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BUILOING. INSPECTOR RECORD
<br />SITE.WORK DATE !COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />D rywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif.
<br />FINAL o/n/r c ffit€/o'
<br />Certificate of Occu pancy T
<br />Notes, Rema Iks, Etc -\
<br />Z€
<br />OWNER BUILDER DELCARATION
<br />I nd.by.rrm rnd6 Fn.t, of p.rllry rhn I m.rml, eom rh. Co d6 l-k.E l,e for llE folhsin3 rNr (5€?011t
<br />t\!in6i an ftoadhn Co&): Any ( ny or ( elr) \tah r.qui6 . Fmil lo onirucl. .lls. iipror.. d.tnolnh or qtr try
<br />dtud(c Fbr lo iir sue., atr. r.{ ir6 rh. .pphdr loi luch Fnn ro 61. a 3isn d !rdd6' illn lE or .lE ir li..6.d FNd
<br />ro rnc F.vnionr of rlE Conrrudoar l-iE!.d l.u ((tq,r( 9. Cottltffiis *nh S<rilI 70@ of Dnnnn ! of th. &dB od
<br />kofBion. Cod.) o. rhd lE M JE i dnnF dE.iio6 !i rh. Iai! lor rh. rll.s.d .rmFion Any li.lilion ofsdlbn ?0:11.,l', !n,
<br />+plicul for . Fmil subj*t! rh. .pplicsnl lo . .ivil pdh y o I nor mor. ihm liv. hun&.d &ll&r (t500)
<br />L d o*m 6arhc FF!t. d ny.mplot6 $ nh srsB a rh.n sk.omFsion. triU dr rh. $ok d'd th. irEl@ b ml
<br />irlddcd or oiIftd lor $1. (56 7044. It6ind sd Prcadi.nr (-o& TIE Co rrlm ! l.kG l.u dBml4dyro,N6of
<br />!h. FFrr- r tr hll<b tr -qer€ rhdd\ &i $ho <t6 $t rsi niBlf or hclf or rhr.ud hir or ha .trr mplor6,
<br />pror id.d lhll ruct imFo\qldt a. fr, inldi.d.r.f6o.l ft1r sk ll rF\66, rh. tuildiE.r i,tr.\ffi ir $ld *ihi. oE )a
<br />ofompkion. th. o"G eilda $
<br />'l!
<br />h.r. $. hddr oaF.r nB rrd lr d rh. dd d hlild o. in+r\r rh. FoFty ft* dE s,D(e.l
<br />l. s.sG of lhc IsrrEty. o.rct$ncl, conlrelins sith lic.6.rl coitr&1oR l(, Ntr{rud ltE rFjal (s( 7o,r4.Irains
<br />.,i lt.t3h. ( .d. Th. Cont&ror'. l-i..B. l-ru do6 nol ,Dply ro an osnc . r rroFny tr ho blild. o. inpr.r6 ih6on.
<br />and $ho codtu1r nn rucfi FsF rnh ! Coddonr lk6ed rlxrJd t\ rh. (-onr*ois l.kmr l!tr )
<br />ldn c\enrpl undd Sdk)n
<br />D.r. oin.r
<br />\ltrR(i E(, aortPt ts^rroN
<br />DIC.LAAAII(I!
<br />I h6.by !mm und6 Fn.lr, otFjor] on.of'h. aolL$ ns d<L,.rn'B:
<br />Ihr!. d*illminr.in!c.nili.,r.of(oBdrr.s.lrltriu(for$o d omFMi.n, a F!\iLt torb sarion !?0oofrll
<br />t h* Cod., for rh. prf(rlrj@. of rh. \MI lor rnrl rh. Fni ir isu.{
<br />IlI!!.. { ill msinr.in $ ort6 c.mrEEd bn i6lrma s rcqon.d b) S<lhn lr 7u0 .r rh. I lbor Co&, ror rh! Ffotu. or
<br />0t snrr for whrh lhi! Fnn i isEd. My n(t6 comrd'sion iMiuc. cMis &xl Frli.y nunb( 6.:
<br />I col,ly thal in lh. pqrormancc oih. \o!k ior \h'ch rh'r Fmr n !!,.{- I rhalr mr opk') an\ Fv)n ii tn! na6
<br />$ a b h.$G ruhj.tr ro rh. $0*6 mnFdion l,*! of ( lhaomii drl ifl s&,ultl h.<on. sut (t ro rlE
<br />{odd ..mFerionrNiliomofsoriDnl70oolrh.I.tnrCod..I
<br />6 l(, oimiMl Itnhis .nd
<br />cnil nn6 ur ro on. hundr.d 'h.usd J.llns {ll(
<br />T)';'lii'
<br />,*ro*-o
<br />I hs.hy aflifln und6 ti..ahy ot Fjtrr)- lhoi I liLsstlund(Fo\nionof(tq{(0(comffiin!rnhSari)n7(ltr)olDnisi)n:t
<br />of rh. au'6i rn<l lh,r6s[ns (i .. 3nd nr\ hcoq,r,n I
<br />I trcn.( ( ras Y -/ t-")l-:?,^\tt ,."K
<br />o?33 (
<br />( ()\stR(( I l()l\ l.t.i\Dti(i \(it:\(\
<br />I h@q( amrm und6 Fuh).tFru^ rhar rh(. r a coNrudFr lBlin! rftr ror
<br />'h. Ffonllm. of rh.$orl for \ni(h rhir Frnit E
<br />isnr.nlSd:rurr.Cn ('r
<br />ATTU(INLIEC!38AIIA!
<br />I Eqr(J rrfim undd po.hy of Fjory om olrh. following d<lsarionr:
<br />I)tml'rioo PdhirsArhoros Norificalion Fcddal R.sul roN (lnl.40. Pin6)
<br />R.qun.d ldld otNotifi (slF.
<br />I drt rh! lh. a.d-.I
<br />l.dif' rhd I hrt. rad rh
<br />irnr rqediry ab..kxr6no\alar.nor q'pli.ablcro lhis p().d
<br />ir iicof,d l68r to complJ" \irh lll( irv rnd (i,un'y
<br />,, Llf. \r\ , (lsr ic L$\ '.rl,nrLfn',!tr,r.
<br />lzi ltt.h)v. morutud pror.d' ror
<br />,\flrlir*ni or ,rtdr Sig Nl
<br />{=*A#
<br />riz. !.F6.t dn6 ofth'rCh,!ft1.?
<br />IE[iil
<br />Pool Fence
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