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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNEI Bt'ILDER DEI,CARATION
<br />I h.Ehy lllnn !d.r Fnrlr, rrf Flllry thd I a .t.tr{, fmm rlE G' r-tF Lroc l:* lnl rlE lnbruf rc:r,n (SA 70.11 5
<br />Bunn.s lrl Fnnisi'tr Gnc): Any C y or Cotrnry ,hrh rcquirct r Fmi b co.(d(r, rlrcr, mln,vc. &fr)lish or r.r.tr iny
<br />(tuluR. Fffr' n\ 6\uec. rL* rqufn rh. +i,lxfr ftf skh |Erm ro iL. stEJ {lrcmnr rh, hcor {E ! li.nri tlRad
<br />b rlr pmvFont ol rh. (i,nrh(rtr'i l,E.nlctl La* (Ch'prcr 9. ai,mtuE'nf * h S.rnon 7tm or Drvnxrn I ol rlE BunB( .r!
<br />Prn si,nr CnL) or rhzr lE r rlr ..r.ml'r rh.rctnln.id rlr h.t( ld rh .lk!.d .r.rqr kr An' vnlllnnoaSdan 70.1I t hy-!
<br />!!tno l'tr aFrn( suhjeklh. aptlMnlr. rcrvrlp.nr[y l n.t mE rh.n nvc huftlFJ nolk!il5ur)
<br />_1, rs owmrol rh. pn'Fnr, i, my.mpkry(r *ih wt8.r rs th.! c,k NrFnt.r{n. *il tl, rlE krt rn rr {erE n d{
<br />in.ddl qofi.rd lor {I. (Sc 70arl. Aurrsed Pnri(anr CqL:'l lE G)nrrEroar Lidnc trw &r! nor lI, ytrruowmrof
<br />rh. ln{try wh,hidro.ntn'BrlEbtrnlwhdsuhs' h'm<lti, h.Mlfor lhmulh hF n lEr oq.rployt.s-
<br />pnrvirLJ rh, su(h imF,Erd! c ftn i .,rl.J oroltaGl tlr sh. lr, h)E€. ll! lnnll6! or itr{trtmor i $U wnhn oE lt,
<br />ol lonphrr,L rlr OvE BuiLr dl hrE rh. hon,.n otpn,q! rh, tE r rlE Jrl r h!r! n rrrcE tlE F,tEry tix llt FrFx or
<br />I. is.wftror rh. F't'.ny, !m.klu{v.lv oih(rnt *dh lr.rn{d udrldo6b r.nrru.i rll I',Fr rSN 7(X4. Bu!ft(
<br />rn Pn,kaqnC(ilc'lhrCt,dri(n'\Lnchi.tjwddrnnr!flilyn, own.r ot pn,F v ulN hurld( o. rmp!)vcs rhcrn,n.
<br />rnJ *ho Lodrkk 1,tr rkh I'i,rrk wih , O'ntrron 1 hcnrn I'x^uri () r lI (i!,ri.t, ! Lr.hr ljw )
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<br />m .knF orlr S.!:iir
<br />1vof,f,l:8s:glltflitlsArla!
<br />uEclaSauaS
<br />I hkt y,lltrm unJ.r |rnrlr!.1pc4uyom ol rh. nnkr*m8 J.rlf,rrrr)n\
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<br />h.v. rn snl drr.! . ctn'li..rc ol (irgx ro S.lrln{r n k,tri.oiFnuan, r. th)vrr.J lor iy Sdlir 1700 ol tlE
<br />L{htr c({c, ror rh. tErlorflfr. ol tlE worl l{ wh.h rh. Itm[ ir Frrkl
<br />_l hr!. rn(l *,ll numrrn f,orkrrr L omlr tr\rri,n 'n\orn,x., at rqouc,l hy 5d rr In tilxr ol I lE I itrtr (ii.. ntr ihc FdolfuB. o!
<br />rlrf,rkl(trwhf,hrh^nm,s$\kdMvworkr^'.nrFhi!(,hh$atu.(!Er! rl F'l(y Dtrn$cr{c
<br />Pohcy Numb.ri_Erpcr
<br />l.cnrlyrtu olh. p.rlormN.,'l ilr *oit ntr wh.hrhF Frmi tr !skJ.I rhrll nn.r{ DyrnyFron h.nylMEr
<br />r! rrbltom objr{rh rtr roltd. comJrns.rtr'n hwrorcrlrrom!, urj rrEc lhd n I st,ull h.oft uhj.( turll
<br />u,rtor' $n{Enqr n. povs.n! dl Selon :UUr .l rh. lih, (-dL. I lrEll lo(n*ri h lT'rttly *irh ilb. lf,o$r,.i
<br />WARNING: f{turc t, {dr. *ork.6'conp.nido. ovrdt. rr urUwhrl, drl .h.ll sut'r.t .n cmpL'y.r h {mrrllrNln ml
<br />.Ml fm! (I) b or hu.drtJ rlbusnl ll,1L6 (tlft,,tll!), rn Jnxrn h rlr .r,q of (.n{Enqrior. d.EE.s rr trovd.d Lr rh.
<br />Sdt,n 1076 o1 rh. ljhr Cirl.. mr.({ {xl rnorxy'it&!
<br />UCEMID-CONIAA!:IqB
<br />DEcl {IATION
<br />I h.rcby rllrm unil.r JEmlty o, fEUury thd I am ltrrnkn undcr pn,vlon olOupr.r 9(conftrrn8 v[h Sdrln 7ml) ofDrYtrDn I
<br />dl rh. B!.mri lrt Pn,f.(!r.s CdL. .r hy l.cn€ ! h tull f.N. .!, .lf.d
<br />califi8!&rolttfliDMilcEllt
<br />Ih(rhyrllnhtr l$ Fmhy ol Friury thll lhcr. r r (.n{ru(rrrn Lnlrn8 a3.k_y ntr rh. noforuNc ol rhc eo ntrwh(hrhrJErnn( 6
<br />nn'c'l rS.. l(ri. C'! C I
<br />AITLICANI.DIIIdEATA!
<br />I Hr, ,rm unLr Fn.ry d F ,llry oF or llE rolb*u8 rt.lllr rrrl
<br />Dcmn [n Pcrm ]A.tE{ol Ndnic.rio. rcrhrrl R.tuhronr (T k (l(,. Pd6)
<br />_R.quft J lrn( of Nrr,frtr$n
<br />I ..n fy rhrr r,I l.!cr.l rtuhr$ns rlstlf8 'sh.dnr rcnMl d n, lrt r.b,. ro rhs F)Ft
<br />-l(dyrhrIh.k(alrh..r?lrrlxDrlln.r.th.lrtE.hrEnn'.rnn$n!(mrI.Sdt,$rqrlywdhrllCr,!d6utyo'n ,xn.(\ rn Srrrc l-rw\ rlir'n3 n) h
<br />Itrr. n.nr()NJ pn)F-.n! r!tr niltlrrnr
<br />eonsrucl!'n. dn hcrchy iurhru. rcFc{n6nkt otrhtr C ynlCoudy
<br />\Appliunr or A!snt Slrn.lu
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<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 />Lllvll4'l U"xrrt t?z ,ib)
<br />Certiricate ot Occu n
<br />Notes, Remarks, Etc
<br />D.l.:
<br />Drt _ Cdrrrd _
<br />FINAL
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