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BUILDING- INSPECTOR RECORD
<br />O$?Tt:R BUII-I)EN DEITARATION
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<br />Pbf oG Cod.) or rh.t lr rlE i d.ra dE.6!n sn 0r tEt for lh. rlk*.d sdFD. A"y vi.ihrio. olsdion 701 Li br sy
<br />lp?lirsr aor t Fnn subrEr! rh. lrplicet ro r.irit p. ly of mr mc rbo 6!c hundrcd &lld {lJoo).
<br />-1.
<br />s ftE otrh. F!Fr). r Dy otplo)6 rnh r.86 s rh.n $k onFEiio( s & tlE *ql nlilr tuE i! d
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<br />rh. FiFV slb 6ildi or inlF.!6 d.EL rn who .h6 sh $orl hiN.lf or hd*lf or llmusfi tn tr ha o@ nnplot€.
<br />rrDvi,.d ilu st imFolllrdtcrll iid&ldo,H Iu rl l[ fiorqs.llE hrildins d !,r,*-nd it 5ld $ihh m ]d
<br />ofmmpldion. rlE (xn6 &rtta will h.w rlE hrda ofF.virB tni n orlhc dii tur buiu or inlhr rh. FoF,6r d. F,Fo$ or
<br />l. a oqd ofth. Flpqly, d qdusr.ly coitra.los s irh li!.tu d conracbB to .oddcl lh. projdl (SE. 7(X4. BBns
<br />i,'d hokii ( od.: r'n< Codrrdon l-i(.4 Lw .!)€ mr rppl, ro s o*ns o,ForEny q h. t{ild! or ihp.or6 rnd@n.
<br />r *ho colrrel3 tor such FDj.rr! *'nh ! Corftrfflr ltdEd Frddd b rh. (o.r.dm r l-re laJ.
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<br />0 .rnrl utxlr s<lion g-" t-,//Z ;J^t'2$'ZDr Q
<br />I hd.h! ami,n undd Fnah]_ of Fj!ry oic ol lh. aollu$
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<br />ljbor ('o<|c ny rh. Ffolrr@. of rh. *oft fo. rii.h rh. Fmi 6 asu.rl
<br />_I hov. End will n.inl.in workdt comp.Bnion isur.ncc. u rcqln.d hy s.<l N. I700 oarh. lrh.r cod.. lor thc pqforlre. of
<br />rh. wl fn {hth thir Fnn L is.<t My wk6r omFlrion i!fure.&io in poky numbr E:
<br />I cdirylh{ in llE Ffoffi of 0E Nrt fd whf,h lhn Fnn n q.4 l3hdl d{ @plor r} Fsr ir my nEr,
<br />e a t. b..on subi..l ro rhc wortd' onp.Mio. h*. of C.lifomt, ud lsr lhd il I lhould t{.orc suti<l to lh. -
<br />sr{6 comp<iMh. Flrtidtu of SdbD l70O of rlE ttbor ( o(k I JEIL lothunh snpry *nh rh.s p@!iir,G
<br />wAR ING: r.ihrc r. w. lqld odFsdni m!€.sc ir mh*tu1. . Jdl rubj.< o aphF lo simind F ri! dd
<br />h onc hrndr.d rh.Brn dollm (Sl00.lr(xl). ii dn(in tu rh. .o$ ol .onrFnsdnrn, uuxB a pn ' leJ li)r rh.
<br />Sqri'. 1076 oloc LAr co&. i.rdd !d.lldrE!! fa., /t7 ./)Z L/4 r-e-,,,,", l-29'ZDtq
<br />I heb, artrn u.dd p.Mlty o I pdju ,- lhar I m li
<br />7/
<br />ng sirh SE i(nr 7lr0(i) olI)n$u.r
<br />of ih< ttBtrB !d Pnfdoa Con , &n m, lhN t i. tull lore !n cltal
<br />gllgauc r!.liNractqENtr
<br />I HD dTrm undd FE[y or psjur] rhr lhd. u t oldru.rFn lddins ted, for (h. FIoIrffi. o(llE r.rl hr qhih rhi! Fmi ir
<br />i$u.d (sc !097, Cir. c.)
<br />t.nd( r Nm.
<br />-
<br />L.nd.lr Addr6
<br />-
<br />attll(adr.lEcl,aaarra!
<br />I hoi, .fE6 un& Fuh y of tEjur' oE of thc aollo$ me rkbrdirs
<br />Ds*ndion Psmns'AltBrG Norincdrn Fci6.l R.guldion! ( rnl.40, PM6)
<br />-R.qut.d
<br />l-.rin of Ndd.dir
<br />-l
<br />rdi[ r hd th. Ldaa] r.suLlioE Essdins BtErot r6fur d a. ndr qplatbk tu rhts nmlEl
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<br />cdiry rhar lh6vc r@d rhi! .l)pliorbn di rdr.thd rh. rhv. inf.nn.lion ir cotrc.1 I arrd ro .onplt *irn tll (-il y ond Counly
<br />odinad,nd sr!t. Lr$. ElnirB ro b(ildirg mdrudnr.. &n nd.by aurhrn.r.F<ni n 6 .f rhis ci' t ad ( ounl! io 616 ur$n llE
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<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathing a/qt6 l.r\46rv r/rt2-'
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<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 3 lZ'r \\3
<br />^lrt(6Certificate of Occupancy -v
<br />Notes, Remarks, Etc
<br />H;:.::;;:.. u\eaPrrnrire nrmr rpri ,: L_j
<br />-/)
<br />Q..An^
<br />Flood Zone Certif.
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<br />I 28- z,rl
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