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--,IT.OINC-
<br />INSPECTOR RECORD
<br />c MENTSSITE.WORK DATE ID/SIG.OWNER BUILDEf, DETTrARATION
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<br />'^ry!A rlIm ri&r FMiy o, pqiu.] rllr I m ddF fiom llE Codrd6' Lkru r,* ror r lolkslg l@.ISd70ll5
<br />Buin6s .d Proacion Cod.) Any Cily o, (ourry uhich r.quir6 r pqinir lo conirucl. !Is. ih!.ov.- danolirh ot r+.r sy
<br />rruae prrto it! i!{lft. .!o r.qsi6 th. fpltsl ao. $h Fni to 6L r i8i.d niacll $r lE or {E it lilE d F,rrr
<br />ro rh. FolilioN of rlE ConEer6! Li*ncd Llw (Ch.9r6 9, ComficanS wirh Sction 70(x) of Divnion I of ilE BEi,6 6d
<br />PNfBhB Co&l or ri.| lr d sL t qdpr lhdr:&!E !n llE b6! lior 0E dlr.d doFiof,. Any vbldbtr ofs.dior 7011.5 t y uy
<br />appli.6r for r Fnn $bj6€ lh. .t li...r to . civil p.Mlr, of mr mi. $s fivc huit d dollG (l5m).
<br />l. G os F or rh. FoIE!-. d ny oDDld)6 r nh sas6 s rlEir ik conDdErbE nru {b 0t rqt .d dE tuE i! Dl
<br />inlgd.d or otrdcd fd..lc {Sc ?044, BurilB ed PmfdioN Co&: Th. colnrrcltr r l-(aM L!* do6 tul @ply lo d 0[6 oa
<br />0E FrFry *tr hrl& or itr+.o6 tlEEr !n *'ls d6 rxn Klt li@laot h+lf or lhrcugh hi! q tE os .nplo,6.
<br />poriLd $.r kt irFrqlf e ld -rai.d ddk & sh I[ hof,6q. tlr h]ildq d irqotcr ! $ld,ihn m ]r
<br />ofsmgErntr dE ()*ns B{ittq wilt hav. lh hdn oaFovilg thi h. or !h! dA mr hliki or inFDw th. F.Fr, tor E rutIDe ot
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<br />B o$n6 of rh. Fopcty, m dclEiv.ly co rscrios $nh lic.N.d coiiMorto oBlrucl ttt Foi.( (S< ?o44. Au!6
<br />!d h!Ed{ Co&: Thc codtuo. t Li.* L,w &€ mr .prl} ro e o\E ofFoFdy tr h t!il6 or inp.ord ln6@0
<br />md *h. olnM3 aor tuh Fqar! *irr . Conrdo(3) ltcE , pnRd ro llE Conrt..r.rr l-rcde tr*)
<br />I m.rnt d ld Sdti'n _.U &P( fordir l6n
<br />D.r. lrind
<br />$oRl.r[s' ( o]uPt. \sAr r(,]!
<br />DE(IAAAIIA!
<br />I hdcbr.fii.murd6 poulll orpqu^ otuofrh.li,llo\ rlr d(lo.r'ons
<br />-I
<br />h.vc rd will minr.ir. Cd ific.rc ofcongt lo S.ll.lBur. for Nrl(! c.arpdolidn, s provid.d lor hySetion l70O oflh.
<br />t hd C.<b. aor dE Ffoffi o, rlE *!* lm st llEFEi aiietd
<br />-l
<br />h.rrDd*ill mli ein *o*nr' .omr.N'b. iGsrEq 6 r.qund br Sd irn 1700 of ih. l.tor ( od., for lh. pofotlle. of
<br />rlE sqt fq shah rhb Frn ! isd M, *dla onp.dirn ilBuuc 6ir -d Fliy ntmba n:
<br />PolicyNuf,ba:-
<br />-I
<br />cdiry rhar i. tlE FfolrM. of lh. *ort tor $tth rhn Fin n qo.d- I ndl mt dploy uy p65n it .ny muE
<br />- s to t6o@ ruhjd lo rh. md.a' conpaldion hB olcllilomiq d ,sE Od if I itblld hdom rubdr lo lrE
<br />*.rtd' @mF!.rbD FDviri.B oasdn l?00 ofrlt t Dq c.do I ddl fonn*i! oody rnh lbr Forti!6
<br />WARNINC: F.iluro ro sw mri6' .o$p@rioh ord.g. n onhwtul. lrd rhrll 3ubjd e olploF to aimid Flnil od
<br />civil rbd up ro orc hu,rH rho8..d dolLE (llm.om), in dCnion l. rh. con ol..niFMio4 &D486 B FoYAcd br rlE
<br />S.crion 1076 ot0E L!{ Codc. incd .Dd ftdrty ! lq
<br />IEII.AIAIIO!
<br />I hq!t, trm u'r& Frly orFrury llrr I a [.d u{dd Frition of Ch+lc 9 (onllldilg $it Sa&. 7@0) ot Divitio! ]
<br />of lhc B6i!B dd hfBriJE Co&. .d by lkd. L b rull fod ad .llcr.
<br />LH?-='au
<br />coltsTRlr(Tlo r fllDlric acfrt(1'
<br />Ihq.b,.mrmunddFn.h,ofpsjuryltdth&n!NNlruclionLndin!+d.yforth.psfomr.cofl&M.laorshichthtF,rhi
<br />isu.d (sr 1097, Cn C,
<br />AIIITLANLDECTJIAIIO!
<br />I hoq afrm uidr p@!hy of Frjury on. of $. followint dalerlionr
<br />Damlnhn PmnlAstqror ltotifEd{. F.danl R.suLt bc tI nl. .l(). P.n6)
<br />-R.quncd
<br />kirs olNolificdbn
<br />-l
<br />..niry d t. f.1k l r.sulrlioB tsErlrs abaor rdv.l c d .pplic.bL lo lh! proFl.
<br />-l
<br />.dify fit I lrr Ed lhE .reli{i,. id n.l. lhi lh. !bot! 'nlo irn i t6dl. I .sE ro @mpry $nh .I Cry .!d Courn}
<br />ordi6c6 rd Srd. t p. Ehing ro boildo* corstoctiorl !d h@bt lolhorn. EprE6ndivB of$6 Cny Ed Co!f,ly to 6tq ulbn tlE
<br />.b.\r @ri.iEd prnFrt 6r Npldhr FrIEg
<br />n,,u-,".*-,,*-,.* l +la-7'??
<br />-,
<br />'.', 4trftZ
<br />Pmr,( rr.(prrno: t\u:'*4u-><c"J t
<br />Set Backs
<br />Forms/Steel/Holdowns ?26 rj tueI
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<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 />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL {-/o+c'1 Pcz)
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />T-Bar
<br />Flood Zone Certif.
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