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SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILD€R Df,L'AiATION
<br />I hd.b dmm unda p6ahy of pdjury lh.r I o crmpl frcm rh. Co.lr.cloE t-icsc ltw lo! thc fdb*ins r.&h (Sd 7011 5
<br />Itsin$ dd P.ofsn n Co<L). Ao! Ciry or (ilunty nhich r.qun6 ! Fnn ro Nn.ltud, !id. imr,.\., &nolith or l4.n a!
<br />srNdwcFnrloni smq rto rcquic llE 4disl for such Frnn ro fiLr!{Ed irdd6r lhd rE in i lica*n poed
<br />ro rhc F\.b6 of ltE co.i*roir l-rc.re.d tr\ (chrprd 9. (onntri.s qih S.nion 7(xxl ofDivieion I ofrh. Ilunns and
<br />Prcfsnrh! Cod.).r lhli h. or sh. n dcnpt lhrcnom md lh. Llir for ln. allqr.d crmprirn Anyrigltrionoisdtion70rI5b.ny
<br />ra,rlicad lor a pd,nir iubjcrs in irrli.ml r...ivilttuhyolnor mr.rhM n( hund,cddolluJ(t500)
<br />flr{,.S-"* o,r,.
<br />^,.nr.
<br />or d} dplo}6 trnh sr*c s'h.rsk(.nFdnn. nild. rtE tr.l.ald !h. rME. ! on
<br />inraxlal or otrd.d fd !1. (sc 7or,r, aBin6 Md Pr.aBiod ('d. T1k (-onrdors Lk@ l,s do6 n l qI'r] to d o{nn or
<br />th€ FltEly \rho boild. or inl!.o6lh@o. ud who d(6 such tr!,t himsclr.r hBrcllor rhnush h{ 0116 .wn mpli,r.s.
<br />p.ovid.d rhrt such !qn)!dn ils e mr inloljal r o,rdd for $h I I IDB c. rh( t!ildi.* or ur{io\ 6Eni Ll s,Lj u nhin on. )tr
<br />of .onpkr'( rlE (,cffi ILikk $ill tf,E rlE htr&n of rni,E $r rr or rhc dn rn t{itl oi iqm1. tlE F!Fr\ f( tlE Fnrr* or
<br />l4 n*o ot'r'. r,"xny. *.\clun\rb conri 'n! wnh h.mKl .ont.rloB ro .odrucr rh. proj..r (ss 70{a. Buiind'
<br />l^i htk- cod. lhc('onhcrLtr! l-'c.ns. us J.6 nor 4"'ly lo oosnn.rFoFny$ho buildsor nnph\6 rh6o.,
<br />md f,n).o B13lor s.h FoFlr $ nh . Coddo(s) li.rB.ri rElM ro rh. (-odr.d.r! l.i.e l,tr l
<br />Fiff-.,pr -4. s-r,-*"'b- tS 17 o.*'l(
<br />DESJAAIIA!
<br />I ls€by rmm un&r rEnlhy otFjuq nn. otlhc folkrrn3 dcldilnN
<br />I h.\. ri Nill minr.in . C6ri,Erc of Colgt r, s.lalNurc tu s$t6 compssll'on. s Fr\ij.d tor br scrir. r7(x).irh.
<br />Lltor ( .de for rh. Ffoffi. ot ih. \o fd$nEhrh.Fnd a an d
<br />I har. .tr{j f,ill nlint.m s 0116 .omp.6.tFn iNur.ft.. s ..rltrir.d by 56r nn !700 of rh. I !bo, ( od., n, lh. pdfomM.. ol
<br />thc worl aor which lhir F(mil is isql My vortct comFsti.n iBurMcc c is $d policy nunb- E.:
<br />PolicyNumb.r li\pirs
<br />f{8.-,n,r',, .,* p..r"@. dr!h. NorI ror rh'ch rh! Fnn E Budl. I rhdlmr mpk,r er Fm. 'n.nr noF
<br />s srr. h(.ft tut 6r ro rh. hn6'omFMFn l,s 6f crlif.m( rd .sR rhr if I .lsuld trtoft $tr.<t to llE
<br />10*6' 6mFmr ion prol irio6 of Sdhn 1700 of rh. Lltor QtL. , 3lull. fonhNnh .omFly s ih
<br />'hoe For nod
<br />WARNINC Failur. lo kuc $oild' compoMtun srFln. ir nnldutul, dd .lDll subl<i M dplot? ro $ininnl F!hi6 ed
<br />civil nn.r up ro onc hundEd thouend dolld (t100,000). in &ldirio. t6 rh..d ol comt nsrion. dmr$6 $ providrd tor lh.
<br />sdhon .10'16 0a rb. lrhtr cd.. i.rdd d drotrr.- r tc
<br />-,",.4.(t.i?
<br />DICI.Af,AIIQ!
<br />I hd.t r lrm undq rE ll) oIFJuD lhn I m liLqE d unds I'ori9ior of( hq,is 9{srmnins snh sdthn 7000) of fi iridn i
<br />of $. ttdilB r.d ftsrBioc Co&. dd n) li* ir h all r.R! !n.lTdl
<br />callrBl,lqltorLtduac-acr!.9
<br />I h.r$-! rfrm unrla Frhy o f Fju.y rhd rfid. ir r sdMnn kliinS lgtr! to. rh. Ff(,ruc. otllE $orl tnr u{i.h rhi Fmi u
<br />&Gl {s6 !097.cn ( }
<br />AfIU(ATLDISAAAIIO!
<br />I h6dD,rJrm undE pcnihy of pqjury o& of $. fd los ins dal&lr ioot
<br />D.mliion Pmils-AstElos Notil-rcurion F.d6.l RcsuldlioB (,nlc 40. P 16)
<br />i.!un.d tnrd olNdilrdin
<br />I cdiry lh3l lh. a.{6!l r.8uhlnrN Esardirr atElo3 rd.v.l trrc not 4rlMbl. lo lh! Fqcl
<br />g(flq,ll rhd r ho",od rr'o lppltrion in nd. rhd rh. ab.\. inft,nMid. ir.old I '!,e ro Nmrly anh !u ciry 'nj
<br />(i,u \
<br />ohlimft6 .ntt srd. h* s ElddB ro tlildr.s .o6fud n{ ,xt hd.b rurbrn..5in6 of rhs chy r.d ('ounrj_ lo dt( llxli th.
<br />rtx\.n,otk'ncd rop.n) fitr iEFli,r
<br />\t,t,li(,trr' r[(nlsiIni(u't x C:15
<br />remi,Fnrn.(pnn,): *_ Mo
<br />:-F
<br />rl Lrl qm lre 7
<br />t7
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subfloor/VenVlnsulation I
<br />Roof Sheathing (t l'lel l+ t. N-LLI-{\6&,
<br />Shear Wall
<br />Framing
<br />lnsulationi Energy
<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 />Engineer Final Report
<br />Flood Zone Certif
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<br />FINAL 7/t477'Xfzzt )
<br />Certificate of Occu pancy
<br />Notes, Remarks, Etc
<br />BUILDING- INSPECTOR RECORD
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