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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE tD/stG.COMMENTS OWNER BUILOER DEL(:ARATION
<br />I lEr.by rlr,m utulcr Fnrlry or p.rjury rh.r I d .r.qr hoh rrr Gintr&1,E h6E U* lor !h. n,ln we8 he)n ( s& '7o1 ,.5
<br />B!nm$ .,n Probsbn Cclc): Any Cily or CNnlr rhrh rcqllc! i iFd nr $nirucr. .lr.r. hIB,v.. &Bnirh r EFr $y
<br />jturu., Frtr b ns ssu ., .lso Equt r tlE .mll.inl lor rBh IEr r r) rit r risrJ {tl.t.r rh.r rr.t it u lE.trrd nuorit
<br />n, llr tn)vs$$ oi llE Co.lr&kn's LicnsJ Lrw (Ch.t'icr 9, Conmmrs *irh Sdkn 7(ID or OrvrFn ll ol th. Burrcs! s!
<br />PmL$Dnr Co.l ) or rlut lE or dE i! .r.ry'r rtE froh.sr rbt tr:s r,, rlr .lk8.rl .r.rgii'n Ant voLlnnofselrr 7ull.5 by.try
<br />.t?lR.nr tu r Frmi subFts ltE .pplfrnl to . .iril FMlly of Rn mn. lhln lit hunl&rl Joltdr 1t5tr)
<br />_1, .! owr. or rlr F+.ny. M ny .,p,oF! wnh wr86 .r llI, sl $rtfftu, r & llt wdl ,rl ilE xurc 6 d
<br />ur.*al t' ofi.cJ fd qL lsa.7044. Buras rnJ Fror.srlni Grr.r T|r Cr"rBim r Lr.r l, .lE Br q! , k' & .l€ ot
<br />rrEFtdy vh' t!d& rFtrE tlEqn.!n vlr) (16sts,t iNttor idrllor itwrih hr r lE oq.r+hy6.
<br />Fovrtd $.r tuh imFtrEfa e d.rdrlal *off.Bl ftr.t.lf.lrw. rlE tndllc r.rFsid ! sU *.1i6 G Fr
<br />of.urllldrE tlE OwF Suiltr y'll
<br />'.r 0r h.&, o,F)yrE d lt d JE dn d lllrl uqmE dr FIEiy lstlE FaIrEot
<br />-1.
<br />$ o*Er of tlE F{dy, e .r.l8,Ely L!.rtu1!U w h laqE! $l'lrsiE b {,NrMr rlE FrFr lst ,Oat. BBIK
<br />.,ll htrlshCa! TIECont lm ! Li.rM L.,r,rs mi .ml, ro d o*r. orln,Fny qh $u'!rrd hthEi lhdM,
<br />.d wlb .adfu! rd rkh FoFk wrn r C i (, [..,eJ FEd h rlE G)nr,rrd ' Lx.M Lar.
<br />-2a (
<br />DECI.ABIIq!
<br />I h.rhy rflnnundcr Fn.iy or IE ury orc ol lh. folb*ug dcll[.rioN:
<br />I h.E .Jrl wnl flrntri, . Ccnifr.r. ol Cornt ro Sclf- lnruE fq kl,tqs $nqrnlrrhn, 8 F vrLd tu by S&lhtr :l?m {l lh.
<br />lrrtr C\rlc, ,.r llr Ffollrlec ol lh. *d lor *hiLh rh. pcrnir i! trrx.rl.
<br />I h.vcdnJ wrll mdrruin worlcrr.ompcnsarion msuBtuc. as rcqtrr.l byS(rtrh l7{ll Irh.Irlxr (ir!. ntr rh. p.rli)mh-'c ol
<br />llr w.rl rnr sh(h lhN pcmil is h\sl. Myworkgi rohFnsrx ortr,fr'. .rrf,r rd Frlry trumh.r ,.:
<br />Rni.y Nunbcr:-ExFrcr:
<br />_l (.nilyrh.t r rh. ixrli,rmRt of rhc w{rl itr rhf,hlhis p.rmi il nrBl.l sh,ll nor.nli}h'yrny Fhon tnrnynrnmt
<br />sr Nr,, h(or suhrd b rlE krk.^ Lrip.nirrk,n hwsolCrl'fomr. r.d UEc thrr ril rh,u! tE.or tuhFI brlr
<br />wn*da .umlEns,rn,n ntuvi'ons ol S.ciion 17(I) ol th. L.htr Gi., l rlull. r,"thw'rh $6t y e h rhls !n'v(i,nr.
<br />WARNING. Flrlur. b s_uE *nlrcB conlEns.lion corcna. rr unl.*txl, (rl shlll rxhF! r. .mtL'Fl lo oni.ll FBr.s !d
<br />uivrl rrmr uI t. ox hundtd lh'us.nl dollss (5ll)0,q$). m &l]irDn k, rh. coi or omF,nxdn, drm3.! rt F,vrlcd ntr rlE
<br />Serh. 10?6 ot rh. L.tr GrL. inlcresl.nl .ltomy r krt
<br />,,,,/e'g - 20 2l
<br />nBcl ^ laTtoN
<br />I hr.ty.rrm unLr Fsxy or F jury rhrl IrhIEnGIunLr F)w.n ol Ch.pls e (.r'ltl,mus r h Sdbn 1D0) or DflB.n l
<br />oI rlr Bu@s nrl ProfcsbB Co&. .rn my liru i. o hill foN .nl.Ifal.
<br />COI{SIf, UC'TION LENDINC AGTNCA
<br />t h.rlry .ffrn rBLr Fd[y ot tE4rry rh.t llE s. la[lBrln l.shu .Sc, (' rtE Frftllrla. or rlE sxl lor vnd rha Fnn i
<br />N.rlrs-.vr7.c!.c.)
<br />AIEIISANUTESJEAIIA
<br />I hddry rnim !nd.r Fn.lty of FrJUry oE oI lh. louowin8 tk hrrionr:
<br />D.B)hi,n P.rrub-AsrEno! NdifirllEn f.&ril RcSx htkrr (Ink 40. P.n6)
<br />_R.qur.d L.ttcr or Nnifu'bn
<br />_l (d y rhrt rhc lcJcrrl rcAuhl ns r8u,jin8 astf,rlor rcnrvll irc nor .ltt rabk rr rhr I'n,rd
<br />lrcnnyihrrlhN.caJthi\rptkanona {rr.rharrlrrh'v., litk{L,rrnnly q hrll('irrnl(i{dy
<br />rh'v. mtrrrnEd nn'p(ny lnr
<br />I
<br />I dA o
<br />)
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />tl I
<br />FINAL q 6\7^DAtr-}-)
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc.
<br />Cai..
<br />t.t CML--r-
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