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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OiJT NER BUII-DER DTiLCARATION
<br />I hs.by lmm unds p.i.lly ot pqjnrr lhd I m .r.nq,l E.n rh. (.odr&-loE LirN t { for rh. tolbs lll3 rNn 156 701 t 5
<br />8!.in6r t d Prot<br Cod.) Any aily o. (tunly shth rcquiB r Fn il lo (drud, .lld, inro\c. ddmlsh or EIin d,
<br />3rtudmi Fu ro ns sueq sle rcqutro rh. .r,pliclnr for rucfi rErni! ro 61. ! siAn.d n,tmor thEr rE ., shc t li.nr.d puB!,'r r
<br />ri rn FoirhB of rlE Cof,urroi! Li.6!.! U$ (CtuIia 9, (ilmfth8 $nh Sfrlh. 7000 of DtrisFn r ol rh. lrGins lnd
<br />P@r.$ion! Cod.) orrh'l lE or rh. i! sunpr llE.liom ud rh. t6n for
<br />'rE
<br />!lL*<d crnDrri Ait rhhrnrn of s.cr$n 70:r I 5 br dy
<br />lppltot lor. p.rnd 3ubj.n. rh. applic..r ro a.ivilpcnrhyoroor nor.rhd 6r. hundr.d doll$ ( t50o)
<br />-1.
<br />a 0*6 ollh. p.!Fny, or my drlolG *ith M86 s En hk of,Fdion. $ill6tlE$(t,'drlEsnd@! ml
<br />inr6rj.d or o,T6d for sk (SE.7Or4, B$i,B ud Prllblioro Code IlE Onrrdoi3 Lt.M ll* &6 no( .Drly kl o oqE of
<br />rh. FoFty *'ln t!il6 ry urgnE rfidor.d *tr dE ern *vt hitu lf or ha*lf.r rhmush h'. or hd osn cmploycr.
<br />rrcvid.d rhat soch iryrovml! @ d inrad.d or otrad lilr..L lf. b\as. tlE boil,liry m hqovdEr ir 5ll ninin "E 16
<br />oafr,iptiio'! rrE O*c B{ildd Ell hlr tlr hr&n ofFrrrng thd h. or rlr did d brld o' up.!E ft FnFry lor rlE F4or.f
<br />l.6o$M ofrh. pr.Fry. o .xluir.ly.odrrdi.g snh li(o!.!.o r.do6lo$Ntrucl rhcploldt lsa.7l!4.ltErs
<br />tnd ADfsion Codc:'Ih. (i'nlrrlort Licce L.*'&6 n4'r,hlououn6ofp.orEny*hob{n&orimpror6lhtd,..
<br />md who .oltlra.l3 lor luch protds wirh. co 6.10(,lf,sB.d pul!@r lo rh.codraloar Li.c llsl
<br />I e .r.6fl urda s<rrn
<br />tlatf,Ei5laut};lsaflo!lr[(l.alalla!
<br />I ho.Sy rmm urds pdEhy ot psjury on. otlh. folh\ ins ddt rll krN
<br />I hr\r,x! uiu mlinrM . CdrifKrr. orcon6l ro Sclf-l6uE fo, $o 6 compdlillFn. a Foldcd aor bvsdn)n:r70oolrh.
<br />l.boi Cod.. fo. rlE Flolllldc o f llE f,lit for stkh rlE Fnr i! islcJ
<br />I h!v. rnd e 'll mlinrlin sort6 .omr.6rtior i6ursnc.. s cquR{ b, Sdr hn lTtxl orrh. lrhor ( od.. Ibr rh. pdlonf,e. of
<br />lh€ $orl aor $hth rhi Fnn t &!d My s6rld conFldi,n iMa. @irun Fh! nunh.r ar.
<br />I cdlily rh,' in rh. Ff6,Ia. of th. sorl for $tihrh'r Fnn a sucL I ddl frn moh) m, tE$n rn lny m&F
<br />sr a to h.$E subjal to tfi. wrt6 rcnpcNlIion l.w5 o f Caliaomn, lrd a8E thd if I shrll*l hao'rc .utid l. ih.
<br />{ort6' omFMio. Fo\irioB of S.dtn ! 700 ol llE linr ( ode I shrll. fonhw'th comFly r''lh lh.s prcvnionr
<br />WARNINC: t!il@ to 6u. *orLd cooFuaion cordsc i. unh*tu1- rnd irull $bj.( d onprolq r. dif,iol Ftrli. rnd
<br />cilil lln6 up lo onc hu.dr.d rl$uud dolld ($100.0$0), in rddirion ro th. cosr of cotr{rsrioi. 6rDs6 a pturA.d aor tlE
<br />sE rion 1076 ofrE trlor Co<lc inrsa rd d1otrDi3 fc
<br />LICEIIID.]LANIAACIAB
<br />DECIJ8AIIqdIH',!,Irnund6 Fn!h, of pcjury
<br />'hrl
<br />I m li.dr.d u.dd pNvi.m. nfch.rr6 9 i comnrnci.s sithSdirn 7Ul0) fl)nisio.l
<br />of rh. BaiB ad Prof<D6 Co&. &n my l(.u ! r tull forcc rd.lT<r
<br />talllallcrQt.L[dDllclc[ltr
<br />I horby .IIm und6 D.Ehy of Fjury thd lhr. it t conrddion bdinB 4*, for th. rEf.ffic ot lh. tr orl hr \nth rhir Fna n
<br />iecd ts6 l097.cir c )kd6 ! Ne.
<br />affu(atrLuigla rus
<br />lhd*y.lnnn und6 p.nah y of pqjury on. olrh. r(lk'*ins 'lelr.lionr
<br />D.molilM PGm 3- lbBros Norifi.dtn'n F.lj.ral R.rul0r tr8 (Tn l. {0, Pd6)
<br />RGlur.d l..trdorNotificdion
<br />I colifr thc lh. fcd€r.l rqubti,B.eadinrr 6tdm rm\rl a. nor qrpl(ablc h rn6 projd
<br />I cdrft rhd I h6r. r6d rhG .fi,hc.uon el $r. !h!r th. .hrv. rnfomdnJn a cotrd I .8rE ro c.mnly \ irh ill ( it) and cotrnly
<br />ordituft6.n<! Srsr. Lln ch iry ro tlildrs coldrud ior en t(ctl{ lurlFro. rqr.6rn 6 o f rh'! C( r rnd Cotrnry ro dr. uF. rh.
<br />abov. mdnon.d pmpdy for iNpccrion psB,6.
<br />Allpli.rnr or,\!mt SiAn.lure
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />Subfloor/VenUlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing (.t,s- 11 ) c9t4 .('{y)
<br />lnsulation/Energy
<br />lqnryall
<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 />FINAL ?'/t- rt J)'S..L (a\
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc.
<br />I I
<br />I
<br />I I
<br />I
<br />SLAB Floor I I
<br />I I
<br />II
<br />I
<br />I
<br />I
<br />I
<br />Flood Zone Certif .
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