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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNI:X BUTLDEtr DET'AR TION
<br />I @/ .frm lnda p6!Xy orFjury lhi I m dmpt toh rh. CoI,r*16 t.ioe ln fo. rlE 6[o*i!g tB,. (s< m_rl t
<br />B6'ns !d Profdbn Cod.) aly Cny or Ceiy whih EquB . Fni lo .o,uru.! .lta. i,bp.ov. ddbli+ or l4.n oy
<br />nrudu..F.rbia Bl,aE. rlo r.qin6 rl.! *pr6r h.$.nFhnb 6L. rigEl nrm' thrlttriEili.cEd FEltn
<br />ro rlE FvtioB of rlE C.nmor'r Li. .d L.* (clrFs 9. Conrl:@in3 $nh ser.. 70o of Diviri,D I of llE BuiEg rxl
<br />ProlB.N Cod.) d rbr lE d rh. i .r.$fl rhq!fron rd th. b6a for tlE .lh.d d@Fhn Any virlnirn ofsdrDn 7011., b, &,
<br />.p!li..nr lor r Fmir rbial! rh. +?lic&r r' ! cirit pd.ny of er mc lh6 6!c hundcd dollrt (t5m).
<br />l. s o*n( of th. F.Frly, or my cmploFa wnh u.g6 s th.i elc ompcEdnrn. wrll & llt *o dl0E$n(1@itut
<br />inradoj or o,TE.d lor slc (Sc.?04r1. ltBin* 6d Pmtdioa Co{tc Th. ( ont..roc! l-icN. llw d.6 Dol .Fply lo M om6 o I
<br />rh. Fopdy *ho hilde or n'pirv6ll".@a rn *k' dE !.h K* him.lf.r h*ll or rhmuah hr or hG oM drployG,
<br />p.ovidd rhd such mFoffis E d hrdrd.d u olI.ld aor elc. l[ hovd6, rrE hliulg or unForq,ar s sld wnhi. o.. Fr
<br />ol conFklFtr rlE o'$n B{iEd vill h.r! llE h!(dr of!1orrs thn ,E or 3lE dn d hild or irF.Dr tlE FoFry 16r llt Flpoe of
<br />t. a of,E oarhc FDFry, m.rdNirclt ..ddrg *nh licqE d co rar6 h oldru.r r,E Fora! tS6. 7Or-1. &!!B
<br />.nd hrEir Cor,.: Tn Codrdoir LE@ ljw &E mllpplyro e o$'n6 ofFoFry who hrikt! or ibFo!6 rhq@tr
<br />.nd wh snr.d3 fo. $.h lnirdl' rnh . (btu-ro(r) lkdE d Fllld ro E Coddtri Liuu Lru)
<br />I e.roF uil( sdio.
<br />Ihl. Ortrr
<br />WORI(ERS' CONtPf,NSATION
<br />DECIAEAIIO!
<br />I h6.ry rnirn ond.r F.rliyor lqjury on. orlh. lolloEiry dEl{llio6:
<br />IMv.d!willroi .in ! Cd ificot. of CoB6r ro Sdr- lBur. fm ro.ld $npdrdon, a Fvikd aor by selion 1700 of rh.
<br />Irhor co&, tu rh. Ffm. ol rh. *oll for $,tkh rh. Fnh ii irslcd
<br />I h.r. ud *rll nlinrai. *6116 tump.tultbi 'e@., a ..qoiEd by sd$ l7m orrh. ubor C.&. fo,lhc Ff(ru. or
<br />rli *vl ftn ri{h rh5 pqf,i ! ed. \ly {dt6',* 1 Sfo/e F-nrl
<br />,"r"r*,o' loJoqjg
<br />omFsio. ilMe...,a in
<br />,,0"- ' //'/- LO
<br />I.a!fr rhd in rh. Ffomnc. of th. uorl for *hrch rhis rEmn is i*u.!j, l3h.ll drr 6phy rny F$n in uy me6
<br />$ r ro b.comc NbjEr ro rh. $od6J odpordion Lw! oacrliaomir. ud a8re rhd
<br />'r
<br />I rholld b..on subjcl lo llE
<br />sul6'co'npcreariooprcvi5ioroofsdionlT00ofrh.lrborCodelslDll,fonhenhconplrqilhllrEpovilioN
<br />WARNTNC fjailurc to su. wort6' comrENrnin .ovcr.s. is unbwful. ed !h!ll lubjel o dplorr ro 6inir,l Frtrlra. lld
<br />cilil nnd up ro on. hu.drsl rhoMd dollG (tloo,lxro), in dddhion kr rh. cos ot.oip.Nnnrn, &m!a G Fwid.d f rh.
<br />s<rrn 1076 ol'h.bb.rCDda i 6d Md dbq- ! ad.:4-/?:4^
<br />DpclrSarlotr
<br />I hcrby jTm uidi !a.ty of Fju., rh. I d li!!.d ordq Fovili'tr ororBs e (6ffi'!s ynh sdibo 7000) or Dir toi t
<br />ol llE B6itB !d ttofsd Co<L, .!d dy ltd* ir in tull bie .d .Od
<br />,..*..,"*' dtl 3712 6s-
<br />,.,. ' ,/ z '/2 "/ 2 6._." !"iJ
<br />COISIBI]CIIONIEdDIIG.AqII.(I
<br />I l6d'y .rfm undd FEIy of rFjury rhd thc. n . cotudirn laditrs udy for llE Fftuc of lb. *!rt 6r uhrh rha Fni !
<br />e.d(S( 11097, Civ C.)
<br />l-r& r A&is
<br />-
<br />AIIU(ANfDICIJBATA!
<br />I hody lfm und6 pdaXy ot pdjury on. of rh. lollos 'ns d<l,rdioB:
<br />Drmolirion PmireAsbdros Norifi cdion r.d.rrl Rcsulatiod (Tirl.40, PrnO)
<br />R.qun.d L.lrd of Notifralion
<br />I .dify rnd th. fad6.l EguhioN E8ldin* Bb6lor roEvil e mr qplt.bL ro rhs Folal
<br />Xt .-it ,t. t l'."" toa tt ilpdtdior id ia. rhd dE lboE irlondhn ir corar. t {Ic ro o,41, r'ih .rl ci, .rd cou!,
<br />rdine6 !d sr.l. t.s diilB lo hrlili,B .oEr,ldbG tn horh, anl'o.i4 EF& i6 otfiir cn, !d Cor.r, b ana l4o, dr
<br /><1
<br />.br. ,Krk..d FoFry for iqtrL,.
<br />"nZ, 'e
<br />/a- /a. /
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation Ir 1tr6Roof Sheathing ffiDn{)tle/{^4
<br />Shear Wall I
<br />Framing
<br />lnsulation/Enerqy
<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 />I j )
<br />FINAL thslkla *v.lful ol
<br />Certificate of Occupancy I
<br />Notes, Remarks, Etc.
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