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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDET DELCARATION
<br />I h.rcby dfrm undcr !.ndry ,,f Frjury lh.l I a crcrq'r tuh llE Cotx.rrB LrctrE ll* nr rh. tuUowo3 rcra,r (Sd 701 L
<br />Bu$,c$ rd holcssi,n clrLl Ary C y or Couni, *nf,n B{.8 r Frni k' .lrnntui, .xd, ,hlln)E, &nnsh rr rFr My
<br />sru u., pntrt, ilt isu4c..Lqr r.guE rlE. i.dn rB h Fnit ro liL , r8ntrl (d.mnr rh.r h. o. {E ! lt.n*rl ,uod'
<br />k, th. rimruiru ol tlr Conrre|q ! Li.n<n Lw tch{iq 9, Cd.mkr8 wnh S.ctnn 7o0o or Drvslr. I Df rlr Burirs .
<br />Pftr.(*)ns CirLl d th.r h. ,r dE B .kmlir rlE!6on {rl rlE b.s6 for rlE dh.d cic,i{nbr Any voLrirn of Sdih 7O.t I 5 by try
<br />.p,lKrnr nn r p.mii luhFB rlr 4flicrr ro . r'v FNx y or not fr,( rhrn liv. hundt.d J.Usr (ttql)
<br />_I.rs owEr ofrlE FuFnr, d my.trpblE v h,.rs r r,rr rek onFolrrbn. wui do rll *ut rn lh. llrurE i! x
<br />dalal .r oltcEd for d. (Sa.to4,r. BuriE3r rBl Pn LisoB CttL: Th. Conrlditr.! IrcM bw l]lB d r0?1, h oy8 ol
<br />rr.,n'Fny vh hilt q lqnrq osle ]n *i. &B *n kd hmrclr ur lE#lf or rhourh lui ir lEr own.n1phy6.
<br />povrlol rh{ rkh r{roEmdr e darlal d ofidd f.( n!.. ll kffi, llE h,irllE u lqftEmt! n i,! *irhi, ,+ Fe
<br />of .ql|,Llr4 0E Oed Buil]a si! lIE UE hnl6 oa F)vins $c tE d tE dn r hdr d irFr* rtE Imt6, fm th FIFE ot
<br />_l..s wmr ol th. F'ncny. .m.r.luriv.ly codrdhs riih lr..Fl codra(^ k, r.nshc! tlr nmf.l (Se. nx,r,46tr$
<br />rln th,l6snn CGlc: Tha Cbnil(ld i Ln..k l* JtFt nn lmlyh ovffi orFnFny who nurt! or rht'mlcs lhcr.on,
<br />rtul eft' (,nrrck ror rulh pNFk vrrh r o)nrr&tln,liensn punurnr t' tlECorrr&ld r LEnr l,*)
<br />_l !m.icn0r trnd., Sccxon_,8. & P c for $n E !h
<br />wotKrRs' colllPEtsarloN
<br />DFCT IRATION
<br />I h.rhy rttum !.J.r rEnniy or Fjury oR of rh. rolk,wmS d.!lf.riom:
<br />_l h.h rn r ill edrm r Cd,rr.k or consm tu Scll-lnruE r,tr *ortqr lomltnsii,n. ! Ir vikJ li'r t y Satioh 1700 of tk
<br />trtrtr CdL. lM rlI FrrffiN. of rhc woit htr *trh rlE Fmr !1 ssuc'l
<br />'4 Mv. rftj vill mi.r.'n lo,tsi (omFnr.ri)n inslrrRc, !s tqtftJ hy s..r (,. 1700 ol rh. lrtxtr Co&. n llE F.i']:r.[_.....l
<br />'* tn whih ihi{ Ixmir ir ssEl. My $.rt6 $,{xtr!ri,n osrtuM udF r l[lry nunlEr dc:
<br />(;Arrll cr-rj frga rllsoe*ltcE col^pA^JV
<br />",,,,*,, ez wG4-_*E3lc33 r:\ntu.
<br />_l c.d fy lhrr m l,r JErrorB*. or rh. uo n{rhrhrhrFh,r r B!e'1,I \hlU mr .mpl,y r., Fcon m rn, lMrr
<br />$, s r', t .rN slbFlr t' r,r wodci onsrtrqri'n h$ ol CiriomE, lll r!ft rh.r !r t rholll h.(om sunjel l,r I]r
<br />h, s i,n{Ersioh p$vuxrnlofsdDn llu)of rh. trh6r C(rlr.l rdl nnhq h$fl{ } rlth thE I'mvnru$.
<br />WARNIN(;: F,,luE r' {cuR **k B Lonlrnerion cov6.!c ! unL*tuL !n rhrll ruhj.tl !n otl'F t, ffil FMI|B {rl
<br />ov'l nn.s uri r' nN ltrkn d rhousanl JolL^ lllllr.Ulo), r!(Dn r' rlE (B or n\rr$n, Jirug.\ r\ nn'v'J.J ,,tr rh.
<br />),.,,, e?-hblLL
<br />^
<br />I l{i(h) rrtrL' uril., Fnrlrynr r^-.rJtrry rhn I xD l'!F,vsh. of Chrt{6I (-'tmhnt wihJsLh,n ?u})) ot Drv^rn.!
<br />dt rlE llurn.( rnJ I'nrrstr'nsOkl.. aJrl nylr.t{ x m lull ntr lrlcllNr
<br />3 +4O+ob
<br />ot /tt /zt
<br />(]('NSTRU(:TION LE\DIN(; A(iFIJC1
<br />I h.rhy irrtrn und.r FElry ofFqury rh.t llE. n..r'orturi)n Lnh3 'a.Ny fttr rh. rEnurutu ol rhc worl litr *lxhih$ Fld 6
<br />h{'.d rs( l0i)7.c'v ( l
<br /> PPLICAIiT DFCI ARATION
<br />I ho$r.nim u..lq Fnrlr, or FrJUry od of rh. k,lbwrnS dfthrdonl:
<br />D.frn on ftrm sArbcnor Ntrlrll..rion tjl\l.nl Rc8vhr tr'nr lTnl. .!1, I'd6)
<br />Rcqutren L!(.r ot l*r'ri,rD,
<br />I(.nn)rhrrrlrl!.JrrJkgulrrx)n\r.!rJ,!lsli$srcn)vrllrcnorrflrl'!xhIn,rh'!In)F.r
<br />f@,r, 't' , ,.'",.,",n^ .rrlkd,n r {rrc rr,{rrrrih,vc !mu! tr,\(.trc(, IJe,(n,Lotrqit!t hrtlcirr3tutcounrr
<br />-irdtrua...'rl \rrrc lf,r\rl,rmt k, hu'lJ r!!ntrrn(r!,n,arlhcrc$yJUrhorrcrlt.\.nr!r'vclolrhtrC()aBlCounryk,.nr(uFn,rlr
<br />rh.r. nrl r,rJ n'nFnr hr $N\rsn"! E -.
<br />l+.*, ** *^i**-4%T- *" ^t-/t-t-/z)r-,,,* -,,",,,r",, 4-f et^rft(r- \#lar\t7fttEz I
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq I
<br />lnsulation/Energy
<br />Drywall LI ht+s?
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence (
<br />T-Bar 3-sl.2l 0rh(\ rl
<br />Handicap Req.
<br />Deputy Final Beport
<br />Enoineer Final Report
<br />Flood Zone Certil.
<br />I 1
<br />.-,t VKVYl
<br />Certiricate ot Occupancy ' \I
<br />Notes, Remarks,Etc
<br />3 -Jl -2J t J E€ 'Y"tt A)-a
<br />Dl*&1tq,
<br />t( 7
<br />FINAL A 7L
<br />I
<br />,",,,,"",,,",(43C^ covg€iO?S
<br />I
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