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BUILDING- INSPECTOR RECORD
<br />SITE-WORK ID/SIG.. COMMENTS (,\4 NEI BUII,DI:R DEL('ARATI('N
<br />I h6rb ,flm unj( rEEh of rqju4 lhn I m c\dF li.m rh. ( odrrdou l.aN l,n fN lh. folhs hs r.aen (S< 70r l t
<br />tt!sin63 lrd Prof*hn Cod.): Anv Cir!_ or ftrud], $hth r.qutrd a p6nir ro odrucl. ahd. mpr.v., doolirh .r €l.n ,.,
<br />srtuclur.. prior lo s issuuc.. .t{ r.qun6lh. appncMr for roch lErnir h 6k ! s'3n !.'dtrd ind lE or sh. ir lEd$d a^'md
<br />lo rh. Fo\ts$nr of rlE ( onkrror s l-icaFd lr$ lch'Iid 9. (i'rrft'nc *nh s.ran 7(100 ol l)ir$i,n t of rh. llcris .nd
<br />Prof6lion! C-o&) or rhd h. or sh. is dmr{ thd.iiom dd rh. b6rE aor ih. all+.d *mflion Any li.laii.n ol Sdir. ?0ll I a by 0.t
<br />lrplicanlforap.milsuhl(t!lhc.pplic.nrlo.civilp.n.hyofnotmor.rhmfir.hu.dr.ddollJ.ilJ(xl)
<br />l. B o$nd.arh.F.rd). or nvmphrc *irh s68d a rhcn 5k omFrdn{- trilld\ th. sorl dnd rh. jMu. s nor
<br />inrovl.doroalacdlorslc(sa7044.Durn6&dRla*iom(il&rht(onhdors|.rcffit*d6ro'{rlrh.qrof
<br />lh. FofEn) $ lm bltlG or inFo\ 6 rhd@ dn sL, rkE sfi unlt h'm*lt o' ,r.elf dr rkouh hi3 or lE otrn dl'lo) 6.
<br />Fo\ iiLd lh.l 3u(i imFo\ffi e ml htoddt.r.fidd ntr eh Ii t6s6c. rh. hiklng or nnfro\M $ arld sirhin.n )d
<br />ofconDki.n. rh. O$rd Uuik .r *rll h.\. rh. trrddi of Fo\ inA rld lE or slx dil d tliu a. .r{nr. tlE p.ol6) hr lh. ,uFE of
<br />l.6osns oflnc llopdy, 6.rcl$ir.ly.odrdi4 $nh li..Ed.o.rdoG ro NdM 'lr lnF lSd 704,1. &am6
<br />!d ltntsi{ ( od. Th. Contrroi. L(.@ lrtr d\.6 mr .pt,l! ro e o\ n( .tlreFty tr ho t{ildr or oprove rhdNn,
<br />and u'ho (nhds for sucn rmjal] *,irh s C. rd.n, li.ar.d ptrRud ro rh. ('onradois t.rc.M b*)
<br />l0 crcmpr un'l( Sdli.n
<br />D.t. ornd
<br />lVORX r: q-i (',Omr'iNSAr'l(tN
<br />DgcLaBArla!
<br />I h6.h lmm u.d.r FMlr! ofp.ru^ oN ofrh. follos ms.lll-!rird:
<br />I h.!r drl * ill roi.ilin r Cd,a.nc olColer ro S.lf'lBu. for s.ll6' NmFBion. B lro\i&ri lor ryq Sdrn lTUrorrh.
<br />Itbd Co&. fot lh. pofolrrft. oa lhc *orl lor qhich llr. Fnn n is.d
<br />lhi\.dnJ*'llrnn,nt.'ns rldr (iimr(nsirn '6u',m. a! '.qutr.d t\
<br />x:T"sHi. efi e"r-r' F.I.? "" -'
<br />*,.,",**%a-1D5
<br />If,n il)n lrm of rlE lrb.i Co&, aor ih. FltnM. of
<br />conr and Fli.y.umbd @:
<br />;,-* re -r " = tl
<br />l.sr'Iylhnl in lhc lEfoirEnc. ofrh. worl lor shi.h rhB r-ftir ir i!su.d. I shdll n.i mploy iny Fs. r. r., mMnd
<br />$ arobdom. t dr b rh. *.ltdr'ohf.Bdrn l.*.of (al'fom'r. elatrrhlr if I slr{ld laor iut €r brlr
<br />trrrl6..mFBtiont,.\aioBolsdx,n17mofrh.lltrr(,{i.,I5Arll-fonhs h comdr snhrhoE,n,vilons
<br />W RNINC: failur. x' s'trc {oit6 canpftdmn.ovd*.6 dnla$tu|. dnd rhallrubjar an mplolw kr onmil FuhE..d
<br />cN'l fin6 up ro oE hundrcd rhouend &1116 (lloo.fixr,, i. nfinh. i. rh.of mmFNrion. dan *6 &r tro\idcd lor rh.
<br />Sel('n 1076 of !h. tihr (idc. i.lsd &d dkr*:'s li<
<br />I hdd^.mrd u.d.r Fah) orFjuD rhd I m licded u.rkr Fo\irn ofChlpls q l.on'6cins sith SelFn 7u$l otDNcnn.l
<br />ol rht tlusins rnd Pmt*rcB C.d., ud my lkde G in f,llio(.md.lTer
<br />v.."*,*.lO X**"*,,.,,s/ta/e y "***geyv1
<br />,", q+A t(2-
<br />?-r Slar) I
<br />IaXiIAICIIaII.IBDIXGAGET(I
<br />I hd*ry alrrn un& rn h).lFrjuD- rhd
<br />'hq.
<br />s a oldrucri'n L'al6-r latur ror lh. Frotuc. oa'h. {orl ntr $h[h rhn Fni b
<br />8u.rj {1i.. r09?. Cn C)
<br />affl.l( NlDfg.daa.rlo!
<br />I h.,!b a,lm un&r rEah) {rFjur.- oe orlh. rolL*in* rk lsdi.nr
<br />ItmlnFn P(nns-Artdn Notificdion FaLr.l R+uhl i,ne i rnh 40, Pd6l
<br />Rdlur.'l Ln'6 o, rdifEdi,.
<br />I td'f, rhd lhc L&r!lr.sultlEd Esrdins Nbglos rmrilr. kl E lrcrblc lo 1fi.,Nr.d
<br />//l cqt,fy llur I h.v. r.€d rht lprhc ion ed Jror.rhd rh..hov. rnronndio. n corui I aarc ro snply rvnh nll(- r.nd (-oun\
<br />\ ordinrncG ud srar. L.trsrck't'3ro hrld'u codrudNn. ad hd.t,
<br />!tFv. mliorcd FoFr! fn tr+..tioi
<br />!,tppli.snl or,tc6l sianrhrr.
<br />: u", ,nr"^ ^"lrn"rl SPA
<br /> r'.@-,"".'Y[i';i ;
<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 />Fram i
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-8ar
<br />tlandicap Req.
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL b/az/r t 5- &'-r izrv 6y
<br />Certifica te of occupih-y-
<br />Notes, Remarks Etc
<br />\
<br />I DATE
<br />>"s1e l]__
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<br />Deputy Final Report
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