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BUILDING. INSPECTOR RECORD
<br />OWNER BUILDAR DELCARATTON
<br />I ha*) .nm udlq p6.ty oaFru.y rh, I d 6anF 6od rlE Co r.da U.ru Le to, rlE f6lL*rs laln Isa 70ll 5
<br />Buin6! a Protdion Co&) Any Cily or Counly which r.q!n6 ! Fitrn l. .odrucl. dr6, impr.ve ddnolirh or r9.n My
<br />s.h,q Fu'o ". i!!le...h. Eqund E lpplas lor Mh Fnn to 6L. tcrEd xrsE Ort or dt ! licnB.d Fs$r,,
<br />lo rh. rNvirirB of tlE Con$atd', t,i€n*! lrw {Chlpr6 9, Comtri.8 wnh S*lhn ?000 of Divtbtr I olrh. Bsin6 ud
<br />at l6ioa Corl) d rh.r lE d.h. i! 66lF tha.Cod sd rlE hGi lor rlE Jh.d doi,io.. Alr viohirn of Sdb.701L b, &y
<br />!,Irlicul tu r Fsit sbjel! th. .p?li6l lo ..i!il p.oly ottu' mr.lh& livc hu.<lr.d &llr! (1500)
<br />_1. 6 olrG of rlE FoFly, d Gy dlplo,6 wnh w.s6 B oEn hk @nFEdion. sill &r dE rqt rn rlr EidE i! mr
<br />idoi.d d ofi6.d 6. sk (Sd 704,1. B6i,B dd Ptr[6$d C.&: Th. Co nddt Lt.e tiw &6 lbl {pl, io x ow of
<br />th.FFy *l'o hril& or irso!€ tba@r -d r l[ dG $h m.l tirulf or tErlaor lhmu$ nn d lE oM srpbyc.
<br />FoviLi fii ru.h imFor6Ei! c d ddi.d q otu tu iL. l( how. tlE llilllta m !rysstEi 6 sU wirl'u oE )6otconpllb( 0E o*c B{ilr6 wiu h.E !hr lnorFou,{ $r lEq {'. dij Dl Uild or irqur th. FoFy for dE Fr.Fs of
<br />-1.
<br />6 ow oarh. FrFrr, o dclGid, .ofterinr vnh lrdB d co,iri.ro6 io codtucr tlE FojE(r (S< ?O14. &a!B
<br />.nl Pt!&sbo Co<k: Irlc cbntrdoi r Lictuc trw d.€ mt .!Dl! ro u orrs oflroldiy eho b{ild! o. inprov6 rhsqu,
<br />od *ho ondr for {ch Foj.rl! wnh . CodBo(3) li.dE d FrBd ro tlE (o'nrdm'r L.m ti*).
<br />I m cr@F undd S<rion_. B. & P.C. for rh! l@an
<br />I)rr. ()in.r
<br />llltBlilBlLll)lluls,utQtlll;rl^&ura]
<br />I hrrchv rllirtr,untls psl to, |{rjurloncofthcl,,lkrInS d(li!rlitrs
<br />_l hlvc ed eill Miatiii . Catifrd. of Colqr lo Sclf-lEu. for wkst @oD.Mrion, a E$rit d tor by S6tio! 1700 of rlE
<br />u! ]Ade ror t1'.Ffalllr. otrlr qdt 6r rtkh ilE Fri ir isd
<br />-5 h.E .d *'ll @d.'. wrd' @nr,.6!Dn rBllluo r EqlirEd by Scrih t?@ otdr L.bor C.&. h. rt p6fo1ts. of
<br />rh. work iorshrhrhf pdnir c su.'! My*orldr 'nnnulc!r'r'.r x Fn'r) ntr'nlx' ire
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<br />io lhc pstomlnc. orth.uo,k for which this Fnrn is islcd, I sh.ll ml mplor ey ns$n in My DUF
<br />$ arobeom$bj.dhrlEro 6 omFMion h*! oacditoB,a .,!d qE rhr if I ilbuld b6oE stt<r ro trE
<br />uo.t6 compNlion pmvnioB of Sa]lion l?0ooalh. tibor Cod..I ddL fonhwirh comply wirh thoEpmvirioN.
<br />ctrrl fincs ul) n) on. huidnl rhousnd doll,c {il0(}.|(r0). r aJl'rN,1o rhc
<br />Sarion !076 oa ElrborCo&.i dd rrd.ndEy
<br />-".1/18/ /4
<br />DEC|JaATjO!
<br />I hs.by .Ifm und6 Fnilry of Fj!r, lh.l I @ li.6a.d @da Fovnhn otc]1lplq c (6n1Mcins wnh Sdnn 7000) ot Divsion I
<br />oa lh. BdiB !d PEfdbB Cod.. &d ny lt6& ir n! tull 6r tn.rd.
<br />t 7 (o
<br />2 tq
<br />calslalcro!-LElttllc-acEll,f
<br />I hcby !,Im und6 Fdly or p6ju.y lhd rh@ b ! NModb. Lndne .e6cy ror rh. Ffoffi. ol lh. m* tur whrh lhis Fnil i!
<br />isu.d (Sa. 1097. Ci!. C ).
<br />ATT!(:ANLDEII.ASAIIAX
<br />I hady .eB u!!& Frlly of Fiury orc orlE rolbEin8 &(brd klE
<br />Dqmhirn P6nnlkb6l6 Ndi6c.rioD F.d...l R.eulIbn! (TnL 40, P!6)
<br />-R.!oncJ
<br />lnle ot Mnifi cdbn
<br />:f'*lh. Lddd rc8uhrioro r.*adins ab6'u3 ra.o\', r. ton ,pplr,bL b rhn F6Fr
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<br />cslrlv rhd I h!!t rad thi,r .rolkd 6n ai sr5t. rhd rh. rhlv
<br />ordmrnc6 Md S' c L,*: ddiry lo b(idin* .odndion.(-[yarlCoumr rodts ul[n lh.
<br />abov. mdrion n p6Fny ntr
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SubfloorA/enUl nsulation
<br />Roof Sheathing
<br />Framing
<br />lnqulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL 1[p 14 ,t u-a4 fu)
<br />Certificate of Occupancy
<br />Notes , Remarks, Etc
<br />^pp
<br />..n' or
<br />^36r
<br />slyqluE
<br />s"",,h* -."(p.ir')D A r<^.2/lz14
<br />Shear Wall
<br />Masonry
<br />Pool Fence
<br />Flood Zone Certif.
<br />l(t/ lo/ 14
<br />5
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