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BUILDING- INSPECTOB RECORD
<br />SITE.WORK DATE ID/SIG.
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf looriVenVl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />Masonry
<br />Pool Fence
<br />T-Bar (
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL {tt(1 .\.t 1l {y
<br />Certilicate ol Occupancy
<br />Notes, Remarks, Etc
<br />I h.rrr .rluB unLr FDhy ol Frjlr, rh, I m.t r{'t iirm llr C.drrbF' lld€ ti* r,tr
<br />'rE
<br />i,ll'*tr! trs,n ts.t 70ll 5
<br />Bulin.r\ ,tt Pnrta(k,n Codc): Any (ily or Counry shth Eqou.r r Fmil l,' onntul. rlrs- irlpn'vc, dcnnsh or Ep.r uy
<br />{MtN, Frrii' nr !!ust. .tar Frrdr rrx {illdr to. !!(h lrml t, liL r r{E l nitftnr rh.r lr or {E 6 ll(nkl lEdd
<br />(, !h. llt,vsrnr .r rrE cuntr&ioi3 t,r.trEJ Lv lch:fl( 9, (hnm*rh! wnh SNrrn 7(100 ol Drvr$n I ol rhc BunN$ ull
<br />Pn{c(N'n< cli.) or rhri h. or rb. tr .r.n{rr th.Rfrun.nl ttE h.$ tu lrE lllcs.J .r.n!ii,n Ary Y$hri,nolS(trn701I t hy..l
<br />4r'l(:nr tor r F@r \!hFt trE rltllf,.nr ro rqvrl Funyot n mE rh,n rrv. hunltcrl ddll{r {ttml
<br />-1,
<br />.r opmr or trE F'Fnr. {, ry .qtl,F.. *nh wr86 ai rh.t ok .r,n{Enrr,n. w.ll & rh. kft .,n lh. (ur6 ! n,
<br />licd.J n ofi.EJ nn et (S- 71x4. Bulmi.tul Pn,t r.[m C,rl.: ft (nnr-G t L.# L.* &Er d, rlrlt t, owr ol
<br />rhc I'n'ttdy wh huildr inpmv.\ rt Eotr uJrl *lll dmt tsh url hmrcli d h.rcll ot rhNuSt hE or h.r own chPl,'y..s,
<br />Irctd.J rh, iufi dlf)wdr e n{ doLl or.fic.d 1.. ah lt hoxE. rtE t r\a or flFrtdd !$U*.hxd Fd
<br />olon{,ldi4rlrowErBuiln*lh.wrhhl^tn.fF'vutsrtdlror{E,lndnhrxdnlnErlrpolEnytulEInrFEoI
<br />-1.
<br />11.*ftro, rh.In)trdt, rh.\clunv.ly.odr.(rha *nh lE.ncJ .odtrrod !, ro.{N( rlr F'Fd (s& 7(}4'l Bu.trs
<br />rn Pnn6a,n(idcr 1h. Contsrk''r l.'ccni. t-rw d*{ nor !r,ply lt) M owncr ol rn,ptny wk' hu,lJx or rmlmvc\ rh.'con
<br />rnl f,lx, (r*tut l(* tuh Fr.!n p h r Oflrarod \) l(nrJ n!6unr h rh. (il.ln(nx ! L..n< b*)
<br />_l rn,.kn\i ond.r S.rlhn -B &P( r,trrlt$nrn'n
<br />WORKrRS' t'(IMPENSTTION
<br />OECIJSAIIOIi
<br />I lErcby 1lltrB!nd.r pcdlty of Fjury oft ofllE (t!lL*tn8 &rl{rrims:
<br />-l
<br />h:E at r rll mmrrh ! Ccndlzi. ol Coh{d ro S.ll.ln$rc |,tr *rrkdr .oqrnd x'n. rr F)vrki ntr hy Sar[n :l7m ol I lr
<br />Bri!trrufre.1th. uoll itr *htrh rh. Frm . trix.J
<br />w.d *rll D'nr.h srlcr' urnFnr.tr,n o{r.h., .r FquGJ t'y Srrnn .l7m ol rh. Ltitr C.xL. lor rlr Farmt or
<br />t ttr trhkh thh Iimi tr tr\u.d My w.ik.,! c, tinrrr!)n 6untrk. crntr Lt{lA.-'\qT,
<br />)^Lsal2ol Zo 1 L=
<br />-l(cd'lyrh 'nrtr lrilormfr.olih. work tn *hrh rhtr l.rh n srkJ., \hJllmn cntPlo, rny Fron nany mMxr
<br />q, r\ r
<br />' h.ur iuq<t n, rh. $o*.^ ! 'nlEnilt tr$ l.wr dl c.hfi nia. 'ni r!e. rhlr 'l l rhrld he.nE \uhrd b rlr
<br />Hrtcr n)m{xnqr[i I'n)vlsirN of S( ri,n l]m.frh.l:trr(irl..l dull. n h$nh drrily wlh rhE nn'rtr$n.
<br />WAiNINGT h'lx( n' (uE *)rt.r .omp.nuh,n $!cns. '. tr.hrlul .n,l thatl ruhJ.d m mPkry.t (' LriM,l Froh.s anJ
<br />.'v likr uI) n, oft hu lrcd rh'uerl Joll,r ltld)rh. ror of &riEnahm. dm!.s $ ,nrvil.d t{tr tlt
<br />S. kr rlr:6 or rh. I-.'lu (iiL t(
<br />DECIdEAITAN
<br />I lEFby fm unl.r Ful,.r Frrury rh, I m Lqsn od.r lh)v!i'. ur chrPlct e r.r,nEEuu *ub
<br />ot rh. Burms .d Ptn.rsDd Cuk, art my l..n* r o tu[ n'nr ul.1l(r
<br />C.Lb 4?3Ts-b
<br />coNsTRtr('TloN I r{Dllt(: acEilf'l
<br />I h.Ehy.lltrnr u.dq FMtyoi FrI{y rh! r}dc s. onnturbn hdr! lScBy tu rL Frt,,rm. dl llr
<br />APPI IL]ANT DECLATATION
<br />I Hry drm uLLr ltn.ll y .l pcrPry ox oa i& n,lbwsa &rLflr $ns:
<br />txfr,lik'n P$nnrA.h. .s N.rrlE.l[n lll.al R.!ul!h'ns (Til. il{], P.n6)
<br />_RaNftd L.rrcr ol lldil.rrtr
<br />I (.n'ly rhrr rhc l.,lc'JlkEUlrrr)tr\ rLes'lirt r\if,{!x e'Brrlrr nor rmlnrhI h rhr |n't.r
<br />rhd I h!v. Erd rhF applt.ri)n ul nrr. rh:r rh. rh,v. nl(,mErDn ! cotrc.r.l:!G ro.omPly w(h .ll Cd, .d County
<br />oniinlnl.\ dl Sr.r.b*\ ELrh3 n'r.\ ol rhr (-'rY rd ('.utrry r! cnk trrr.rh
<br />lhnr nrnrx,ril F)Fny ft,
<br />ApDlicxnl or AE.nl Sisn{lu
<br />COMMENTS
<br />Forms/Steel/Holdowns
<br />Flood Zone Certif .
<br />tru.J (S.c 109r.C'v. ( ).Llla!Nrft
<br />IrDt.,'\ AJ,tr($:
<br />z-{zto{11
<br />I
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