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BUILDING. INSPECTOR RECORD
<br />SITE-WORK ID/SIG.COMMENTS
<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 />Framinq
<br />lnsulation/Energ y tr/t, /,? ,-,. DtrLLt 7}/ SY
<br />Drpvall
<br />Ext./lnt. Lath
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />9#r/itFINAL \ DtiLt en r(1r
<br />Certificate of Occupancy
<br />OWNER BUILDER DELCAR TION
<br />I h6.1, llfm und6 p6!h, of tEJury rhd I n B.m$ fmm fi. contreroR Licoe lrs tor $. follo*hs raa,n (sd 70! I J
<br />Bsi.B snl Prof*ion Co&)r Ary (it! or Counly $hi.h rqui6 a Fml to onntud. .nq. imFov., ddnolnh ot tqrt r,r_
<br />tucrd( Fior 'o
<br />nr iM., !k rcquiE llE pdtur for Mh Fmi lo 6L a 3irn d siandr rhd lE or rL i! li.as.J plMr
<br />ro rh. Fovilnd of [. Comrdd r Lkocl tt* ((1Eplo 9. Colm*ins *ith S..lEn ?@0 of Dinthn ] or th. tltrms d
<br />PmfdioN cod.) or rh! l' d JE ! .rdpt rtEcnom .nd llE b.sn tu $. alLscd .ronprion Any tiobtnn ot SdFn 7011J br lny
<br />op?litrr for r Fhn sbja]l3llE q'plr6r ro r.ivrlpsulyotml &E tho fiv. nu(H &lls! (1500)
<br />l- s NE ol0r FoFty, or mr mthr6 snh *.a6 E dEt $L mnp.dii',, till do dE f,dl rn tlt rME u d
<br />ida&j d ofid.d d rL (Sa 7or.l, BlsilB rd PDfd66 Co&: TIE Codr<rd'r Liw l.* dE ml {tl} r. d otr6 oi
<br />ih. FoFr) *tb Lt J.d !rqD\€ fi.ar rd rh &- sn $st hilrlf or lE$ltor rhDu3h h'r 6r hd o$, mph)6.
<br />Fird.d lt'x sch !'qhy.GB ftd ddj.d trofielt)rxL.lf. ho{6q. Ehildiry or irg$qd.5ldrih,n(r \6
<br />of MrDldia rlt ()*E &ddd {il lr* rrE hlitar olr.!}i,B $i lE d tE dii d hitd d !ryo\r d. F!Fr} for rlE F,Br or
<br />l. s o$E of rh. FDFry, o 6.hsr$1, codrdin* srh l(c.d.oturloR lo coldrud rrE Fojcl (sd 70,r{, nBrK
<br />{n hDfrsim Co& I h. ( onkxror'3 t,i.G L!* &6 .or snDly ro u o*.s of p.op<rr *ho buildr or inpro\ 6 th6c,n,
<br />ud sho cotiBlr tu uch FoFr * h. comncro(.) 1.6!di pllllld b
<br />'h.
<br />Co rd !l.relrtr)
<br />I e .rmfl uds s.irin I &P( idrhls rcson.
<br />llaxf,D&ll(ollfliNlArla!
<br />DECI.AEAIIA!
<br />I hscby .firm unds pdulty o t psjury onc o r ltu folk's in8 d.clrattuE
<br />I h.!.0dwillmainldin o(cnifical.ol (i)"s61to S.lf-ltrsuE lor *0116! .omFMrio.. s Fovidtd lnr bySdlion l7l)0olrhr
<br />t-abor cod.. nr rh. Fafonndn.. ofthc troik aor wnich lnc p6'nil ie isu.d
<br />IhflectrndqillmF'nr.'n\f,Lo.'ro rtrnrir(rr
<br />'trsurnncc,
<br />Er r.nur.n b!. Sclmn l7(Xroflhc lihn(i,d., fd rh.lEar{nrn...l'
<br />Serbn !076 of rlE liv (ii., ds.r. j dro.Ey
<br />rhc wI fn' rnrh rbr| r.rn[ 6 qnl My r-lnd' 6nFM'on iMMc. Mi6 !d rEl$ nuhbd e.
<br />cm bct/ t-
<br />po,ryNudbs: hl4o{p6o1o2,.,".'342./7
<br />I Gi6 !d 6 rhc Florle. of rh. $.rI for $hrh this FE't is isql I !h,ll Nl onplot mt Fen r.ny muF
<br />$ 6 to bcom suhd b tlE *od6'conFaiion lr*! ofc.l'tona d tgE ihd if I slDlld b<oft $tixl lo rti
<br />*! 6 mmFsrionrmlili'doas.nn l?00oarlE libo. Co<,.,l srrll fdn$nh onply *ilhllse prerlioa
<br />wARNlNc: r.ilu. ro m f,ortd' omFdhn m\a!s. ir unb$tuI. t d .lull ebjcr M mplott ro din!.!l FDiE ud
<br />cn f66 u, ro oE hrn lr.d thorqlrl &116 {ll0o.00o), r rdlnbn lo lh. coe ol.omFNiio.. d&!36 a ltoerl.d aor rh.
<br />,\pplic$r or ,tg.nl siBnr(urc
<br />*>^
<br />?___-
<br />DECIASAIqX
<br />I ha*, .ltm u,r& p...X, or Fjury lhd I 6 lie!.d ud.r Fvi3io. oaqrprs 9 (offiiD8 q'nh a!finn TUJo) .f t)r 6on 1
<br />6f th. Bci'B !d Prctsio6 Co&. rd my li.ru n in tull foc sd crf..r
<br />grNlalgIlaNl.E!.DllcJcll(I
<br />I hcby ommlnds poEllyolFjuryrhd thdc n d $Ntudir.lddins asdcy iorthlt-tum@c. olrlEworl for shichlhqFnil rs
<br />iss!.dls( 1097, (n ( )
<br />AITUIATLDECIJAdIIQ!
<br />I h.d,) altm undd F!h) of F)ury o ofdE tolbsiry dchrllioB
<br />DnmlirF. Pmilr'Albdrot Norin.n tu. I'.dd.l R.suhhn!{Tnt4{. Pon6)
<br />Rctun.d lnrd of fdirfonn
<br />I .a ii rtd rh. lald.l r.*uld nN r.*-dns BtEl6 roN\ !, {. mr .r?l..bL ro rh! FoFl
<br />I rdi4 ihd I hn. ral rhi! q'plrd n. ,n *.r. rhd th. .lFv. iofomdnn i. .ofrl I .8ra ro comply s(h lll ('r' rnd ( ,)unr!
<br />ordrmft6 .nd Sr.r. l.$s rclrr{r ro
<br />'ns
<br />colErudbr rn klb ldlbrn. EF.sdn 6 o I lhit Cny .nd cDunr) k' d. orrrn rh.
<br />3I\)1. 'n6rukJ |n.tdr ir
<br />./4/dzGZ -Z 7/7 /7
<br />DATE
<br />I
<br />Brown Coat
<br />I
<br />Notes, Remarks, Etc.
<br />----Z--'
<br />1*@chs,- CZo/C- <' . 4rc.*^umbs --232/2A
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