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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.O*NM AUILDER DELC R TTON
<br />I ha!b, !,Im undd Frhy .f Fjury lhi I m .rdB tom ftc Codncrm Lc.* L!* for lh. tollowiB rd1nls€.?011.5
<br />Bulin6i dd Poasio. Codc): Any Cily or Couny which rcquiG ! pdhn lo connNcl, the, i6prov.. &oolilh ot EFt dy
<br />ntucrur- Fi,r lo irs i!ffiq lLo r.quir6 th. +pli.el aor 3Eh IErl lo fiL ! sisn d ni.fl@l thd lE ot CE i licd!.d punud
<br />lo rlE Folitio6 ot E Co.l,xld r Lk nr.d L.E (Cll,p(s 9, C;Mfti.r rih Sdbn TOOO of Diti.b. I of rlE &!i6 ed
<br />Prof6ios cod.) d rhd lE or nE i' ao!fl lndstoh d lh. bd! for rlE Jkssl .taF8n. a.y ri rio. olsdnr 70r I J by ay
<br />lpplicsr for . Fnil tubjd! th. .Crli6r ro . dril F li,ofnol n.lha fi!. hun&d.lollIt (tr@).
<br />-1.so\ffioalh.Fopcny.ormydployavilh*ts66thcnxrhcompcBnn.$illdotlEsott!dlh.$tulwi!ori,rdrt d trotrdld for el (Sc ?0.1,4. BBiE ed Pml6irB Cod. ]lE co rEloatLklMt!!rhdnol4pltroEoqcol
<br />rrt FrFry s lF trnl! n dpmrs ttEEG !d wls dE rdr sri hirelr or h*lf or llFwh nit @ lE om mdoy6.
<br />p.oviLd tlln uh mFDtcrEgEd -nor&lorolEld 6. it l[ rB**. trE hr'lllit+ d aryE.1ld i! $ld $+n d td
<br />ofmnpldior dE O*nd &!lrc *ill hE tlE hr.l6 of FoBs $i lE q {E dit n, hrild d i,4.!w th. Fllqiy to. tlt F,Po* of
<br />-1.
<br />sosGoarhcFoF). !rqcluiv.ryo rrlins *ih l'.a!oJ conrdm lo cordrci llE FF lsc.704.{. BGin6
<br />,'d Probi. Co& TrE (_otu.dd r Licox L.*'{kE ml eply to o.rG ofFoFry $ho hurl&.r idpo!6 lhson
<br />md sho odmi l' Mh FrF! vnn. Codrrlo{, lid!.d prurl lo llE codnd- t Li* t s)
<br />_l m .rcnu unJcr Selrn
<br />D.t. ortr.r
<br />\l onxERs; conlIa1$riior
<br />DEgaaAug!
<br />lhs.by amrhundd FBIi) olFlur) orcoflk nnhn ins &cltrarx,B
<br />-l
<br />hd. ed sill @idri. ! C61iftrlt. of Cotrhl to S.ll-lBo. for srldi codr.n.lion, a Foidcd ior hy Sel ion l70n ollhc
<br />tibor Co&. for ln pafortl1m. of llE rort for $'htt tfi. Fnn i isua,
<br />-l hrr. and $nl minr.i. *!rt-, conpc.t.I itudc, 6 rcquir.d by Sdion !74'O of llt Ld.r ( o&. for rlE FfM. of
<br />rhr srt lor whth rhi! Fmn it isEd My mrld' comradio. iM-.c cuit dld pol(y nmb.r e
<br />Polry Nobbcr-ErPit6
<br />I cdiry rh.l in rh. paformk. of th. worl for *hEh lhn Fn'l i3 i!-al I Jdl mr mploy !.r pd,n i. ry m6E
<br />$ s ro b.<oru rubikt to th. rort6 compoErlion lt*. of c.lifomit i.d asd lha if I tlbuld h..ori. trlbjdl lo lhc
<br />$o 6 convrution pmvi!@6 of S..riot.lTlnolrlE tjbor Cod€,l iall aonhwirh .omPly silh x'E pmvGDtu
<br />wARNINC: r'.'lu. ro !e mrt6' onFEahn @rmsc 6 unlrstul. od idl $b,..1 e oploF ro aihmd FEli6 &d
<br />cril fir6 up k' oE hurd.d rlb6.fl! &116 (lloo.0l)0). in idln.. ro rh. or or.omP.rB.tioi. d,n e6 6 Fo!'&d for lL
<br />vr.,
<br />DSC|JSArIO!
<br />I lad,, rifm ui& pa.!y of FJu,y 6a I d h<qlcd u.dd Ftirion olch.gl6 9 (offi,{ rnh S6lbt 7000) .l Dilsiotr t
<br />B ( od.. !d ny lt.e 6 in tull lorN dn .fidr
<br />ry\
<br />t
<br />gIliIaucIauulDINGsG[l(I
<br />t heby lmnn undcr pdally o f pqjury thd Ln6. a . .odd.lbn kndins !Ed.t aor rh. Ffomuc. otl h. erl lor shkh lhie Fmil ie
<br />isu.d (S( :l0rJ7. Ctv ( )
<br />a.SlllcadlDlicusAuo!
<br />I hd*t .fm !d€ Frlr of Fju) oc of $. follo*itr8 &rlEdioN:
<br />Dn&,nio. PdmneAlbdio! Nor'ff,.tion F.dd.l Rcsuhrioc (InE &. Pu6l
<br />R.qun.d L.lta of Noi6cnion
<br />-l
<br />.drit rhar rh. t d66l rc8lLrhE r.s!d!u Bt6ros r@v.l e mr tppli.lbk lo tha p.!j.tr
<br />l.di& rhi I hrc @d th6 rrrl.db. dn o. rhd rlE.bo!. '.,omiFn ..6d I +E ro Nmdy
<br />orJin.nc6 Md Si.r. Llus cl,lqr k,.odtudio( dn hc.tD ulhori& r.FMrdiv6 of lhir ( ny
<br />xli)v. rohotrc\l r)' f,*n! i! trNr{(rkn,
<br />apDlionr or ,\rrn( Slp.rlu*
<br />Pmilc n.n.(pnnUl
<br />it2;s
<br />Set Backs //,/ \<-o-
<br />Forms/Steel/Holdowns 1z L k.- s6
<br />Erection Pads -cVd,^
<br />UFER Ground /*//,
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathing 5a
<br />Shear Wall K,
<br />Framing '/2rfi ,,\*/
<br />lnsulation/Eneroy
<br />Drylvall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif.
<br />#at ll /zq'zlr 5\5{
<br />FINAL tlztlrg ,1/2tr1 )
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc.
<br />COMMENTS
<br />,,/,
<br />l2 ,/,. ..lulx
<br />il t<.
<br />I
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