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BUILDING- INSPECTOR RECORD
<br />SITE-WORK ID/SIG.COMMENTS OWNER BUII-DEII DEt,('ARATION
<br />I h6.b ,frm und.r Fully of FJUry lhd I m crdpt tro6 rh. (n rdoR Lt.e t s lor !h. folk,$mr rd)n tsd Toll 5
<br />&!u* sn Profdnn ('ct ) Art (-It or Cod' trhrh r.qutr6 r Fmi ro co'rnruct. alr6. rmFov. d.fr,l6h or r+.n &]
<br />nMd., Fior to s Bffi.. .&l rnp,6lh. rpplkd for ru.h p6ni ro lik r rtkn rdaEn rhd lr or sh. i lic.r6ai poNd
<br />ro rlE Foliio6 of rlE codE o.! l-ir.nsat b$ (cluFs 9. Conofr,ns *ith S.crb" ?000 ot lhBr. I of rh. Bu{s lBl
<br />r\radbru Cod.) or llEl lE c alE n.rmd lhd.fiom ei 6. tEir f.r rh. rlhs.d.Gnprio. A.y \(ldion.f sdr)n 70rl 5 hr a.,
<br />rDpli.. aor a Fii slhjEli rh. rflllicdr r. r.irrl p.mh y of nor mor. lhd liv. hu&tr.d dotl6 ttrm)
<br />l. 6 osF ol I h€ FotEly, or nry cnDlotc with wr!6 a rhor gn. conF$ton, rnl.to thc worh dlh.{ru(rlGs n.r
<br />inlodd oroffr.d rorel.(sd 7(11,1, Uusinds ud Prof€srioa! ( dl. 11. ( bnrackn s t,icd. tiw do6 nor sonly k) !n o$n6 ol
<br />rht ,(rndy *to boild. or i,rF)v6 rh6q'a and $h. d(6 rrh *rr{ h'nr.llor h.*lfor thoush hi! or hd o$r.hrl,'r-G.
<br />pru$d.rl rhar such imFrvomt3 e B, hrsrdcl or0lf6ll aor sk l[ lf,)$6r. rh. hrkiin{ o. in+ror!ffi i! f,,ki $ [h'n o )a
<br />of.o.r{1lrion, llE oend lt{itla $ill hAr rlE htrda olFlrtru thd rE or lE dd er burB or m!rctr thc ,nFqq n, lh. Ftrrx,s or
<br />l. E o$E of ih. FtrFrr, m dclBtr.lr.oturms trnh hcc!.d conrrtoa kr lldrud rlE Flrcl ISd 7(xd- It6'6
<br />$t Pr'as{ Cod.. T1E Codrxror'r l.'c@ lrtr' &6 fr, {plt !o m o$.d of FoF) $no hdiLiL o npror 6 r h6 6..
<br />ud uln oddr rtr s.h F,j.(r \nh. coffio(r k<sq, Ilnuar to th.Cunrctois Lale ljsl
<br />lan.\cmfl und6 S*!.n .B&P( n,lhlrr6,n
<br />D.(. - Orn..
<br />n ou{r ii, conrPrlNsalll,^i
<br />aticl,alallo!
<br />I h(.by amm u.dn p.n.lry. f !€jory on.. f rh. aoll.$ins drleatn,m
<br />I h.\ c en will mim.in 6 (_.nili(d. df (-oEdr t6 Sclf-lNu,. ntr wo.l4 .-npss.rion. 6 ,.ov .n tor t y S.dm llr(x) of rh.
<br />Iibo. (odc ad ln. Flolr,e. ol rh. $ MI for *hd rn Danr i soGJ
<br />Grur.d t'} sdfr 1700 or$. Llbor Codc. tor rh. Ffor:re. or
<br />n. 'tulle .ffi td Filit numbs r.
<br />,. ,, 4\rnw
<br />I ccditlhar inrhcpdnrnDnc.ofrh.worr lorwhichthis psm iE u.1j,lshalliot oploy any rEs)n 1n uny mun6
<br />$ &s kr bccon. suhjd lo lhc *o 6'conp.nsalion lass uf('lliromid, dd +6rhd ifIshould ltcom.3uhJ.!l k,rlr
<br />srrr6' onFNtio. p(,rlrioN o I tcl on :t70o ol th. tlbr (id., | {EIL n)nh} nh .odtly * irh rh)e l,.\ irnN
<br />WARNINC: Fdlu. ro su. sorrd ..dFE li.n .oran*. i! unL$lul. d ihall 3ubFr d mplo)6 kr $miMl FBhis d
<br />civil in6 up ro oft hun<lGl rh.a,r{ dolld (1100
<br />sdion 1076 of rh. Lr66r c{xk srdd ,ld dioffi r
<br />O0O). in &ljnn'n t, Ih. con of n n, d.rr.*6 .r ,r.\ d.d tu lhc
<br />I ho-+r'a,Im und.t Fuh, o f pcrjury rhal I e lic.nr.d un&r Fr rxnr or (lqic 9lo.1ll@ina u h s..rn Tuxrl ofDi\ iion l
<br />of rhc usi6 e.t Pmfdiotr! ( od., ird ny li.@ i. in rull nrN dri.rTd
<br />,..,,'.,,.,r. Clb**tllulT ,b 0
<br />coNsTRua-rl(lN LttDlN(: a(:fll(1'
<br />I h.E6y tfim ulxld ,nlt or Frr] lhd lhs. is a odMni Lndits lg*y lor th. FflJffi ofrh. $ t{l fo, $ hth rhir Fni i!
<br />slol (SE l@7.Cir ( )
<br />APPr ICAN r OtCt Alr,r'n{rN
<br />Iho*yammundd r.nalt, olFjory o..ollh. aollo*inr dsla tunr:
<br />I).mlirio. Pmirs-Asb6lN Norific n'n rB,gal R.luLtionslrnl.10, Pd6)
<br />R.qun.d ljir6 ol Norilic,r$o
<br />rrl .frnE ublc b lhn Frj.Tr
<br />cinf{minn ii.otu l4cr.6md)snhrll(-nt.frl(-ou !
<br />hi! C[ ) ,rd (i!.r] !. 616 upon rh.
<br />MP,tt S(4roX
<br />.urlsnr. r.Fetdir6 of r
<br />a[2-rt\?
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />fqlning
<br />lnsulation/Ene rgy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Mason
<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 blA't1 /f'^JliLi
<br />Certificate of Occu pancy
<br />Notes, Remarks, Etc.
<br />I oare I
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