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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE
<br />Set Backs
<br />Forms/Steel/Hoidowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subfloor/VenVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulalion/Ene rgy
<br />D rywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />/r\
<br />FINAL t-21-A
<br />Certificate of Occu pancy I\_7
<br />Notes, Remarks, Etc
<br />OWNER BUILDDR DELCARATION
<br />I h@by .ltr6 uds pdrly of Fju.y 'hi I e d.r!9r frcn rh. Co.n[<1o6 Li.@ I.* aor th. fouo"inS rc&D{S€]ol a t
<br />BuilB &l PrcaBbn (-ri.): tuy Ciy or Coldy $nih Eqlir6 r Fhi lo 6rdM. .h6. !rp.!ve domli,h o ip.{ d}
<br />iird@ Firro ir3 is]l.E. rto rcquErhc tlPltr fr,r *h Fnn lo 6k r listEd nidEn rha,ror 3hc ! lto!.d tulrd
<br />r. th. FovlioB oldE Conr6.loa! Lic..!.d Llw (Cber6 9. ( omfting wirh S..rhf, ?000 of Divnion I of rh. B6in* .nd
<br />Pr.ldioE Cod.) or rhn ll d ir. L .rsrF rhE nom ud ilE b..t for rh. .lks.d crdFhr. AIy lioLrion of Sdio. 70:l I t b, .ny
<br />.spl'cer ror r Fnn $bjd, rlr @lic.!r ro ! civilFrhy otmr mc rh6 firc hu.<t d &lla! (ltoo)
<br />l. s o$G ofrh. prerEiy, or m, mpLrG "th w.g6 s ri.i $L omFMion. *ill (I) llE *rlt sld th. ltrurE ; m!
<br />inrad.d or o,I6.d for sL (SE.7044, BGilB ud ProfdioE Cod.: Thc ao n rois t,t.@ Irw d.6 ml {Cly ro m o*ns of
<br />rh.FbFry wlb bilrt int,lr€ Ea rd*h. dB ial wr hiMllor lE*llo. rtuouClir o, fid o{r.npkr}B
<br />foyd.d rti Mh nry$qEr! ft (r ironcd d otu 6r rt l[ hos!, ttr hli!,t r ingbqd ii ild *ihs * !r
<br />orcotrpkior rh. OsF Duild- will h.w rlE hr&r ofFovi,E rhr lE tr !tu dn d build or nrDror! E F\p6ry 6.llr F!po.. of
<br />l.601601lh.F.F!.o.rcbn lyconfting uirh l(d!.d 6dd6ro NtEruci rlEFoF (S€ 7or-1. &!d6
<br />.,t Abts, co&: Ttic ( ..ndoa. Lk6! Lrw do€ mi @l) ro e oqc .lFlFrt sho b!il& o. ihprorB rhcon.
<br />.nd who (ntracrs lor $ch proFi rirh ! Cor ftr.(3) !i.dr.d puBuor ro lh. Cotnr.crois LicaE ll*)
<br />I M.rdpl un&. Sclhn
<br />l).r. Onrtr
<br />woRr(FRs, ('onriiNsArroN
<br />DtigJtIIlQ!Ihq.b !flim undd FMh\ .f F)u^ .ft of ln n,lliltrm3 &rl,.r$B
<br />I h!v. dd wr ll nlihr.in . C.nirrlr. of Const h S.la-lNur. nn eort6 mnp.nlnion. 6 Drolid.d aor by S(r'on .1700 o I rh.
<br />l,bn cod.. for
<br />'h. Ffome. of lh. $..t for Nhi.h rh. Fnn ir i!.u.d
<br />I hrw .rn will mirn.h srt6 on4qErid irme B 'tqriEd hy Sarb. 1700 oftlE t !o, Cod.. for tlE FfoiMc of
<br />rh. wt hr whkh rh! p.rhn b isld My wo.td onpdlrhn iEuft.fiir .d p6lr, tumbd c: a
<br />I .diry rh.r i. lhc Ftotuc orrh. f,ort fq *hth rhn Fhn n is.!.d. I dull rcr cnphy a, tE$. i. ry nsE
<br />h - to bdoc $qet to rrE rst6 6,pasion lr{: ofc.iifr'md ed .3E lhr ill nDuld haoE nt,d lo llE
<br />Nrld omFE 16. FllirioE ofsdi,n !7m of
<br />'h.
<br />trt . Code I 3IEIL f.dhwnh @qiy enh lbE prortbB
<br />*ARNING !.ilu. ro suc *old moirol.lion rcv6.s. n unh*tu|, od !hrl! ubltl e mphtr io cimiMl Fltii lnd
<br />.ivil t66 up ro oe h!n<h.d tho@d d.,lla (1100,000). ii .ddtio. to rh! s, of comFN.lioi. drrued a Fovi,.d tor lh.
<br />sErF. 3076 ofrhc t hq Code nltqlr d .lorErr &6
<br />IICEISED.(;ANIIAqIOA
<br />DESJAAIIOB
<br />I rE.6,.tf6 u.& Funy or Fjur- rhi I e licqE d u.& Forirbn of Clr.tlrq I (@.jriftinA triLh sdnn ?0m) orDrErn I
<br />of rt Bulld ald Pmr6bN Cod.. rd ny lbcE ir if, tull fore rn.fid
<br />coNsTnucTtoN r FNDl]tG ]\cFic!
<br />I t6cby dIm undc Fdy o r p6jur] lhn llE a. oldruclior ladrs.sfty fo. iIE Ff.lrl@. of rh. mrt ft'r $nxh rhE Fhi ir
<br />isru.d(S( 1097, cir C ).
<br />AIffICAILDEqJAAIII]!
<br />I h.S) rtrrn uid.. FEhy olFj'i.y oE ofilE f.lbnnS &.lrdioa
<br />Dotulnio. Pmtu-Alb.nd N6tili..rio. F.d6il Rlguldioa (Ti|.40, Pd6)
<br />R.qud llrq of Notiidbtr
<br />I o6rif, rhr rh. frda.l EIlirbB E8.dil4 -t rd lgFv.l E mr +di6l ro rhir FoFr. ,
<br />I .6ti& thc I h.!. ud lh! qrdicion .i nnc ltc t .bov. inlorE irn n Nral. I .8c lo 6nply wnn rI cily .'d counly
<br />oilmft6 sd sr,!.lr*3 o blildi.g ctrEodFtr in hady .dh.rt. r.Fs,riG ol rnir Cn,
<br />a.h.r. 6kn<rl ,,opdit for
<br />/,rt)rli({trr trr \!rtri sia ii
<br />E4twtltlv
<br />ll ?...t?
<br />v8y
<br />ID/SIG.COMMENTS
<br />1-'
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<br />T-Bar
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