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BUILDING- INSPECTOR BECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNXX BUTLDXR DELCARATION
<br />I h.r.hy rrlirm unLr FMly or tFrjury thlr I n.r.n{, rn,m th. Conlrl1rE' La.nE L.* for rlt rolb*h8 Exr lS&70]15,
<br />8unrc.r n PnIdftn Gi., Ary C y d Counry *hrh EirFr . Fnr ro .o.rtul. .ltq. r{'mr. Jdnn8h or EFr ay
<br />{Ncrrr., Irrr ro n! ntu ., rlq' r.qllr rh. rpplrrr nn ikt lxmr b liL r rgftJ {rr.mnr rhd lE or iE ! lLf cn Frsar
<br />lo rh. ln,vrsntrs ol rh. Cronrr&lf r La.nql L.w lorptcr 9. Cr)mmncins wirh S.cr!,n 70Ul ol Divnio. I or r& BunElr Md
<br />Pmlrs",rr(irk)drh,rlEu\tI !r.!.htii rlEtfron rnl rrr h.{r iorrh..ll!.J.r.r!rrm AryvrirrirolS(riorTOll llhyr,
<br />.ItlEt tu.Fh,rubjckrlr.ppl{.nrrr'.rirnFEiyorBnd'ErhulrvchuftlhJJolLn!rs5m)
<br />I. 11 oexr {l r h. J'n{rny. or hy cmpl(}F.t ! h v.tcs as lh.r qnc .rnn nr.r ion. srll rlo rtt kfl ni rL {dr@ ii nn
<br />ur.dol or ofcrcJ fi eL r Se r(tl4- Bu!m( rxl l\Ul.(nnr Cd. T1r C,drr(*'s l-r.n< b! dEr d .Jlnl} b u ohr df
<br />rh. Flrdy *h' b'llr o. rIFrFr tlEF'...r{ rh d.! un s't hmklf .. h.rell o. rla)u3t hn r lrr o*h.itrby(r.
<br />ln vi.n rh so.h ,mFtrEmd! e rt{ d.nld or oll.ftJ h, wk lr, h.krr. rh. t ot or mtr,Emd r 3'U wiho orc }!r
<br />olLohoLrnn.rh.()*ncrBu'!.r*lh,rrntunLno,pn,rDgrh{h.or\h.Jrlft,tillorm{rcEtn.lnlElyl,trllEpurF)f,ol
<br />I !n.\.mtr lndcr S.cr$n
<br />wotu(Fls coilPElisATloN
<br />IECLAAAIIO!
<br />I h.!r6y {ll mr utul.r Fniliyol n rJuryon. oltlE n)l!,wr3 dc.k.non!
<br />I hlk {n wrll dd.o r Ccnrrlr. olQ,trEd t, S.lr-lnrurc nn sxt(.6' $nFns.n, 8 pmvrLd ror by Salnn.}?m or lh.
<br />hrn Cin.. nF rtu FrrmLt of lh. utlr ntr *tr.h rlE Fmil N !rEn.
<br />r.guRr hy s&lrrn .!?rlr 6l rlE L.txtr (iilc. tur r lt Frflm. of
<br />in D.urrn (.mr.rn Fn.y numl{ e:
<br />G.rt\
<br />5o1*oOo{il-nq
<br />I (cnrlylhal rlhc Frtolrutu. d, rh. work htr rhrhrhFl(rntrl FsrucJ.Irhrll( cn[l',y liy ltnon in in, mtNr
<br />y, b h.!sm sl'r.rb r& *o*ci !l)n{rnqr[n b*\ of Crl,kffq. ,ri .tR rhxrd I fi'ull h..oft ruhial n)llr
<br />* rlsi . ri{Etrqr rr pnr!!r,.! ol Sai[n l?m ol rlE ljlrx Ciri.. I {BlL nrfi$ih .o.ply
<br />rvtR\l\l; IJ'|tr'( h, {\u'( s^'11. .,{l'l-tr. r4,.rr u^bwlul ! l.hdlruhr.l
<br />!'!,1 lnr\ t, r, o ( hu ,l(n r[!{ \x noll,u\ rtl{
<br />s\-rr$ !076 01 rh. l:htr G{., ur.rcr nl ofty'r
<br />,*" s)?*/?
<br />IECIAEAIIAN
<br />I lml,, .llim lrtr Fuly .r F,ruy lnd I D ldEn unj.. F sDn ot ouFd 9 (6ilmNr3 wrh S.lrDn 7dD) or rr'v8u 1
<br />of th. Burm.\ itn PNt$r,ntCnl.. !n frylt.rc r tr lull rorc lrl.rttl
<br />,.,.",..,',.,..C10 Cqe 7s*"f;2J49 -^**"
<br />CONIIAICIXTEIINOIIC. iEX(I
<br />lhcEhy rlltrmur!L. Irnalryol prrjuyrhrrrh.rc Fr..tr{r!.ri,n [.kl'ngag.nry turrht l)trlnrmn(. dl rhc work l,rNhj.hthr Fm F
<br />i.rEl(sa. lo9r, civ. c.).
<br />t nL.'r N.mr _
<br />I.ndci( tuldrc$l
<br />APPLICAjYT D€CI Af,AT'ON
<br />I d'y lrm untlcr p.nrhy ol F4ury ok ol rh.lollowrnr J€cls.rnnr
<br />Dcml{kr P.rmri-A.lxro! Nd E.thn lr.Jcr.l R.luldonr (Trl.to. P.n6)
<br />R.qur.d L.d(r I triUiarnn
<br />I (.d',r rhf,r rh. lcd.El ft rubrr
<br />roLrr{,|, w h .U (lry rnd Ci'ldy
<br />C, aii counry t' cnrcr !t'nrh.
<br />trl
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathing
<br />Framinq
<br />lnsulationi Energy
<br />Drywall
<br />Exl./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Reporl
<br />Flood Zone Certif
<br />FINAL
<br />Certilicate ol Occu pancy
<br />Notes, Remarks, Etc
<br />_1. ,r own.r ol rh. |h,Fny, ,h . r.lu$v.ly conkkr m8 p h l(cnql odr.rt,F l. .nn{tur rhc pi*.r ( Se 7fi,1, Btr\tr(
<br />rd Pn,!.(r, Colc 'lh.Conrrirlu s L'..nr. Lr*,l,r! +plyn)uown.r01tNFdywho hurlltso. imF'v.r lhcro.,
<br />rol *h, od*rl r(x suh F,r.li w h . (ldLro( r) l.rncJ n!ru, h rlr G"rrr.tx'r tr.n( b*)
<br />Forms/Steel/Holdowns
<br />Shear Wall
<br />T-Bar
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