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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS O1'TNER BUILDI'R T'EI.CARATIoN
<br />I hcrchy 0llirm undcr peulr, or lir.Juiy rhdr l .m crcmpr fn,m rhc OJnta.ros l-icensc L1*'for rhc r(rkJwtrrg lc$on (Sc.?0:115
<br />Dtrsincs xr.l Proa.sn,n Codc): Any Cily or Counry *hich rqxnc\ I lcirnir lo coo{rucr. alrcr. i llorc. dcnxni\h 'tr ruFn Jtry
<br />*tu.ror.. pr ro ns issuarcc. oho rcqlircsrlt xppli.rtrr Lr su.h llcrnrilro lll. ! \igncd {dcnf,nl rld h.or shc i\ licctrs.d puNuatrl
<br />lo rhc pnvisior orrrr c.nh.ktr\ Lietrscd LrN (Ch{rcr s. CornENirrc $irh Sc.ri,D 7Um or Drision 3 of rh' Rr\i"'(\ 'n{l
<br />I'n,fcsio saodc)orthal hcorshc is crcnfl rhcrcfnnnrM lhcb{\h Lrrh.trlh!.dcrcnlrrion Anyvi{firionofS.crion703l5bv3r!
<br />!,rplicanr lir! ! penni subjc.c rh. applicntrrb !civil,l.nrlryornot nbrdh.n livc hundtcd dollir ($5mr.
<br />l.s{uNncrollhcflolxny..rily.ilrotNswilhw.!c(.srhcir\ol.conll)oi\ri(rt.willdolh.'orka ihcaflrrrrchnor
<br />irctrdcdorollcrcdli)rsrlc(Sc.T0l,l.BusincsrndfloicssionrCodcThcConrri.!r'sl.icctrsua,loc!rcranllvhrnowncrof
<br />rh. pnJFny wh, tnril(lso! innmvcs rhcR\)n. unl who d{1{:.h $ort him\.llor hcr{ll.r rhrough hi\ orhcr.sn cnlPlor_cc'.
<br />nr.vidrdrharsrchinrl)n)vcnEnr\{rcnolircnl uolr.rl{ tu qlc.lt houcvcr rlf, huiu i,l8 oi m|nolcnEnt i\ v'klsirhhonc ]ur
<br />ul.otrDlcrbtr. rhc O*ncr lJuildcr *illhnvc rM hrd$ ol t oving lhal hcorshcdid tr.r build ori pnrve rhc In,Ftry nn rhc Purlixc or
<br />-l.
<br />r\o{ncrolrl[ ptuNny. incr.lusivclyconkrcri',g wirh li.ctr1c't conhcron t, cnnnrud rltlojccr (Ss 71!4 Bu{trc\\
<br />r Pmlcs\inrCodc:r'hcContrrr(tr1Li.ctrscLrwd.c\norrnrlyt)n.qic.oinnl]ln,wh()build(oron(rvcsrhcr.o.
<br />rnd who conrnds r(tr su.h rrcict {irh r Conkr.(n( \ ) liNn\cd Nt\uinr rolhcContr.t, s Ltctrs li,*)
<br />lrn'crc 'd undu S\.,u n k & lC lcrrh^ hx..,n
<br />l)alc O$ner
<br />NoRX!'rLS C()rtiUNa^rl('N
<br />DI!LANAIION
<br />I luchynfinouD,lcr pcfrlryotrLriuryon.olrh.tulk,uirr!d..ltr.rrnn,\
<br />lnhtr L-dlu. hrlhclcrf.nun.c., rhc $ork turBhi.h rh. E' rir^ i\suel
<br />rhc work lnrwhi.hthi\ pcnnit i\ isusl My work.N c. rFn\rlion irrrrricc .rilcr . Ftlicy nlmtur dc
<br />N*.,x
<br />( ll tFottutr* //YS o,
<br />,",.",, ye,- oot f-ol -ol- l{e,,,r,*il/o!/ r+
<br />l.cnily rhd i'r rh. |rrrtofl rrkr ()frhc uuk tur rhi.n rhi\ Pcrmir ir i\ruc(1. I \hxll noi cn,Pl,iy nlr! D:r.n in Jn! trrincr
<br />\i r\ h h..oir {rhjccr ro rhc *orkc conPcn\ n)n ltu\.I(-rlin{trir. rnd{:tocrhr ir Inx,ul{l6ccont suhlL\r rollr
<br />s 'k.( .onrF.\rriontmrisi.nsofSo.ri{,n 17{Dofrhc LJhtr (,nLc.lnrrll, tu'rlts h .omrly $ irh rho{ Pnr i\nnN
<br />WARNINC t'rllLm n) 'ccu'c s"'kc'\ .oND.trsdn ,.or.rx!.
<br />reru:Y;r#
<br />civil ftrr tt t, o.. htrDdrcd rhousnJ dolh6 lsl{X).o(n), i
<br />SNri(r.1076ol rhcL'hrCdtc.irrc'cdrndrrtnrcy s,ic\
<br />\;"", e-zt* tb
<br />I hcrcnyrlfifln unicr |E.ilr, orrctury rhd I rm li!tD\cd l.r nnNN(nr !n ChrtftY!l.onnrf,n.$g wIhSLtrirr](xn))f1D \ni(rr I
<br />;:;;hiffi. ru,,*,c3q
<br />K-.4r2L- t O
<br />glNSrBIJcIlON.LIiNDlNCrllifNLI
<br />i\\LcJlS( 1097. Civ. C )
<br />APPI ICANT DECLAfuT'IIoN
<br />Il{rhy ]jnnundcrp.nalry.f prrruryotr..f rh.loltuwnrEdNhrrln'n\:
<br />Dcnnnirn,n P.rnrn*Ash.srosNorincrrinF.dfrl RcAUhttunr(lillc40. t'an6)
<br />R.qtrncd blrcr olNolincdi{ri
<br />_l r0rilir) l hrvc rc rhh edntrl
<br />onlinrmcs r.d Srnrc Lrwsrciuling x)
<br />{h,vc nrtrri,'nc.l pnlf,ny tu i,Fpc.l
<br />\oplicanr or,nsenr si8,t
<br />\""r.*,,..,un,,,,
<br />*,n-".u,An,^..,^.'.,xfrc,o o,trrrr{'hxrr(.rr.'ii.tr )
<br />,"' t",.t/*.d-. -n,*"rr \c. o' ,h- c r in'r c.un,) ,n cn'c, LF,n 'rr
<br />U, ,.," 6-zt-/e.lrq*U,,,,
<br />Set Backs
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />--.J
<br />Roof Sheathing k1t070 Fatn L-Pj-r
<br />Shear Wall
<br />Framinq
<br />lnsu lation/Eneroy
<br />Drywall
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />lVlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil
<br />rx
<br />FINAL t-( -t[h.lrtul
<br />Certilicate of Occupancy fr \7
<br />Notes, Remarks, Etc I
<br />e 0- Or'/r,l
<br />t
<br />Subf loor/VenVlnsulation
<br />of rhc Bun.css {ntl Pnrtsior\Codd. rd yli.ctr{ is in li,ll li,r.c fllcl .r
<br />I cn,l(' . dJ',s
<br />l.cniiyrhir rl[ l.drrrl rcgulrri(,Dr r.!{ iDgrstrdorrrnxnrlrr.iorafnll.ahlck,rhi\nft,f(r
<br />-T
<br />6--77tT1
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