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BUILDING. INSPECTOR RECORD
<br />SITE-WORK IDiSIG.COMMENTS OWNER EUILDEi DELCARATrcN
<br />I ncr.by u,l-uh unlcr lcElry (n l.4ury rhar , M.r.n{i n.m rh. Cont.crtrs Li.nE U* i,tr rhc li nre,n8 r..v,i (S(70.r15
<br />Bx\Grs drl Pml.shn ct c): Any C[y or C,rdy whrh r.lurci . Fnr, !] .1'nifrr. rX6, ,qrovi lkmnrih.t EFr my
<br />srturnE rnn !r, ri\ N\u^-'., rl$ h|!es rhr rmlrdr for nkh Fmr n, rrk . rEEn {.rmr rh.r lE or nr ! l|.trrn ndd
<br />b rh. tftrv(odi of rlE conu*k '1 l-..netl u* (c1Epr6 9, commBr! *rrt sRrDn TuIi of D'vtrx'n I ofrh. Bxnrs.
<br />Polc$nn$ cdlc ) or llul lr or rh. R .icnrl rh.r.h,m .n l lh. tusr t'r rh. rlk8cJ .r.mflkn. Any vn,l.llon nl S(rrrn 70:l L5 by !try
<br />r0rl'(adntrrFmrrubFrtsrh..l''llkrhrror.rvrlFn.lty l.or tr rhrn lrv. huujril.loUa\ (S5{x))
<br />L rs owr of rh. FrF,ry, m m, .rIPloFr w h *.s6 .s rlE, $l. $nFNr@ r dr 'lr wt .,n lh. .rlr ! B,
<br />urcBLl r ofi.cJ (r, xL (Sq.1X4, Botirc3 &J Pn t.sotrr C(rt : Tn Conrkrr-s L..n* t * dB ,l mly ro r owrcr oI
<br />thc !^tFny wh) hud{r or inFoEr trrc)tr $l wh' drs sh *} hins.U or tEMlf.r thmu3h his .r h.r orh (mlloy...,
<br />prclr]o]ihlr t4*h mF lnrds d dn d4tol ollcGl tur * Il. bEE, rlE t rt or lqnmrE a! $ll wntu (tr F{
<br />ol oipLrrE tlr Oftr Bell6 *'[ h.x tL hakn or |n v!ts rhr h. d nE d! D, t !nEF,EiEF,ltly,sr,EF{FEoa
<br />l, .! o*ncr ol rhc nn)pc(y. an cr(lurivcl, .ont!.rirrr *irh lL.nEd conrr(n h ro.slN.r rrr FDi.tr (S( ?044, Busnr$
<br />snh{i\\.ncd.r'I'h.Conrrrr,il.'r.n*bwJiB,rtlynrddundort,JEdy*hohurldtorrh,'rrr.srh.d!,,and *h, r$tuat,f rEh F)F(h wnh. oxfi&r{lo lNnarl plrud brh. G)tuxtri Iitr l:wr
<br />_l trn.r.nrpr unJd Scrr
<br />lIo85EBS:gQUtlSSAIIq!
<br />lECl4EArlQ!
<br />I h.rcby rlttn uei.r lr.Mlty ol lEjury om orrh tulb*inE d.!h.rr)nrl
<br />-l
<br />h.E lrl wnl dnrrs . Ccn rlirrc ol C.rrnl it' S.lrlBurc n, $rldr !r,qxMx,n, t* rtuvilcl ttr h, S(rir JTOo or E
<br />bh. Cui.. r( rlE Frt(mr ol tlE urt for *nrt rlE Fhr ! s(kl
<br />I Ltr wh'.hrhr Frnnr ^ ^s(l My*or[c^'.!rkn msurfrc (dFar $d F,l.y number a
<br />tt <@m q tcb FJn t
<br />,^,rnt^*,, t ?Z /L . 06'17 -?o? |
<br />I (dfyihtr r th.IErr.|mR. of rlFkr n,vh.hrhtrP.rm tr Erkn.I lhlll d.rql'y.nyFBr r.ny lMNr
<br />s .! r' tE-m lubfri r' rtr *rln $mp.Br.n L*r ofcthr.m!..Bl l8N lt r tf I d!u! tEoe ohFr ro rlE
<br />m*di ('mp.Ml $n fmvrbns .l Sdi,n l?00 ol ilr Lrtrtr C,rL. I \hall. 6dh*irh sr{ y ur'h doe Pn'vnbns
<br />WARNINC lsiluE n' surc v cn'.otrwnsar!'n !.!cr!. ir utrhwtul {ftj rhrll suhr.l rn cnfloy.r 1,, siniml F his !trd
<br />.ivn fin.r up to oE hunJrJ rhouqnl Jollu (tllxl,U{D. in r&l i,n ro rn ( { ol.on{Enstbn. !rm3.r rs p!,vrj.d tu tlE
<br />Sel r'. .{,16 ol rlE lihr O!., brcrc{ .!!j .rr(ftr'\ re1 frA2c^ P€ )<a','Vriirusio[ir,ri crlr
<br />DE(]"I.&jI!O!
<br />I lErch, .liirm onL. Fuh, of F!!ry rh.r I m ltrssl unLr F Bs. or Ch.F6 9 (drnmBln3 snt SarM ?q)o) ol Dr'iFn l
<br />ot rlx Aurmr .d Prol$ptri C.iL. lrl my l..nr ir h tu[ nN.d.fi(r
<br />-3 /c6c6z7
<br />D.r..Ll/-Oy-?oZ/t<t
<br />rqn,,suguoludDnrilcEuq -r'|
<br />I rEEh, r,rmo.J.r Fn hyor F Jury rhd ltft r r onirudi'n Ltlns r!.E-y tu rlE F ftmB. of llrq n rtthrhEF !
<br />6ikJ tsr 1187. Crv C.r
<br />L.dcil N.B:
<br />-
<br />AIILISANLDESIAEAIIa!
<br />I tE .hy rnim und.r Fnrxy or ,Erjury or ot th. nllk,*ir8 ,jeldrl iiJns:
<br />t,.mrlrDn Pcmire^rlExrn Noriar.rFn FdLri R.8lLrion! rTnl.40. Pd6)
<br />_R.qru.d tr(d ol tl{,lshrn
<br />_t c.nily lh, rh. ,&t rd rc8ul.' i(,nr rc!{'.lin8 rlt slor rcB,vrl rrc Bn lpplicbk to ihll tt,'j+t.
<br />l{,1.d'lyrh,I h.E -.1 rhn rpph rr,'n lrn n.r. rh4 rh.lhE mturdo. !.ilrur.I.!rb!{nrtllyr h.nc yr',1c:rury
<br />'oii Rc! .d Sur. l,rr rLr ry ro h'U'n! mnia ri,r rd ts.hy.urlbru. rcF*nl8Er ol ll$ Cny.'n C.ui, kr .nld ol[n rtE
<br />^txlv. nrnrntrnl pnlrny 1,tr msF-!totr purlx sc\
<br />,1lplionr or,\ttntSi[Mrun (
<br />* l? (t t Ltr.\o<-it L................
<br />T
<br />r,,. . o/.c\/'7C,/,
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFEB Ground
<br />SLAB Floor
<br />Subf loor/VenYl nsulation
<br />Rool Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Eneroy
<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 />FINAL l-ll-?4 rL&5^t?,DS -7-rl
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc.
<br />DATE
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