlr. rli,rc trrrorNrr i(r i\ cotucr.l rxreloconrplysirhnllCilj nnd Cotrnrr_
<br />rizc r.prr\cnldiv.\ oflhis C ry ttrt C.unryb cnr.r ulxnr rltntlSrrrcl rtr\rrlxri,tn,hrrl(lltr!..xrn'ri,r, ro(1h..t,r_ntr
<br />rhitc.Etrri.D.d p!)Ixdt lnr ^|l({hon
<br />.\Wli( tor.\tenl5i*nn
<br />Ja &r t / ,.,\sr,
<br />r"ln)u
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Rool Sheathing 4lblt?gu,a>/.6---.-
<br />Shear Wall
<br />Framinq
<br />lnsu lation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lr/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL I t//0h.(lr",Ot 1at-
<br />Certilicate of Occupancy el- r
<br />Notes, Remarks
<br />/l\L IT
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