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BUILDING- INSPECTOR RECORD
<br />SITE.WORK ID/SIG.COMMENTS Owl!ER BUILDER DEI'ARATION
<br />I n6.b,! rrm u.da Frlty of Fjury lhd I M ddF &!n rh. Contr!.to6 LicB riw for lh. followhr lNn (Se 701U
<br />UuinBr !i Protaion Co&): Any Ciry or Coulry whth r.quiE . Fmn lo ot*ruct .llq, idFors donolith or Ep.n &y
<br />ntu.r@. Fior ro ir! b!uu.., .&o G]!n6 d. rrplbel for iuch Fnil lo fiI. r riSr*d lrddal rhr lE o, !t€ a lic.,!i.d F,&r!
<br />h rh. rnvirioB of $E Contrcroi! Li.di.d lrv (Ch!p6 9, Comfti.8 *irh Sdtio. 7000 of Divilion 1 of llt auuB md
<br />Pilfdbd Co&) o. rh.r lE o. rhc i. danpr rh.r66m ud tlE bGir for $. .lh.d adBion. Ary violdbo ofs<lb. 701 I 5 t ey
<br />'polidr (n !Fm rubrd! th. .r?lkel to r civil p. ly6f ml mEthu fiv. hu,xH doll6 (1t00)
<br />l. s owof rh. FFrr. d ny @r,!0'6 wth $ie6 6rn n $k 6hFuion. wilt & llE wi !d rE nnIlc i! ml
<br />idcrlcd or ofid.d f rL {Sd.r04-1, BBilB ed PrclisirE Co&r TIE Conr.ld r troe t * {h€ d ?pl, b a orn of
<br />rh. FrFry f,lr.lhl tor inrFrs rhtu( rn *'n. rtEf,dr w hir*lf or hcslforthbush h6 M hd om apbr6.
<br />proviLd thd ruch idFo\6Gr! e @! c!d.dor66cd 6r sL.It now€. tlEtlildu* or inporqGr. $ld *dinoE )*
<br />ol orplrDo. r,E (XE BuildE *i[ ,ra lll hnla olFDviry tlr lE n slE dil tur b]*t n ,!poE dE FtFry 6r ,E F,F* of
<br />l. Bo*E of rlE F!9air, D.icnuv.ly coird6s *rlh la@1.otud.6 to otu llt Foj.d (Sr ?04.1. Bctlr
<br />rn hbtso. ('ork Tr. co dorr L,cN lrw do6 mI .pely lo 6 ouE otFoDsry *ho b{i6! or impht€ lh6on.
<br />Dd {ho o rrl! r( sh F!F!3 *nh ! Colri&ro(,la6.d Fdd loth.Coffim r Licoe li*)
<br />I m .rdF ur& sar&-- B & P C for rhi re..
<br />WORI(EXS' COMPENSATTON
<br />Diclla^uo!
<br />I hd.5! ,mm unda F!l!t .f Fl- r_ oe or
<br />'h.
<br />lollo\ i.B &hElioB:
<br />I h!\.,nw'U tur u.Cd'f( .of co@t b S.laIM for E!rt6 @nFdbn. s Forri.d for bt S<riln 17006f th.
<br />l,&r (-odc. tor th. FtM. of th. *!rt tor u hich lh. Ffl{ . issu.d
<br />N16".. -,1 " u, *-". "rrld ..nFur6n iNuleq s r.q!i'.d hy sB:1ron lToo of rh. L.bo, cod.. rot rh. Frtu. or
<br />rh. \nrl I'r rhrhrh! pan s Ls-d M) uoA6 comFsion iGurdcc ceE !n polK' numbc ,.
<br />, *,", AW:PVI ca n Ztt -t QL',,",,'.,"^*Ug!oalbb2 ...,. ll / t lzo
<br />NE,.dl,r,*,. r" *^@.cc orrh. sorl ro. vhich rhis p.mit is ilsucd l shiu nor mpLy any pdron,n uy mo.d
<br />e d ro b..on. lubjet to th. sort6' compdB tior h*r otcal'iomia ed asE lh.l il I lhould b<6G subjet lo tlE
<br />mrl6'comp.N.lionpmvidoNofSetionl?00ofth.L.borCodc.ldull hnh{nh omplr s ith thoE Pmvilioil.
<br />wALNlNC !_!ilur. ro su. work6 @mp.nslion .ov6.g. ir unhetul. ed sh.ll lubj*l 6 dplols lo ainn.l Fdt!. ed
<br />civil fin4 up lo oe hu.drGl rhou@d dolls (1100,000), in addiiion ro lh. cd of @rp.ulio.. dd.s6 6 prolid.d tu rh.
<br />DECIJ.BAIIO!
<br />I h6.by rmm uf,da Fuhy of Fjury lh.l I n li.sts d und6 Fortio. oachrp(q 9 Gon1l6cr8 wnh Sclion 7000) of Dirnion l
<br />of rh. t\!uB dd ri.fdioN Cod., ri m, lic.M it h tull fote.!d.E6l
<br />C
<br />Vb
<br />I O ,-n*,-o,qab l eb
<br />,.'. (r-l 5 Vlvtv,l a,r
<br />COISIBU(fI(}I}EADDC.ACEBSI
<br />I ha.tv .r,n un 6 Fuhy .f Fjur, rhi rhd. i! . 6dMi.d ld'dilts .Etr' for thc Ffo.rrle. of rhc e$r ftr "tEh thir p<ini i,
<br />iaeld (Sd 109r, Cir. C )lldd r Nm.
<br />ATTIICANLDECIJSAIIO!
<br />I fiddy .trm u& Fuhy ot Fru,, oE of th. follo*irg rk lrdha.
<br />Dsmhbn Pat8-Aitdc Nol'licd.n F.<bil R.suhrioN (ThL 40, Prn6l
<br />R.qo'Ed ldr6 of tldituiid
<br />I .d'ry rhr !h. f.d6, es!hr66 EeedinS 6b6ros rdmrd e nd Tplk.bL ro rhi! pojql
<br />NE .*,r, ,- , *" .- ,* qplastin .n s.r. tnd dE !hv. i,rotuion b (o'rdr. I t€r ro mmdy *nh ill cny .nd ( ounty
<br />o tun.6 md std€ lrsrElllirylo ho.iz EFsr.ri6 of rhi3 Cny&d Colnrllo 616 uF n rlr
<br />rthrc h. n)ndl pruFny lor
<br />Applic.nr or AF$r SiEnrture
<br />\^klslzo
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loorA/enUl nsulation
<br />Roof Sheathing
<br />Shear Wall
<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 />UV ? /1 .-. t-raa, 4H
<br />FINAL b-{t -c --- -- ,4, I
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />OATE
<br />SdNn 10lb ol rhr Inrtr (irJ. imdd
<br />".,.,v1elzo
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