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BUILDING. INSPECTOR REGORD
<br />SITE-WORK DATE lo/srG.COMMENTS OWNER EUILI'ER DEI-CAR TION
<br />I hd.by alttrm undd p@xy oa pdlury rh.l I {n cx.npt 6.rtr rh. (tnlracloE l-ic.@Irsforrh.lolbsitS,Nn(sa70rl5
<br />Ach6 .,n ttof*bn (-od.) An) Cny or Couny trhah r.!un6 r Fd ro .odM, .116, imFot. .kml6h oi rctln a)
<br />slrucre, Fnn to ns Nuuc.. alq' r.qutrd rhc
<br />'I)Dli.m
<br />tor 3uch pdmir ro 61. r siB..n ndmdt lhd tE or sh. n l(6aoj puNer
<br />h rlr ForshB of ilE conrdoir Lica*d trq'tort,c g, (onfrtrins $nh Sdr6n'7(100 oa DirGir.I of tlE nuins ond
<br />PDfcFns (td.) or rhsl lr or sh. 6.rofl ths.fron ud lh. tEs lor rh. tll.scd .rdFio. A., ioLlionorsalFn 70lll i b) nny
<br />sppliclnr for o ,,6ril rubj6t. lhc .tplicdr ro , c'ril p.oky o f nor mr. $s liv. ho.&.d doller ( l5O0)
<br />l, 6 ow.q oath. proFny. or ny cDplo}td wil h *a{6 s th.ir slc compd.rion, will & rrE *n* &d rh. nBl@ b nn
<br />llsd.d no66rdlMr].(S<Xx].8618odProt<ndCod.Ih.coddoirLt.Mljs&Err+9hr.mo$Foa
<br />rh.li,tEry sho t!il&or imrolq Eoq ed *'hr &E (h Fli h'rolf or h6$lf or rhmush ti! or hg o*t mplor6,
<br />p6vi,al $d tuch iniF.r€lEa Em( idaxLd rofid.d lor eL l( lEslE. tlE llillllg or ttpmvaEn i $ld *'hhin ok Fr
<br />ofonplai@ dE OrE hrls viu h.r! llE hdo! ofFourE rhi lt q ,E dn d buill d !rFN. dE FDFry ftx llt F.ge ol
<br />l. s 6rs of th. tr.!rU, m aclN^.ly cod..nD* wnh li..G.d ol,E loN lo Nnnrud ltE Fnj41 (s< 7044. lllBil6
<br />rn Ptt)isi- Cod. l1E (onlrslm s Lic.ns l,w do6 dn !t ll ro d o$ffi oaproFny Rho bl'ld! or inprord lh(6n,
<br />ud $to @dBltads.nF.Fsqnh!(t rdo(r) lidEd puEu,n h rEcolr,*toar Ltdg t s,
<br />I m .roF udd sdrxrn .B &P(-forrhErw"
<br />taErila5:(ou&;rtalrox
<br />DDOJ.EAIIA!
<br />I h.r*.g imrn und.r D.6hr ol Dsun onc o,lh( tollor inr ddhlalrN
<br />I hav. ad *ill ro'dai. r CdliarLll. of ( ongr to s.ll- lBor. lM $ ork6 conFlrdion, 6 For i.t.n aor by Set ion 1?01) of thc
<br />l,htr ( o&. for llE Fftu. of th. *.& fd rn(h rh. Frn ! asud
<br />I havc ard s'll M6ra'n s 6rld .omf.Mhn iM6*.. s r.qrn.J h! Sal oo !7tx) oI rh. tllrtr ('on , for ih. nafolrllilc or
<br />rh. \o n *hi.h rh6 Frnn it i*$.d. My lorld comFshn idru. cffi &d lDlf,, n@b.i R
<br />I cdilrthd h rhc Fformk. otthc $ork tu whichlhispqhil is ir3u.d.I slDll nar mployayp6on i. &y ndn
<br />e - ro tarm $b61 ro rrE lond'omtEsdhn hr r ofc.l'f6mj,. ild +r thn il t slsuld tE .G lbFr to ilE
<br />so*d' .onpqBdion FovsioB of sar o. l70o of rh. IrL.r ('od.. I slqll. aonnwnh cooply *nh lh.r rmvilioB
<br />WARNINC f.jlu. ro su. rvl4' @dF!.lhI svdss. a uhqtuL od Jull tubj.! e dploF r(' oidmd Frhi6.nj
<br />civil lh6 up lo oE hutxlcd lli'@nd &,lld (t100.00o,. ia rddn(n to rh. oi of comFisdion, (h,u86 6 Fo\dtrt fo.
<br />'hcSErion 1076 oathc t,hor Cod.. olq.s md dlonEy-! rG
<br />((/ n P/l
<br />DECIABAIIA!
<br />I hmby .ilim undcr po.lty o I pgjury lhal I d lic.tu d und( I'nvshn aa( hlt s 9 (comn.ins w h S.dnr. 70(xl) of Dirision :1
<br />of rlE BBin6 ai Pr.ldsioB aode rn fty ltG ir 6 tull lme lrl.l[el
<br />C3?Lrd(\umrF (ot 3?'6t
<br />K.R.t^, .C ' H<r44a d<
<br />calllS!(arqEl,EuDllli-6c[r(a
<br />I hcby dfim u.dE Fnalry of prjury rhd tha€ t a coddclion lc.dins !s6cy foi lh. p6fnmm.t of rh. *otl lor snich lhB Fdi 4
<br />isu.d (56 1097. C'Y C)
<br />APPLI('ANI NE(I {RATI(JN
<br />I holt, dfim uids poah'.aFjrry on. of'h. LllowinB dRlr.lions:
<br />Dsftn 6n PomnlAih6kB Ndii.dion t.d6rl R+ubt.6 (] nE {o, Pd6l
<br />- Rdlut d lnrdotNorit abn
<br />I .dliy rhd ihc rirddrl r.glhttuns q.&dins $tE*'s rmolll ec aol !pd(dhl. i. rhb pn,l.d
<br />I cd iry rh.r I h.v. rsd rhL am'liclr ion dlj slal. lh2l ih. 6bovc inaom.r rcn ir cordl I +rc ro compl, wirh rll (ily lnd (irunly
<br />odim 6 dd sbi. h*s rkuB ro b(ildin! coNrudio( dd hs.by aurho.n. EFMldiv6 ofrhi! ( n) and Counlt to 6t( upon lhc
<br />e:.
<br />!t$t. nFrFftn prerd) fo, tup(ii,'n pul\6
<br />n*r-* * nr-,.,.-,.. ,ft t( t{* /
<br />P.mlte n.n.lprlrlt:
<br />/t r*+u /a- n,
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />SubfloorA/enVlnsulation /
<br />Roof Sheathing *tl l;+ s 1>a
<br />Shear Wall
<br />Framing
<br />ln s u latio n/Energ y
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL nltr n Itr11 5+
<br />Certificate of Occupancy
<br />Noles, Remarks, Etc
<br />I
<br />I I
<br />Erection Pads i
<br />v?ft\6<(
<br />I
<br />I
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