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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER AUILD[R DEI,(-ARATIoN
<br />I hecby amrm uod6 poally ol pdjury ltul I m crcmt, from lh. (i,dmc1oB l,irs. L.r nr lh. fouo*inr r@n(sd70llt
<br />lluin6s .nd t\of*nrn Cod.) An' C y or (6uniy rhrn rq!n6 ! IEnn ro ordru.1 .lrd. amFo( ddnolsh .r kFn de
<br />dtudd., Ffi b is ilsllft.. r&. r6+riB fi. rpplr&l for ud rm to 6L r lqEd sdmr rhd lE o. {E 6 licdu.d F--$.,n
<br />ro rh. F$vira6 ol rlE Conr6roas t.aord tr* ( tlpts 9. Comtrio8 s nh ticrhn 70 i ot Dir'tbn .t oa ik ttllina ed
<br />PNfdio (htl.) or rhal h€ or rhc i! .rmfl thftfrom ind rh. ban for rh. rllq.d .rmFion. Any liolorion of Scrlion 701I 5 by ry
<br />arrlicdl to. r Fril subjd! rh. lppliclnt lo a cn il pmh y o I n mtr.lhq fi\. hundr.ddollur(!500)
<br />L a osEofrh.FoFly. my.rr{,hrG silh w+6a rh.t $k enFrunrn. $i[6 tu *at rn dE rf,rrG i! mr
<br />mroiLd or o,I6.d tor sk {sc ?04-,1, Burin< ud PNf*ioB Codq lnc Coflr..rolr Lt.c lrw &E tui qDly ro e o*c of
<br />lh. pFpdy slF toikt or inpr.!6tnmn. !d slb do6.khm hihr.lf or h@lf or thrco8h ht or h6 oM .mplorB.
<br />prolildi rh,' rcl, @FvdGr! d 6l i cid.d dolH frtr sL lf.lnr-E trE hiEirE G iitFrwn ir $B qnhin or rror@ddi4 llt (xE hiilda $i[ lErt llE hrdar of Fur! tL lx o. llE dn d hild d nFo\r dE FoFry tu d. F,F* of
<br />L d 6w ot rh. Fnp6ty. an .r.[rn.l, colnanins wirh li.ded .oirrElod t' .onnncr th. F J..1 {sd 7044, &EnB
<br />rd hokn (ic: rh. Co n loi! l,i(# L!\ &B ml .pply to d own6 of F.Fny u'ln t{il& or iEFov6lhd6r
<br />rnd *ho (od*if *h F!j.r $nh. codd.(r) li..Bol polrld ro rh. conbrror', l-i(tr tfl)
<br />l.0e\enru tr Jd Sceri(
<br />t).r. oind
<br />\ronxf Rs. coir?ritsriroN
<br />DECIINAIIA!
<br />I n(.by am,n undd p.nllry ol rEjury on. olrh.louosiry d(luarn,N
<br />I htr..rl *'ill dinl.n. ( diftr. otcolgn ro S.la-lBE lG rql6 @tr'FsEn. s FDtiLd for ty Sdron l70o orrh.
<br />lrbd Co<L. [tr rh. Ffolffi. of lh. rvl lor *nih llr Fnn b isr.d
<br />lhr\.an{lrillD.'nla'ntro,los'cotr,prnslrioniNtran((.isk\I!'rlh\SNltrnr\rix)frlh.lalxr(,..nnrh.t li'nni rcol
<br />(-:,:, ::, !! {tff)'i ry;;t; "OU "^I cdiatrhd
<br />'n
<br />rh. Fformft. of rh. $orl L. \h{h tfi$ fErnd Lr is.d. I rhrll bi mpkr}.n} Fet. rn int ru6
<br />$ N lo b..!'ft 3ubid lo lh. trnt6' comtE@ i.n l.qs of Cdliaonn. md asre thn if I 3h.uld tE om suhid ro lhc
<br />wo.l6 comrsMlionpmvtiomolsElnrn l'TLxJ oflnc kt[r Codc.l ltsll. fonhtrirh comply rviln lhoe pror irnrns
<br />wARNlNc lirluE ro su. s$rk6 ..mFsion (orrr{c B unl.sful. sd J',ll lub.jdr d plots
<br />'o
<br />ainiEl F.rhB ed
<br />.nil fiE ull b om tuLn.n !hou!d!d rlollrs {tl )). n! rdtnhn h ilE (.r of .orp.di6n, d!re6 B rorid.d ,or tlE
<br />S(non 1076olrrr bbor (-dlc, mr.d. l(,.,./0-p<-l{
<br />![ ! ! !l\!1!\
<br />I hd-,r{ amrn ull! Fsh, of F,[ r_ rhd I m [.aadl unds Ir\ B{r orchrfls 0 (.6Mfti.8 *nh S..! nn 7fi,'0) of l)ir rrn I
<br />ol rh. RNin6s dd Pol6rrc6 Cod.. dd iny I'cdE i in lull forcc !.d .,Tdr
<br /><y9/{*
<br />gr$rurarcNrlnurcaclti(r
<br />I hn*,!.rm u.dd F. r.f Fjuryth.r 'h6.
<br />i3. otrrtu.lion lftrins rs@y for
<br />'h. FfollM.c oaihc srt ftr stth lhir rEni b
<br />i$!.d lsr. 1097. civ c )
<br />AIIUC IiLD!0/TAAUA!
<br />I lErtl .Jtinn uBllr fd.lr\ of tErun om ol th. nnlllNns &( l-:r k,nr
<br />IkN,l'tk,n I'snnG,As}Ettr Nor,6c!i'oi l.!€Bl R.S!|{()nsI lirl.,r0. fd(l
<br />R.qui.i l.drq of N.tilieatx,n
<br />I csrr[ rh.l lh. r.ds.lr.luhtrd l(*dd'nr 6t61or rmr.la. n{ e0lr.hl. ro lhis I'or.(r
<br />I (dr'l\ rhxr I hx\.rttul rlr's r nnr.rhxrrfunlrr. rl.rtr,xrtr$ 's!f"(r l .gr.! h rnn,t]v \1 hill('rrrafl(tiLd1
<br />.rdnnrs.id srxic lNs 'rl,im!
<br />2n.n6'nn\rrl)pqrvtuI\t,plir n trr \!ur \ipn
<br />r.Fenhin6 nlrhu (\r!
<br />YU ''#/f
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathino
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<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 ttlLtL t4 D*rwd >*t /
<br />Certificate of Occupancy I
<br />7
<br />Subf loor/VenVl nsulation
<br />Notes, Remarks, Elc.
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