BUILDING- INSPECTOR BECORD
<br />SITE-WORK DATE COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Eneroy
<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 />Certiricate of Occupancy
<br />Notes, Bemarks, Etc
<br />OWNEI AIITl)IT DTT,CAT TI{'N
<br />I trc!, .trm uBj.' F.Mr, d F+ry 6r r a.rw nom ilr c(fu6' trrc L.v to. E folloEu qs lsd mll'6
<br />Bui.e'r d k.r.shn Cod.): A.y Cny or Ctu , whkh rclli€r r Fmi tn on{ru.l. .X6, ilnpmt. .,.mliii M tp.n uy
<br />n dG, prbr ro nr isaM. rLio EquN! tlE lPplt.d fu. luh Fmir t. 6l r rirrJ n&r rt! ll or rh. n UEiGI putod
<br />h rlE Imvnbd oI rtE C..krrri t,t nEd lry (()rF( 9. ColffiEin8 *th Sdrir 7flr) oa Dvni.n I .ItE Butus &d
<br />ftof.gDu Cod.) r $i Ir d J: ! .r.n+ rHbh rn rlE bsir for rlr ilLlod .krFin Aly vi'hi{ ol Sdbr T0l1.5 b, ay
<br />dprlionr ror !Fmir rlbj.cB rlE rpplh.nr ro !ovilp.Mhyormr mE thsn 6v. hundcd doll!! (1500).
<br />_1. s .sE nr rlr t n!.ny, n m, .iphy..! $!h u{q ! rlE! sl c.np.luh( yi[ Ar rh Ert rn rh. rnfu r d
<br />dnrral d ofkrEl fr !L (Sa.7txr, AsiBt {rl Prollrim Cc] TIE Cddrdt LaoE rr* .r-' d +?ly ro a orB of
<br />rlEF,Fny vt! hildr ( irFDE iElI lrl wlD dc sdr {r.t hil*lf o. lEElf or.tmuh hir 6 lE! ou.rpbF6,
<br />pmvl,.d rh.t ruch lmpmEmd! c dr hr.,'d.d nroo.'rd lor et Ir;ho*?B, trE hildiig or tr4mwEd ir sld wi'hh of,rt
<br />olcmplxia rlE OwE Bu E w,! hlE rL laln ofFovin rhi llMdEdil d bu!! r irrtmw 0E F.Fry fdr lll F,F* of
<br />_1. bo*krolrhr pdpqrt. rh.r.lusiv.lrconrdinf *nh li&trsi N .d6hon{rud llr FDFa (Sc.70*L Buiia*
<br />a'n PlI e{i,Cod. Tn Conrftttrt Lh.nr. Law d6 d .pply ro u ovE of lroFfly *tu huild. inAroE! rh.totr
<br />ud !t ..da, r( sh Fxdr vih . c.ddrdln lt.N.n tntM h rtr cdBM 3 t,j.rN br)
<br />-l
<br />!m.Empr undd Srr
<br />woRxlrrts co Pr-NsaTroN
<br />DECIASAIIII!
<br />I h{.hy rflirm u.d., p.nlty ot pdjury oE o! rh. ioll.* ine dccbmri,
<br />_lh,E]n* l d.i.rCdifu.ofcoM ro S.r-lNE ld qrt6 N.p.dirc s FDviLd for try SdiI rm ofltE
<br />brrx Crn . rd rlE Fldlm ol rlE D t ,q *tth E F6n a iqd
<br />I h.w rnd wrl, minrain mrl.^ cotrFrslri.n i!$!!r(., !r Equrcd by S*rion l7m ol (lE Lh.r Co&, lor rh. F.I0iM. of
<br />rll uorl n{ *hrh rh! IE d ! $ud My *u.l(t orrFMDn E{rtr. ffi !nr-ll, ntE @
<br />PolEy Nlr s'-ErPiEr:
<br />_l dLfy ihn ,n rlr p.rfornR of rlr h* f.r qhth rhn IEmn tr ur.J,I thdl d.nploy sy F-n i^uyM
<br />s I ro h.$m ruhicr ro rh. m*6C mnlEuti.n l.*!.lcdifomr, r igr rh! ir I rhould h...m .uhl.d ro rh.
<br />kA.n conp.Nr.n rmviiaB ol sdir! ,m ol dr tih, ccL, I aull fonh* h $rlpl, *nn lorpowi.B.
<br />WAXNIIC: Friir ro s ffilrs olardto. ovfrlr a !.Latut rrn 16.! obF s dploF rd mid FrrB.d
<br />civ,l liEr up b oe h{.dnd ilBn ri d.lls ltlm,ul)), D ddrbn ro !h. Nc .f @!p.Erbh. dmt.r a Fvrlld lf r
<br />seri[ 1076 of ilr l.k C.dG, i r, 'id rtrftrt f6
<br />LICEIIE.CONIBAITA
<br />DECIJIAII!]N
<br />I h.ftby . nm ur&r IEMhy.r Frjury rh.r l .m lic.nr.d undcr Fovisnn o{ Cfi{rs 9 (..mmnci.8 Dirh Sdnn 7om) .1 Divilio' 3
<br />of rll Bu:ia3! ud ProfeioN Cdk..,n nr,i.e n a tuU fod lrl.ltad
<br />Dor. _ (-@rr..r
<br />(oxslBuclrouj llDlNc-llilNcIIh.Ebyrrlmu.rFMIyo,FrIr,rh,rtfti!ron{turDnlliqrr.Nvfdrh.Frfo|]rla.ottll*rrtur*hi'nrnsFnnir
<br />L*dlsd :r(r91, c,r c.).
<br />AITIICA!tr.DESA8aIIPd
<br />I ha$y rfm unLr IEMlry ot n r!ry orc of lh. lollowrn! &.Lor iuirl
<br />D.mlirrn P.mlieArh.'rB Ndtr.ds F.d..rl R.8oLr... (TirL l0. Pd6)
<br />-R.quu.!
<br />t nq of t{riElis
<br />_l.dJy rtu rlE Ld.nl E[ol'riod c3lrni,l3 !$.ior Emtd c a .pplubl b fin pn,,{r
<br />_l.6if, ihd I t wE d lnit.ppli.ri,n.d rric rh.i rlt rb.E inrtubr n @r. I .3!E io orply wit dl Cn,.d Cdt
<br />mltutu.r.nd Sri.lisi Elnins ro ttrildin! coNrEdi\ !n lrEbyruho.iz qr*rdrEs ot rhi, C*y rn Counry io c 6.pon ilr
<br />lbot dnrbEd pDr,.rry ,6 idFdbn p{rFs
<br />^lrrrrx or A!.rr stn oF
<br />-
<br />lhr..-
<br />07-2015
<br />ID/SIG.
<br />FINAL
<br />tr.&r! Addlu'-
|