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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />SLAB Floor <br />Subf loor/VenUlnsulation <br />Roof Sheathing <br />Shear Wall <br />Fram ing <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 />RwraeFINALbllhlt4 ''^,P!) <br />Certificate of Occu n <br />Notes, Remarks, Etc <br />OWITEf, BUILDTiR DEITCAR TION <br />I ha.q .ftm lndd p.ndly of psjury ltd I m qmF fr!6 lh. coilrclm Liccnt trw f.r rt followhs r{$. (S€ 70ll 5 <br />Buind! 6.d P,ofdion Cod.) Any Cny or Colily whth r.qutd ! Frtril lo co.aruct .116, imFove .larclnh or rg.n &y <br />sh.ic Fu ro i'r igllee .lto EquiE th. apltsl lor un pdbn <br />'o <br />6k . .itn d ndold lhd lE d 3lE a l(oEal Plld <br />ro rh. For;b6 ot iE CotrE-rdi l-ie.Ed t E ((tlprs 9. Conffiuis sih S<rb. 70m ol Diirb! I ol dE ABnB ed <br />PmfsFcCo&)drhdt m ir ir Gr.npr thd.frofr !d rL b6i! fo, UE dLgrd amFbn. A,y viohbn of Setbn 70.tI5 btry <br />ip?licnr for a pcnn $bjaE rhc .pllicot io r civn p@ty o f rer morc fie liv. hun&.d dolld (1500). <br />_1. 6 ow of rh. FoFry, m my qrglorB $nh *+6 a $.n Fh N6Fsion. *iI d. tlE *ql .d d! nise it m' <br />urald.d d otrs.d rm rL (Sa.7o,l.t. &!i6 md Pr.labB Cod. Tt Coflndd'tl,-dEte&sml+Plyloe016of <br />rlE D.nrar, *,t tdl& c ns!€ lh@ .n wh. dE st 6t hNllot h*laor rlroush hn m lE oh dtplor€. <br />provii.n thd !!.h imF!\giE6 n mt ir.d.d or otu tu sl. l( how. tlE bu'ldnS or nq!$aEr i! sB wrhin oE )6 <br />olconpLriorl |lE (nrnn &iha wi[ hlw th. hrd6 of Foqis llli h. or J& dd d hri6 Dr inprort th. FoFty 6t lrt p{rros ol <br />-1. <br />d ouE of rhc FrErr.-. m a.hlntry c.ffilB rnb liued.olnralo6 ro on tu( tlE FoF (sc. 70,1.{, lla!6 <br />.,n Ptslsin Cod.. Tn. Cohtr.dor't Lk.@ lrw &E Bl +tl) lo D o\m of FoFlt wh. ti{rl& or inprcv6 lh66n. <br />lnd who .om6d! fo. ruch FrFr shh r Co ndo(r) li<Gs.d puR!., lolh.ftntrrcioa! Lkru t*J. <br />_l mcr@pr uodd Sal <br />D.l. or.d <br />wonxf,*s co PE\saTtoN <br />DICIASAIIO! <br />I h$bv aoim undd Fuxy ol Fjury o.. ol lhc follo$inB delestioB <br />-l <br />h.r. rd *iu n&!.nr r cdifd. olcoMr ro sdf-IEE fd wt6 @padbr 6 FDli<Ld for by sdti,n t70o oltlE <br />L.bn Codq tilr llr Ffonll'G oii,E {qt ad $hkh r,E Fmr it iBu.d. <br />-l hr( sd *ill mif,rrin wo*.d .omFEllion in!!runc€. s r.quu.d t y Sdion 1?00 of lh. L.txrr Cod., lor lhc Ffolm.. of <br />rh. MrL fo. shich lhi! FDit it iso.d. My worldt' coftFEdioo icuie. ffit .,rl polky numbs s.l <br />Policy NuDba:-Erpt6. <br />-l <br />cdiry rhlt in tlE Ffo,r@.c of rh. *ort for whrh this Fnt L! irs.d- l ih,ll ml dploy st Fren ir uy melc <br />$ s ro brnc $hjir! h 6. rort6 emFurhtr L{! ofc.litomq ,id tsE fir il I should t6om sb,..l lo rlE <br />*!rt6'orp@.rb.FDtiii.Botsdbn!7(r0ofllrLltorCodel{!ll.fonls-ihon9!*nhrhorPtovitb6 <br />WARNINC a.itur.l. su. srtm' edFsaion covE!*. n onbstul. sd 3hdl 3lbjrxl & opbF lo oifttrd Frlkl dd <br />civil finB up to oE hundr.d rhoudd dolld (t100,000). in lJdnion ro ltu mn of compcNrion, dmted a p.ovid.d for lh. <br />lhtr Co<h. mrd.c od .tiom!'WCncutr>-- <br />r ri r l&-'rr t or r t\r TiA <br />ar( l rtt\ l ro\ <br />I h6.hy artrfl undd pqalty of Fjury lhal I @ li.oki @dd lr$!i3i)n ofCh.Dlc 9 ($mmdcins $nh scrirn 7000)ofDnisnrn l <br />of rh. B6ilB.nd ProfNioN Co&. !'d my licdE B <br />'o <br />tuI fora lrj.Ird <br />+t1 <br />gallraullloNLllDrdclcEl(l <br />I hd.6y arm ufti.r F.ah, ol pdjlrt rll, thar it . oldru.lbn bdins lsftr hr rh. Ffol m. of th. uork aor tr hich rhit F rn ir <br />i$u.d (56 109?, Civ (.). <br />APPI ICANT Nr('! ARATION <br />I ho*y lfm uods p6.hy ol pajury oft of rh. nnL,$in8 .t (ltr.t ionr <br />l).mhior Pdnl^ltd6 Norilrrio. F.rl6rl R.guh ioN (Tnk 40. P!n6) <br />-Rcqu@d <br />tnra olNorlft!hn <br />_ I cdiry rhd rtc Ldral ,.*!l,li'tu r.sedins stEsG rdoc, rr. mr .pplicablc to lhir FDjer <br />-l <br />cdr't rhd I h.* 'qd rhi!.ppladit. dn rd. rld ih..tor. inr.ildroo 6 coBr I tsE'o 6rlpb *nh.[Cn] Dd Cou t <br />6rdi{r6 ad sd. 116 Eb irts ro hildins .odru.1na !n nd.tr !'nlhrnc r.Fsi,ln 6 o r <br />'hn <br />Cn} .d Counl} lo ord uFn rlE <br />d C nn on.J lr'.t{n\ ritr <br />,1t{,li(rnr or ,r* r sign.rtr.€O.rr, !1q <br />rer €6,, Evan S <br />l,l <br />I <br />I <br />UFER Ground <br />::rrl tq <br />I