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BUILDING- INSPECTOR RECOBD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWN!]R SUILDER DT'LCARATION
<br />I h.Rhy rtrm laLr 0.nrl'y,,1Frpry rhrr I.mcr.ml{ lbn rh. G)nrehn lIcM Lls tnr rtr nnb*iry rc.er(Se.tull.l
<br />Bunrcs .nl Phrrc.rir Cct r Ary C y .r Counly rhrh EquGr . F n kr ..hrtur- .Id. 'a9n t, &tulsh ot EFry
<br />ntulr. I'rx tu r !r$er, rls, Enuft!
<br />'lE
<br />.J'tlr.nr td *h tmr b rrb. jBEJ (d.dnr thd lr or {E s ll.neti lrrsrr
<br />ro th. F,vtsk,nr or rtr Contrr(tr.s LE.nsd trw (Ci.iiq 9, ConEBinr w t Sc.rNn ?u}} ot Div'slri 1otrh. 8ulift$ sd
<br />Pnri$i, Culcl q rh.r h.or\hc is.i.trpr rh.rcfron.nd rh. bui. roi rli. ,lhs.n .r.n{i 6r. Anyvirhrk,nolSetiln7011.5byrn}
<br />.r'!lr.n' ror . Fmt $6Fk r,E {rlE.rl b . (rvrl t'.Mlly of rx dE rh., trt. hu rql JolL6 (lt@l
<br />_1. rr owr olrh. I,lFny. or ny.n ldFs w,th u8.!.s rh.a tuk oElFn{non, wil rb lh. wdk.,n llE sturE i ft'l
<br />hr.nld ordaLr.d tor s,r. (Sd 7044. BusiF$ d Pnlr.skrs Cii.: TIEct)nlr&rd, Li.nE Llu d.r! B,l lmlyro.norrcrot
<br />th. F'tsy *h'tD &q lqrrErlEEh.d wh, dH Et s*t hrlelf or ls(lf or rhn l8h hE d ts owtr cr{lkr,frr,
<br />pn,vtLal rh.t rEh lrim@dr E d it.abl lrollsai fq el lt lrffi. dE tndrll3 q qr)Eftd u 5ll *nhr,tr rr
<br />uf!\rprrM. E()*Er Builld sd hlE Ellnl.nofF)vrytlErtrqrlEdild'rhn!(lqmEUEFrEl,rtrlltrtFEoI
<br />_1, rt o*E olrh. F,iEny, rn.khnwly on6a1n8 ! h lia*rl $nutu(r rr (orrB1 rlr F Fd (sa ?o&r. Bu.rs
<br />.Jrl thrkrs C(xk Ih. Conkaror's LL.., br d€, nn .I,l ly h s owM oI F,'tEny *li) hurLlt or t6ltroy.! rlE..o[
<br />rtul who lr,nrnllt t)r slct FrFl., h. conrr&1o(n l.cnEJ !,nMr b rhc coi{hciif, s l-r.n* l*)
<br />_l .m.rcq, lnLt S<ri,n_. lt &PC ftrrh\E$n
<br />WOltKTRS' COiIPFNSATION
<br />DICIJB{UO!
<br />I h.rchy !r,i.m un&r lrtulrt ol Frrur, nr ol th. f!'lk,*hr d.{hriii'nr
<br />I hrudwrll mhl.h r C.nrf(rl. dl C.n.nr lr' S.lllnsurc ti,.Htrtsr (nIENdbo. !\ t$vrLtl ktr hy S&tron.l7)0 ot rh.
<br />tltu c(rlc. nx lhc Frfornrec o, lhc wod ,itr *hich rh. pcrmir n s:u.J
<br />_l hrE nl *'ll Mltrlin ,ortsr' romoccrrxr i.\ohnc. rs ftslntJ b, Strbn 11l} or rh. t tnr CftL, d rlE Frr,xrllnt ol
<br />t,r *ort nn *hxh rhB Fm u ,\ftl My work6' $nqr. rb. 6rur.N 6.r., Inlly.uhtEr e:
<br />Iucnifyltul in llr p.rlilrB roflh.*o ,nrwhi.h'htFrnir ir 6s!.J- I rh.ll , .mnk'y rny FRn' ,n rny muxr
<br />$ { h) l&-a {hj.ri ro dr srl6'on{lnprnn Lvr or Cdifom!, .,rl .8N rh.l
<br />'f
<br />I d,u! tr.om {tFr nr rlE
<br />q,ldr r$n{.^s'i,n Fnvskrns I Sdrkr ]1x) of rlE lihr CqL, I ndl ftrih*'rh .r,,t9l, *'ln rlrl. nnrvrx,nr.
<br />WAiNING: Enurc ro su. urk ^' conyrnsr('. .r'EBa€ i{ onL*tul !d rh.ll srbj.{' m dnploFr (! dEin l Frts.,rl
<br />civ nncs uI) 1,, om nundrcd rh,usanJ dollu (tlOO,U$). in q.l'litDn b rh. cor or comJEn$tx,n. d.nr8.s as Povid.d lbr rh.
<br />S..rirn 1016 ol ri. LrlDr Gn., hrcrd nl !(omr's r*r
<br />LISE IED.COtr1!ACIqA
<br />DECIJEAIIO!
<br />I tErh, .t[m u'rL. ItMxy or F,rr, !h, I rm L(scJ lnLr Frvdrin olcn F6 e (!!nmBhi rnh SGrD 7UJ0) of Driibtr l
<br />of rtE 8$img rrn Pot r rtu GrL, .d mr l.mk s n tuU foM .rn .fidt.
<br />carElallfia!.1&Dllc-aGE8tr
<br />I lrrhy .lim !Btc. Fdy or FI!} tnrt rhE! ir r ohrBli Ldns .FBy tM llE IEfm. of tll kt fri lixh rt! Fbr u
<br />is.u.J (Se. 1()97, C'r. C.)
<br />ATSUI:ANLDECI.IIEAIION
<br />I hdlty .tiE udlr Fn.hy ol F,rury or or rh. lolk,era &rbhr r,nr:
<br />D.m'l.r,n P.rm[s^sb.lkr N,*lrE.txr lti.r.l Rc3uLr.nr (T!ktl{l. Prn6)
<br />-ltcqtiEd
<br />txrrcr ol NdifrarDn
<br />_l \d y rh:r rh fdlErl r8uhrDB E8-dr8 .slE !x rcmv.l e nr {ru$L ro rrE F)Far
<br />_l .drly rhar I tuvc rord r,rB lppl@rrn ril nar. rhlr rh. {tr,vc rnlirmron N cotr cl I rBN n, r.n/y eih aU Cny rnd Counry
<br />oniruL$ o! Srirc Lr*r Eh'e3 kr buillnr(oNlerin. r h.r.6y rurhtre Rlx.rnrrnv.s trl l hs City un! Counly nr .nrq uFn rh.
<br />.h,rc m.r$Eal In{Eny tu nr
<br />Applrur or At.nlslr luF:- lx
<br />P.E IFMmrerlnlt
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulalion
<br />Roof Sheathinq 2lLllLt b*vE 4
<br />Shear Wall I
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It4asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL Zlttlzr Dd*t j
<br />Certif icate of Occupancy
<br />Notes, Remarks, Etc.
<br />Forms/Steel/Holdowns
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