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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER I'EI,('ARATION
<br />I hd.try lrm u,r& FEhy of rEjury lhi I d qdF ton 0E Cffi-lc Lt* Lls |i!r $.lo[t*ing l6i (SE to]I5
<br />tlci.d .,rd Pmasion Cod.,: an, Chy or Coud, which r.q!n6 ! p6,nt lo cocnru( .lrq, !trFove dEnolirh & q.s &y.
<br />ln{rrq Fi, ro irt ixle...lo EquiB lh.49lt&l for dh Fd ro nk t riSiEd riml lhi lt ot dE ! licd!.d Fmu'
<br />lo th. FovirioG ol ttr ( ohtn ror! Lt.mcd llw (Ch.I/16 9, Comtrins wih Selio. 70m of Dilitior I oI fi. BuiEn &d
<br />ProfsioN Co<l.l 6 rha |t o rlE t ddF rffiofr ed lh. t-i! for lh. .lke.d 4oFiof, An, violtlion of Sdir. 701 L5 hy Dy
<br />!rpti.! lor . D6mil 3ubjcl! th. !ppli(&l lo ..iv il paully of el mE lho li( hidt.d {hllut {ltool
<br />S{,P"*.,,n" **r. o' my.n 10!6*irhslsdsrh.n$kohFdtLs'rr&'0Er\ir!dotrntlci!d
<br />idar.Ld or olIB.n fc nk lsd ?(x{. &!itl6 md Pr.fdriB Cod. T1E Con rcin . l-ic@ lrw ths nol lpply !o !n o*n6 oa
<br />ih. F$rEry wt hril& o. !4nr6lh.a( &d wrb d(6 sn *$ll tiBlaor hdrlf or rlmuan hit qlE o*! or+hr6.
<br />F.rildl rhd uh mFltlrEB G d aind.d w otuld i, 5t ll lsFg. llE hrildiiA ot ,rFlteE ir $ld witin n. Fr
<br />otcorglctioi rtt Oqna t!{ildc *ill hN ltE hrdar of Fou{ tL lE or JE dn Fl hiB e iqmttllE porqty ft{ tu F Dcol
<br />l. 6 osffi.lih. Frtdy. m dctusr.ly.odr&l'r! $ h l(qs.d..fu!d.E rr co.ntud llE II\,r..r {S< 70'14.|}o$nd
<br />anl P!r'f6ei.n Codc: 1 h. Co.rsd'3 LicN l..w d(E mr .pply ro u ol c .f Fol.n) sho tturldr or imProE lhnon.
<br />.nd trho c.drtr. fd such p.oFr qnh. ( odEdorls) lEo!.d p!s@' ro rh. ('onrt.tor! l,ic4< l.s)
<br />lin.r.mnr un&r Sclkn
<br />,,.,, it tz /q o",- !t-e-4 .9ryr*
<br />DECIJAAIIOX
<br />I h6.b, trmrm otrd6 F<nihy of pqJury o.. of rh. aolkr$ !u.Lrls.tioB
<br />I har. od sill @inl.jn a C.n ificll. of CoMl to S.lf-lBU. for $o.16 comlEcl bn. a Fovid.d fd, b! Sdio. ! 7Oo ottlE
<br />L.lx, ( o&. tu lnc Ffoffi. of lh. *st for "trth lh. F n it i$ql
<br />I h.r. .'td * ill tudran *orld' conp.Mhn iGunrcc. G rcqunal b s(hon :1700 .r rh. L.hor (bdc, ror rh. FfomM.. of
<br />rh. Mrt aor which thiu pann i! ieql My *orL4 .o.ilEs.Ii,n ilMffi. ffi, ad lDlty nuntrt i.
<br />('ni6
<br />Policy Numbf lrpiB:
<br />--\ 4-*,r, r- ,,r. *r"*.ft. orih. *ork aor whkh rhn Fnn i' su.d, I crtl mr crwhr rn, F$n o &, @E
<br />$ stob<oG$t.dlolh.f,lrta NnFt ir.l.*! ofc.lilorra d.rrE lhn iflnruBlt oG lubid ro tlE
<br />@dd coopoerion pmvisbN ofsdion 1700otllt t bot Cod..I lrtlL a(mh$nh omPly tr'nh l,s. Flrtio6
<br />WARNING: Frilu.lo w. wrld'onFBdior ot6tg. 6 hL*6r1. drl tull tubid o nPloF ro ainitul FlhE dd
<br />.ivil fn6 up lo or. hundr.d lhouord d.ll6 {!100.000), in tddilion lo lh. coi of coirFBrion. d,r.36 ! p.o!'d.d for dE
<br />Sdiotr 1076 orrE lrbo. (o& a 6.t ad {.rry r tc.
<br />-- ^00,,-r, f
<br />I ta I:\s!.I) ( (,\ r Rr( r()RDtoitallo!
<br />I h.rcbytrmmunds FuhyoIFjurylh.l I m lilaE i ud.r Fovaion olCh,Fs1) (comrffiiru u'nh Sd1.n 70m)of Dirisbn t
<br />of rlE Blsffi 8l Pr.aBioB co&, en n, li.@ Lt in lull forc dd.ft{r I
<br />COIISTRI]CTION LrNDINC,TOENCV
<br />I hmby nmmundd porhr of ldjury rlEl lh6.nrcotulru(nn k dinB.sa." for rh. Ff{.lMc ol rh. $.rt i)r *hi(htht Fnn i!
<br />is.d (1i< 10r)7. Cn Cl
<br />APPLIC,{\'I' DECI Af,ATI(IN
<br />I hdir,! lfd un<16 Fnalr, of Frury on. of llE finhwinr dc.bal iod
<br />l}mhion iomnlArt'dd Nor'forir. F.&nl R.BuLt ioN ( lnt {0, P.^6)
<br />R.qun.d lnrd o, tldifidhn
<br />I cdif! rhd rlE t <Lrd r.rurlFd\ qeJins 6tEdos rou.le( mr 4Dl'.thL (' lha U.Jd
<br />5f.9,n,*, t*,*,nt qrlrdi.n !n r.rcrhd rh(.tr\c,nrotuk n 6.odal I 'src ro onrly s'llh dl (irrmil cotrnr,_
<br />od,.ai.6 lnd std.lr(. r.ldrn8 r, buildinB coNhrtion, {d hs.by .!th.ril. r.t}Ml!li!6 ollhE Cit! ed (,'u.r! !o nl6 oFrn llE
<br />.hlr. trEt[Ed Fop.ny ror Ga-.-rh. nrFE
<br />appu-o,..,rj-, s6-r.. ]<dae<- 6Oaq< rh,. 1l )Zl1
<br />pmrrcn.E.rprh0: * Srrsa 6lab4)Lfe pau)tzfir/
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />tt
<br />F|NAL / / l, 1l l1 Fi '4n-/0Y
<br />Certificate df Occupancy
<br />Notes, Remarks, Elc.
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