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BUILDING- INSPECTOR RECORD
<br />SITE.WORK ID/SIG.COMMENTS OWNET BUII,DEX DI]LCARATIoN
<br />I h.rhy rfitnr und tl.Mlly of F,ju,y rhar I m cr.t{, ftum rtr (hnrndoF l-k.n{ Iie [n rh. nnk,*in8 Eo{r (IrL 70.11 5
<br />Itusin.$ .Bl P,orcsi,tr C.ncr Any Ciry or (hunly *hid r.quirc\ tr Fnir to conirru.r. rlrs. i'q,oE. 'Lmlnn I EFn mv
<br />(tuliqr. ri, i, ft i*u'R, llF rcquircs rh. appllnnr fi, lurh lfnnir r(, Iik ! $3rJ {rr.ftnt rh.! lE .r rll. n li..nrd lEsanl
<br />t' rlE pn,vni'nr of rlE (onrmt i Larnsd ti* (Ch,plct 9. (intmminB uith Ssri.n 7lr! or Divnit. :l ol rh. Irult$ ind
<br />Frol(r'n\ ('id.) or rh.r lE M dE ir.rcry,i tls.troE rxl rh. tEsk ld ttE iltscd cr.qrion Any vi,brhnorS.ailnTrl:ll l bv !.v
<br />rmlklnr rd ! Fmn .uhj.!r rlE aprlt.nr ro , .iv il l.Mlry or ml m.. rhm nv. hunlr.d doll$ l rlmr
<br />-1.
<br />rr *8 nrdE r.m,my, or my.ErloFr wnh B!s6 s rlEL oL ontE.dn.. ,illdr rrE rnt.!d llt nnt1E ir d
<br />inrdit d or olt Ed r, rk (S< 7014- Bu.iEs tlld tttrsiB Col. Tlt Conr.rd\ tsre lr* dE nl .|?ly ro u o*E oa
<br />rlt Fqdy rtn hiitlr n ii!.rs rh'm sn *b dE {dr kil himlr or rEEll or rlEosh hh d h.. orn ctI,htd
<br />0rovildt tlbl rEh nF,wr. rftdir.nddrotuf,rb lt noFB, E txildhS ( irrnerrEd kiHtlhhiE F
<br />ofcrrPhi^ rlro*E Alittr *ill trE dE h!d.n orFov4llr rEor {Edn dn hild lt+rtrE dE FtrIEly n rF FEo{
<br />-1.
<br />ri ovE ort,E lrDFny. m.(luriwly $nrriiE *nh tirn<d o d.F t' @nrtur rrr Ftj.r (S.< 7Ol'1, BhiE<
<br />r,n hrarir cod.: Tlr Co.rr-ror'. Lk.nr bs d(s mr.Iily ro d o*F or FolEn/ eln liild. oi int mEr lhdm..
<br />.nd wto oifBrr ftr rut Fsi$r rith. con,sr.(1) lis<n Nr.ufr io rlt codrridr Lilm b*r
<br />_l d .r.m,!t uftld Sclion-,"..1!-;//7t
<br />UU.l3]rTr\
<br />I h.r.bt lrrfl u.dd ,Enrlly .f Fjurr. ot of rh. rdh$,.8 d..lar.! ions
<br />-l
<br />Mr !n * 'll flinrrin . a.nifKrr. of Con*nr ro S.lr ln\uE tot *rt6 on{tnqti,n, 8 Fl viddi nn by Sdrhn :l7ln ol ilt
<br />lilln Gnc. n, rhr Ffol1,m ol rlt *ort lnr *hkh rl.t Fnir ir kiu.n.
<br />I hsv. cntl $ill n$rl! itr work r' .or{E.slrion iniursEc. .r rcqutcd by S(r i'n 170(, ol rlr I jrn (iri. tu rt Faol]1lmc of
<br />th. *ort r(tr whth lhis II.mi' it irqtn My qorkdc mmFNri'n in{r1ft..srirud Fnty nrhh.r r.r
<br />I..r|lyrhxri',rltnrtui,run.cr'frh.*orktur*hichrhi\pannir A ^{rn. I \hill n.r cnl,lor r t l,cl"!r in rtry nr $
<br />v, mr)h.$ r {rbj(d !,thl $o*r 'on,r.n\rrion hw\ or Crlltu.rrlr. r lx8'rr rhrrlll \h8ltltl.onf, {'hic.rt)llt
<br />trrrkcF.ftrrfitr$ri p(ivi\i,,n\olS.dnrn17(x)ofrhclrtry(inl..l\hrll.r,)nhsirh.otrDly$irhilrrcIJ('!1\tD\
<br />lVAt{NlN(: I:rihm n) a'dr. !Drkcr\ .unDcf\rri{,n.o\.r 9. '\ utrhslirl nHl! n'l.rar ri ( l,lor.' i' 1'trnnrl|t 'lri\ rtrl
<br />.'vil ,n'r\ up k' ntu hu r rhou{nd
<br />Sr.ri,n,.1l)76 nr rhc lrhr (qlc. itricre{*,.,.9,r=/?:-----
<br />lrrlLrr.l.Iu:
<br />I h.rny.firn u ls rtMlryof lEijurylh,I in liantn uti.r I'srirhn.f (-bltdIkr.rm(in, *irhS.dnn IIxl,orDillrhnl
<br />or rlE alriBr ltn PFfcrii.rr Cdi.. ad my la.nc t in tull for !n .fid1
<br />l.irnr( h\r
<br />-l]..n*
<br />Ntrr*Er
<br />D.t. ( odrxlor
<br />C(IITSTRUCAION Lf:NDTN(: ACFNCI
<br />I lrrciy d,ltm und.r FMny.f F]l]rr that l,Eft i! oNndi'n k,ni.g +trt itr rlr Fflrntu. ({ th. *ql t, xh.hrhir Fni R
<br />'sBd lsd ]{rr. civ c )
<br />trn&r'r N.m
<br />-
<br />AII'.IIAILIIECIJ8AUITB
<br />I h*{ty lllm trrk, rnsl', ol F,jur} om of rrE tollo$ine deLn!i(r(
<br />l). rnnnn Pcrmik AslFlros Norifi.ihn rti.r.l Rceulllion\ (Tirk{1,l'rn6)
<br />k(,N r(l l.rh ,'l N,{,lixrn r
<br />4,.
<br />.'r'lr rhrr rhc lc(lcrrlr.xuliri{nn rsrdin! r\tr\ros Rfrivrl m nor ipplkrbh !. rhil FoFl
<br />rlE.h* inforndion n otu ! l8c x, on0l} wirh.ll Cily.nd Counly'tt rhrr lhn\. r( l rhi\rpnl'.rini l {.rcrh
<br />okl'nx'x.\r,lSrrrrt-rs\r.lirin!n,htriklinscotr{chyrulhnirc rrll,lvnrorrv$ olrhir ( iry !'rl (i,unr, k' cnrd uB'. rrr
<br />,,1itr. rnrnnnrl ti','tr1rtn, tr
<br />\pt'lnnhr !, \rrnr sirtrxlurr
<br />D,?0 -11/4
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathins </ f //f Pb{/2 tl l,r/
<br />Shear Wall r
<br />Framinq
<br />ln su lation/E nerg y
<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 />Enqineer Final Report
<br />Flood Zone Certil
<br />P //1141 rqtr/-VL /OI
<br />Cerlilicate ot Occupancy
<br />Notes e rks Etc 17a /
<br />-+
<br />DATE
<br />ldrL r Add.r.
<br />,9.2-/7
<br />FINAL
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