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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/VenUl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />tl I //// /./J,4,F|NAL IU l'tu
<br />Certificate of O'ccripancy tt
<br />Notes, Remarks, Etc
<br />OWNTT BUILDER T'DITARATION
<br />I h6.t' iltim und6 poiltv ol Dcjurr rh.r I d .r.'mr iiln IE Conlr.cloB Lirot. Ll* aor rh. followin8 l.en lsc.?01 I .t
<br />B6'n* .nd Profdtu. Cod.): A., Cny o. Counry shrh r.qric ! pann l. coinrud. all6, iap.oyc. danolnh or r.p.tr sr
<br />cddue Fbr 'o
<br />hr i!.tr.. .to r.{uiB lh. +pli.Dr for $ch pann ro fik. rs,Ed sr.6r rhr lE or JE ir lkd!.d pl,$dr
<br />to dr FotB{6 of rlE ( onlr*l( ! l-rc.n-d be {Ch.Fa 9. Comftins *lfi Sclion 7000 of Diltion } ol rlE DBilB ed
<br />PmfdioN Cork) or rhll lr or 3tE i! ddri rhs.&om &d rh. bBn for llr rlLs.d Bf,Fbr An, rioLlior ols<dbn 7011 5 b, oy
<br />apphcdt aor a Frn subj*r! rh. rppli(.nl !D a .ivil !..alt, of mr noE lho fivc nurdrcd doun t 1500).
<br />-I.
<br />B o*ffi of E FoFly. n my mplolG wnh w.g6 a $.ir $L otrFdtldio!. "ill &, llE wdt tj dE rrurc 6 ol
<br />i drLd or ofiqd fd rl (S€.r0,1,{, t u![B 6d PrDfdioB Co& Trt G.k.dr'r LtdE Lrr iIE ml *91} ro - o$e or
<br />th. FbFiy wlb liilh n inrp.o€ rlEEtr rd uno dB s.l' ert hiEklror hq*lror lhrcu&h hn o.ls o$t. ploy6.
<br />provid.d rhr! 3uch inFrv.m8 e mr iidrLd ofiq..t lor eL lf. hosdr.llE hildins or iiFovdffi b sH {ilhin orc ts
<br />otompkion.lh. olffi ltrilrla viu trv. E h!&, otFovdu tlld tE or dE dri mt h!! or inqlE lh. Frpcty lbr rlE Frpoe oa
<br />I. 6 o* 6 oldE prnparr. m .r.lGtr.ly cotud !u r nh lic.6.d ..d,&1oB ro odmd rlt Flijd (sd. ?ol,l, l,l![6
<br />ard Aotos.nCod€r l lrc conticroir l.ic@. L.$ d6 not @ly ro d ow,6 of ,,oFny who build! or ihprcld rh66o
<br />sd who conhcr! tu ruch Fo.J.dr wnh . Cor r.donr) li..rs.d p!Eu!]l lo thc Contr.crol! l-k@. llw)
<br />_I m.rmF undd **rio. .B &PC fo,lnB rcen
<br />D . ornd:
<br />WORl(FRS' COMPTNSATION
<br />DECIASAIIO!
<br />I n@b, lmrm undd Fdty of pajury oE or rh. follosinr &(lr nB
<br />-l
<br />h,e. s'd u ill m'flru r Cdrifsd. ol ( oisr k, s.lf.lEG for wkqr comr.nsiron. s pmr ricd for urq sdF. 1700 ol rlE
<br />I ibor Code aor rh€ pqfomec ol rh. *ort lor wh'ch lh. Fnn d i!u.l
<br />-l
<br />hrrc !ftj u'U roid.i. mrtdt .orp.@tion ierdna s Equtql by Ssrio. 17OO orlh. L.h.r co&, aor rh. Ffolrffi. of
<br />lh. $rI f(uhihrhi!F6n ir isE M,wcI6 onFBrbn ilutr cair -d Fliy nbcE
<br />SS-he €*-J
<br />q,LaO zL\) -7
<br />I cdit rhd ir rh. pdf.tffi. of rlE tro fd *h(h rhi pan'r i! e.4 I rh.l! mr @plot .ny Fsr in uy .lrffi
<br />s 6 to bc.of,c autidl ro rh. erl6 .ompadbn 1.6 ofc,lifom,r. trd lgr ltn ir I lhould tE oc aubj6' ro rlE
<br />e*6' cooFr$lion pisvi3ioB oasdrnrn 1700 of rh. lrbo. Cda I null fonhwilh .onply wrth lhJs povisioB
<br />wARNlNc F il(c to suc wort6 .omFsalion .!v6as. ir unhwtuL a.d iujl tubi{ e dpbya lo sininll FuXi.! ud
<br />cnil 6n6 up ro or hufrlr.d rho6.nl dollss (tl h.dlnhn lo rlr.or of 6nFBri.n. d.trEsB B rrovdGl ror lhc
<br />Sdhn r07b of rh. bhtr ('odq
<br />'nr6.r od rnolB
<br />^)'rz7-+
<br />urrl-uDLlMtll(raBut(Li&tuqr
<br />I hdldy .ff,n ui& Funy of FJury th. I o li.d..d uxla FDliri:n of CtTid 9 (.onlJr8,,B $nh Sdbn 70OO) ot Dtabn I
<br />of rt LcilB ud Prol<ba Co&. di ny liGe ir in 6rll aoR rn.fial.
<br />rB 9rild'3ZL-IZ '.7 b+
<br />Cq!IIA!CIIqA]Ed!I!IiIGE!(I
<br />I hd!b-! llIrn un&r FMty olFJUD'lh, ltE a.co ru.lbn Ld,l*.rfty aor tlE Flm. olllE *ort h. e'l'kh rhi! FDi k
<br />is.d (sd l097.cn c )
<br />AIIU(ANLDESAAAIII!
<br />l,.9*.,lnn und6 tdih, of psj!,, onc oath. folloEins dalsdionr:
<br />D.n.lntun P(mn$Art$ros Nolificdion t.d6al Rquhtuns (Till.r0, Pan6)
<br />-R.q0n.n
<br />kr6 olu.iifriion
<br />_l colrry rhd lh. Ldqal rcsuhtoc csddi.s Nh6tr Gno$l d..or 4pltabl. lo rhir rrcjd
<br />-l
<br />cGlify rnd I h.v. r.a.l lhir +plicdion ei st.l. lhd lh. !h,r. infor,nnbn n .ond I .8ra lo conply wnh lll Cilt .nd counly
<br />odi@6 .d Sbr. L.r: E!r,E ro hlildiI* codndior ni lE.tr arth'ri& E!.6driv6 ot lhn C'ly u'd Cou(y lo ard l4o. llI
<br />'bo,.
<br />mnm.d FoF r rd m+7nn *T t J
<br />^ppldnror^rdrsh
<br />tun L/ 'L ' /
<br />Pmhrr,.(p. l, o -rN,iLL: /o-.<
<br />d7,,
<br />a74qvJrD7rbl,wnf.a_ry,nfl fl rgf
<br />Erection Pads
<br />Pool Fence
<br />Flood Zone Certif.--------T------
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