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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDf, R DELCARATION
<br />I rEr.l'y .nkn unl.r F lry 0r Flury rh.l I D .rcnd &!h rh. Odrxlm L4M trw rM rrr r{'lh*h8 Fen ts.a. -11.,
<br />B!5@!r .d Pror.(i,n CoL). tu, C y or CN , eh.h Eqr6 . FE ftr codtur. .lld. urIroE, &mlifi , EFt .r,
<br />rrrucrurc. F(tr ro . tsu.N., rl$ BtuiEi rh. aflii..d tu 3qh Fmir h tiL r siBed {.r.mnr lhlt lF.r ir i li(.tr d Fr$sr
<br />b rh. lsrvr&N or rlr Contr&n" r La.nkd t:v (Ch.pl.r 9, cl'lltrtuin8 qith Sali[ n ol Diyisnr I 01l,E BhEs .rd
<br />Ptufts.nr Cc!) or
<br />'h.r
<br />Ir d rlE B.r.FC' rhftfrom lrl rll h.$ ror rlE ill.f.J cicqrrh An, vrLt&nol Sardmrl t br.n,
<br />lp?tErnr itr r Frn tubFB llr {Dll($t rorc'vnp.EXr.ffl mErhrnliv.hu rrqi dolris (llr).
<br />l. .r r*,rr oi llE FlFrlr, or my ctrployat vilh u.scs $ lh.s $L ronFnrr ion. vd & rtt *rt rd th. ,tuiE B n'l
<br />lrftldl {ofi.Fl fG sl rsd.?o41. Bu.Bs &<j PrrtisEE Crlr TL Gl'r,-tr! tx.B t *&F!drJpl,b owor
<br />rtrl!(l|in, whot ! o n!ft,E rlfFn, r lwlrtJ(a h hd hmrlrdr llMlf or rhnulh hn d ls om.rptryer,
<br />poritlcd tnlr ruch imlrJrcmdr F nn hlnJal orodirctr tur uk l( holfu, rL t iU|n8 {r nitk'EEd ii r,U rirhin uft Fd
<br />Df.orqlklr& ttE O*rcr Bui!6 *i! luw rlr lxnLtr ol rFvut3 th.i lx tr slr .Iil ml hd q lqet dr Fq6, ft, tlt I,,FE dI
<br />_I. r! own.r ol rh. F,p.ny, .m.rdurwly ronr&hn8 wnh lic.ni..l cotrtr&ron lo.dn(rudr rhc Fuccr tS6-..7041. BuM.$
<br />.rn t\'rciwCd.t:ThcG,nrrMtLE.n€L.wl,tlamt.!tlyk'MoyftrolFotEny*lnhrild!o,idfmtrrll.r.on.
<br />Irl rh, Llnr^_.t nx shh F)Ar! *[h t Co{ar(,l, li.n€J lBhM t, rh. Cdhrd's Lr.n< lje)
<br />I rnc\cnpr tnJc, Sccr!,n
<br />l4aEf,Els:Sqltra$Ira!
<br />DECLARATTON
<br />I hctby rfiinunJ.. Fmlry f Frury.r orlh. rdh*o8 &!ll[rlhns:
<br />,*.h:F nl * l tu'nr.D . Ccnr({c oi Con*nr r, S.lr-lnsur. ,({ sortdr' ()fttEnqti,n. .. F,vr].d for l,y Sel Dn 17(t) of llE
<br />r clrl.. nrrh. Jtrtulffic. of lh. work nr whkh rh. n rmil r,$u.J.
<br />.d *rll Enith wods' .arqEMlnn iBU.B.. s r.qultn by Sctnn l7m of rtr Ltrr Cd., nr rlE Frlrm. of
<br />n{rhrhthB Fmr B lqd My*mlsr ohFurr'tr E*-,--..uF nnF xy mR*{' ft.5).[ {"^. L(;;edrtt4o ^t\.2. L
<br />_, (d,rrrhl
<br />'n
<br />rh. Frformrcof rh. worl for rh.h rhs IE n[ r islBl I nullmn cmnl,rrny pcB,o rn oy llrlmr
<br />s' rn,tE$E br b rlE k{td! q'r'ltnsri,r l,*. o(C.l oru. r $Rrh.t !*r d hcom subF! hrlr
<br />krrlsi $nlrner!'n tn'vlr(,ns or S-r (,. .l7(x) ol rlE bhf, C(rL, I shrll. i'nh*,th .rhJiy vrlh rh'E I'n'trur
<br />WARNINCT Fs u* n, $drc workcrr roqi..eril)n cov..a8. rs unllvtu|, .nd shallrul'frr m.r{,loycr t' lriminal Fulris rnJ
<br />0rn l,n.r oI k, om hu*lrcJ rh'uuntl J.llar ($1fl1,fi)0). in rJd{hn n) ri. (\r dr.om0cNrr)n. &d3.! rt prouldt Id rh.
<br />S.rtr. 10?6 or !h. lrllr GrL. ot.rdr nl .t(my'r k
<br />x","l-1, -a ?,-
<br />IECIIEAIIO!
<br />I h.rchy rlkmuftLr lEuhtol p.rJlrr rh:r I rm Lc.n{rl r Lr l!n,hx,n ol (1ufl6 9llonmtuina * h Sc.irn ?0OJJ of Orvun)n .!
<br />ol rh.llu\iNsanJ l\olis.i)nr C'od.. aftl mrli.n* N intullkr(. iil.lk(l.
<br />t L rls
<br />saNtlB!]!;Ilq!..LllDui,i-dliE gr
<br />I h.rh, llltn untl.r Fulryol Jtlury rh2r rh.E $. utrr{Nt$n L.lint stcBy nn lh. FbIlllr[---. olrh. krk fitr whilh rhs Frftr s
<br />APPLICANT NECLARATION
<br />I hsd'y cfm uBlcr I*mhy of Frjur, om ofrh. tull'srg ilcclrrrri'ns:
<br />D.Dlr$n P.rmh-AG.skx N{rrE.trr k&nl Rqulirnr\ (llh40. Pd6l
<br />R.qutrcd h cr.iMn nrrrn
<br />-l
<br />(cnny $rr rh. i|Jsrl r.Suhrnm fttrJmg.\trios rcfr)v.ldc d rll rrhh i<' rhr trtFr
<br />:$*nrr,n,, ** *"u *rapplriodn.rll & rhlrric ihrr. rnl(tuo.n kcotr*r.I dgrc ro q,ml'ly with rll cily aftl counry
<br />!lif---'.,,1 s"'. r-...r.rD! i' hrrLims .,,ntu.n'n. {n h.'.hyrurhtr& rcF.eorrr'v.s otrtu! cny.il c.uryr. c.tc. uFrn tlr
<br />rhorc ftnkrftJ lnlFny for
<br />/&plir{trr r Axcnl sistrxltr
<br />f
<br />L'LL'11
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVlnsulation
<br />Roof Sheathing ^lz5l21 DP€ry
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />(
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL 348'4 1[L Cz:nll-'r@ vzq
<br />Certiticate of Occupancy
<br />Notes, Remarks, Etc.
<br />Shear Wall
<br />Pool Fence
<br />,,r""",".,,.. C^31
<br />\" a -zl -z\
<br />^!L{ (s{ :l1$7. cr c )
<br />t.nJ.ir Nrm:
<br />f-------T------
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