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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulalion ll I
<br />Roof Sheathinq ilnDl w{t&\/1 {a
<br />Shear Wall I
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />tl nl tg.utlnFINALtlzsl^l adI
<br />Cerliticate ot Occupancy I
<br />Notes, Remarks, Etc
<br />tl"t
<br />O1VNER BUILDEI DEI-CAR TION
<br />I h.r.hy rffrn unJ., Fn.lry (,r Frjury rhd I m.r."{i rron rh. (',nr.ckn Lk^€ lrw n, rlF hllowS Ersr (Se.7ollj
<br />B! nc$ rd ltofc$on Colc): Any Cily or Coudy *hl_h Equn.r . Fmi r,' ..,rlMl. .Id. inlpn,v.. .! nrh qw ey
<br />nMM., Fbr t, nr is!4!. rl$ hquEs rrE {I . r t sulh tEm' k, fiL. r{rJ n.ktrnt lh.' lE or tE ! &..!.n I'Ur$.!'l
<br />nr llI ImvisrrN or tlt G'nreui L.rnsj L.v (atuIis 9. CDnmBhB v h Scrrh ?fir,'l DrvEDn .! ortE Brim..rn
<br />Pn,r.srrni Cq!) d rni E{dr F.rn!, rhglh'h.nr E fi.\r. nn rlr rlts.d.i.nlFh. AryvFhrimors.d..7oJI5 bytn,
<br />.ptli..nl tu r I'cmrl subFrls th. rmli..nt lo a eivrl Full y or nol frE rhu n!. tun&c! dollm (15@)
<br />L4owErorrh.FDtEny,dmy.mploy6wnhp.tcs.srh.,g,l.(of,pcMrhn.uldorrEs k!nrlErrrGtr[n
<br />dcard] m oflcrn n, dc (Se.?oat, Buiftsr mJ PDlcsNB c,rr. TlE Conrr.Ltr s lrrc L.*,ls i{'r'lyh-otuol
<br />rh. FjHy wlh t{ lr,, ur{h6 rh.rda arl ehr *- uh urt hrmalf or hcklro. rtNuEh h,r tr h.r oqcq,Llyet
<br />pmvdcn rh.r such ui{nrEr r E u, n'crrol r ot En nx s! ll, t'wE rlr tx lls o lqn'EdE n s,x *nnr (E F{
<br />of coml .lkE ttr O*n.. Bu&kr *,ll haE 0r bnkn ol In,vrg rhlr lE or dE dil Dr hortl or in{K,v. ln. Jn)tEly rd th IrtIDr or
<br />_1, .! owr ol rlr FrrEry. a.rrtunEly N r.ro3 s'rh lt.n<n (ornrF ro.\,Bmt rlE FrF..j (Sd 70,1.{, Barsr h,&su CqL: Th. Conrcnr's l-rcns tl, &Er Nr iptly n, rnowcr oa[lnrrny whr ho'ltls nr mJirov.r th.r.otr
<br />.ni wh' Nnrn.ll rir such !n,].{r wrrh r Conrtuk,(, li.cnsn I'uftu.nr tu rlr Ciflrudois LiLcnF Li*)
<br />I {mcremo urhl S!\ln,
<br />WORKEIS' CONIPENSATION
<br />DECLIAAIIAN
<br />I hcRhyrllirmundcr p.Mltyol Frjuly trc .i rhc Llhwfu de)rr.ri,nNl
<br />I h.r.d !,ll tudrtr r Ccn,lirrc of Con*d n, S.lf.I6uE n{ s{lqa (r,mFnqti)n,.r F'yrlaj Lr b} Sellr !?(r) of rtE
<br />Lrhr C,n . n rtrFrl,'lr:ecsf rllB*tu*nrhrlEFm ( srEd.
<br />Vi U"" ,n *itt ."inrul, *u,k.s ..mncnsali,'n insuan.c, as rcquuc.l hy Se.'li,n .ulr0 ol rhc lllytr C(dc, fu rhc rrrortutue rl
<br />th( s,{lntr}hrhihEtl(mr,snrhl Myw.r|r . ml!.Nrhr rEurocun nl Fnly trumh(r d
<br />c-", tlq{e canrkhs..l',{r\ I nS ForJqqqorq . la-t-xo}l
<br />_l (td,fy rh,r n rfi. Frr.lmL. ordr poA Id whrh rhr Fm! r BrEJ. I rn U *n .rploy.ny Fmn u.ny luE
<br />e rht-!rtutrdlotlEK 6i.otrlFrqrpn Lw. of Cdlroru, .!n .s!c ih.r d I nu! tE{ft iubFr ro rll
<br />hrt6 $n{Erqlnn liubi,N of S6!b. ]7oo ol rlr L,r,q Cd.. I Ill,lL ldhanh (nd, wnh rh* Fowia.
<br />WARNINGT Frnur. t' su. v,,rs con{Enurx,n ovae. B unLvtuL .,rl rh.ll {hFl e .tr'J!h,y.r lo si:ul Frhai.Ei
<br />civn,in.suptooxhundrcdthou!.nddoll.B(l,uJ.ujo).insdJihonx,th..on.lcomrEns.uon.dimlEs..lmvn.J{orlhc
<br />Sc.lrr .1076 of rhc t t[r Cod.. ol.r.r r.,j .tlomy! L.r
<br />Y7-aoal ,."",,y- 44aer.i[i rriifi<rr rrx
<br />DEqIAA.IION
<br />I hcNhylltum u cr Fn.lry of l.rjlry rhd I am lMnBl utulcr pfl,vtion ot Chflcr 9 ($mmh-inr w h SerDn 70d)) ol Divr(,n l
<br />ol rlE Busimlr dn l &rnc$onr (irL, dll ny l..ns r u tuU nrc .rl calirr.
<br />L-qsr$Ll3
<br />.-?-rort x-
<br />cq8tlBlcuaal.llDaclliElrJ
<br />I tiEby rfrrm lnld Fnnry u, Frlury ih.r rlE Lr r L$dturn hnlna r8.tuy ld rh. F.flllrr8r rtr rh. *nt fd vh.h thB Fnl s
<br />I c.nily rhir rhc rcdcri r.pnho,,n\ E8udm8.rb.{or rcB)v.ldrc trol .ptli.dhl. n, rhr pn*.1
<br />!l (nn, rh2r Llk E! rh! rmlrrri,n &l qrr. rh.r 0E tboh Dtomrrn s (dr I +E ro (drqly qnh . cny .nl coury
<br />odn'rc. lnJ St.rc ll*r ELrla lo h'!lln3 .G(ullr( rrn krcny &rbri! rqrc-d r.! or ftl1 C'r, !n Cou , t, .nrd uFrn rlr
<br />I
<br />APPI IC-A]IT TIECI {RATTON
<br />I h6iy rllm ud.r Fn.lry ol Frrrry oE.f lh. tulLrinS ddrr.rirs:
<br />D(d)lrio. Pcmrs^rlEiin N ,If,lrxr Fdl6l R.8lbrioB (T k .lO, Pd6)
<br />Rcquircd L.(cr ol *xdur.n
<br />^, l-"-lo ll
<br />Erection Pads
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