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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 />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulalion/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Beq
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif -
<br />,--\
<br />FINAL 411-a
<br />Certilicate of Occupancy
<br />Notes, Remarks, Elc.
<br />oWNFI BUILDFI DELCARATION
<br />I lrcht rlftri unrkr Fnrh, ol Frjury lhd I m .r.rnr tun r& Co rtrm Li!.€ LN for th. ,ollo*'i.3 E$. (st 70:t l I
<br />susin.1. and Pofd(i'n Cd.): Any Ciry or Co!n!, *hkh r.quir.l r Fmil n' dr(dcl. !lr.L ifrnhE, #mlish or EFtr My
<br />nru.rurc. n i(tr ro irs niurc. lho rcquim rh. dpDlk.d for su.h rEnnir to fiL . li8ncd {ar.'ftnl rh.l h. or rh. is licenrcd Nrlcnr
<br />ro irx Fn,virionr or rlr Conrrrlois Lt.nrd L* (Ct!fld 9, Conmrine wirh Sslhn ?(m of Divnio.I ollt Butift( nnd
<br />PmL(i.'nr C.d.) or lhr lE ir rlE n cr.qn rlftthn .id trE lrril tu tlr .lh.n .rcrriion Any rirl,ra. or Sd bn ?0rl I by!fly
<br />rppltr.r for r Fdn $hF1r tlE .p?la.nr rrr r orll p.oty ol 'r Br. rh.n fi\t h!ftlr.d dtlh^ (35{x,
<br />-1.
<br />!! n*Er of rlE trlFny, ,tr my .dtloF.r sir h wnls .r rh.tr q,L (,trqEnsrion, r rll do rlr *nt 4l rlr ll.Etr i! n
<br />inrcnlrrl or orIcr.n r.r sk (s(.7()44. ausims rnd Prof.sions ('(xk 'rh. Conteroir l-i.cne tis d€! mhpllly h i. owE ol
<br />rhc n$Fny f,rr h{rld{ or ir{n,!.r rlt@( 4d wtb dr* trh k,* himr.lf or hcr{lt o, rlm!8h hi\ or lFr oun .nPk,ycc{,
<br />t k,vidcd rhrr rkh impnrff. @ mr id.nl.rl.r.lfcEd for ek tt th!$t tlE triEit8 nr intmErn ir $It *thin m F!
<br />oaflFILtir rlE ()9N auftkr rill h.r rh. hrd.n olFuilB rhr lE ntdUn ldld., infftt rr. FIEry r tFqRd
<br />L r\ !r kr of rh. nn,rEn y. rm crclur iv.ly .n' r!.rins * iih l'(ch.tl .0 *106 n, ..rnrud rlr F!c.r lS( 7(X-1. Bu{ks
<br />lul th,l!$i,n Codc 'rhc (i ruckr's Lr.nrc l-0* dncs Nn lnnlyrr' otrosner olnn,n y*h. huild!or impn,vcs rhcrcoh.
<br />rnd *ho (rtffi l,n {Eh Im,crc u'iri r (inectl( \r licisctl funenr k' rhc (r,.rrMkn s l-iccn{ lN)
<br />rlslry
<br />D[rLA.EAltUr
<br />I h.rchyulltmundcrncorllynlll.rjtrro'f, n,rh.lnll,)sin!'lNhrrii, (
<br />Poli.! Nun f,.
<br />Iccdrryrhrrinrh.pcrfu.numc.rrh.*ortl,n$hirhrhtFfln 'i Nlu.d. I rhall rn c uhy any ltrqr in dny nMEr
<br />v, N n, tE(nE subj.rr h rlk wnAc6 .onrFn\i i,rn lrws of Cu|fttrtriu. d tr3drhtrr il I {hxld tEconE \uhF rorlF
<br />*.*cr' $q{n$r ion l)hvfio.i of Sdinr .17(xr .l rhc t htr C,xl., I \hnll, ronhs ir h lrnnnly u irh lbe Frcn irrn\
<br />WARNINC l'.iturc ro surc K .F n,n|Fnqri,n.r.me. r\ unt,ulijt. rnd \Mtt n$Fr M.mtkJtrr !' rimiMl Fmhi\ r,ri
<br />dril 6'H u,' ro om hundEd rioraid dolrd (ll(x),u < of omFndnr dlmt.r $ pro\id.n ror rL
<br />r;"7iu",, '1 l
<br />DEgIJI{II]N
<br />I lrsbr rlfrmud6 FMll/.lFrlury rhn I In lttnrd u Lr lln,rtil. .r Chqi( 9l i,mEr ing sirh sdi'n 7uD, ol D^ tio. l
<br />of rh. aorift.. rrn ln'fd.iri ('od., ltd ny l(cre ir h iill loa: rn .rd
<br />(IIIEIBIJ(:IIq!.IAUNC.AGEICT
<br />I n .!5y rrrm oftt r l.Nxy or Friry rhd rlsr ii. onrNlbn L.din!.sd, ro, 'rr Frt({ffi of llr hd for rtih rhir Fnt b
<br />irucd (S.c..l(R7.Civ C )
<br />L.nd.ir Nrm:
<br />-
<br />l.rLr'r AdiEss
<br />affus Nr.IrlluaArlgli
<br />I liln! lnirm rhdd p.nnlryor Frllry orc ol rh. nnk,*in8 d(lsrurinr
<br />Dcnrniri('tr t'crmir\ A\t[no! Noiin.dk,n Iid.hl R.luhltun\ ( l lc 4r). Prn6)
<br />R.rlrikd l.($ of N(rnklri,n
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<br />enif, lh.l l,E Lds.l EluhioE tSrJ'nB rbbr rm!.| e (n qdi.hlc i(, rN. Fj.d
<br />nM (i rrybrtrrd trFn'rlr
<br />I (.nny rh I h.kR&l lhi{oppl(urionrd nxr. rhrrrh.rh'!. itrl({nhrtr,n ncorc.r ItrSrr,comply
<br />.il rr\ Jtr\lsrarc IJtr.,.lr'ns r, hu'l'iinE,ornnhrr,n,.# hcr(h\ Jurhwc rP'c*arDhr.. ',rrhr (-rrr
<br />ah{c nrn,r,kn nmn ry,, ^*'2y",,v*4/2....___
<br />Appllonl.r 16l SilNruF_rif (-
<br />".;,,--*,,"",;
<br />t/<-€r,.'r-' trt+"2 t /s)3
<br />J(@J*yNGpA-
<br />--/ r.a 6 r'( r' ,h, rcr-{
<br />,'dLJ(rL'*I"'--'. -,/ *(riKFR,i'arrntP!'\sArroN
<br />-I
<br />h.E rrn sil Eide . (.nifEt. ol Con-nr ro S.lf ltruE ld qit6 @flgEdion-.t Frvi.n ror bt S.dhn ]7filofllE
<br />tilrr Cod.. rd EFrI(m ol E wrt lo *ti.h llE Fnn i,stn
<br />-l
<br />h.v. .id *ill minr.in ,nrtc6 Ntrtrndh, inruram.. r EquiEd by Sd i.n ,u{ of tlt bhor ('o&. for tlE Frf(ffi. ot
<br />rhc *Drk for *hi.h rhir l.dir ir k.En. Mywork6 omFnr.lhtr inruruNc cujn.rn lblaynunb.!E:
<br />Ii, \.( I's lnrn' N,,',r\,
<br />Ihn.
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<br />II
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