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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 nsu lation <br />3-291Roof Sheathing I Y'IL <br />Shear Wall <br />Framing <br />lnsulalion/Energy <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 />Enqineer Final Report <br />Flood Zone Certif <br />FINAL VJ r)il <br />)Certilicate ol Occupancy U <br />Notes Remarks Et <br />+ <br />OWNEN AUILDET DELCAT.^TION <br />I lrfthy r,frn ult r FD,ry ol Frjury rh. I o c!.trI'r lDn rlt Grrrar6' lr.n- ll' fin !h. ft,tlo*o! R.:'n (aL ?011 5 <br />Bunn.( .Bl fn,rc$i,'n CoL): Any Crry or (irnry whrh rcquiEr . Fmil lo Lun(ruc|, rll(, imlttrw, &nxrsh ot EJEtr My <br />derurc. rrn h s (trm., d$ m1urcr lh. +plrsr htr rEh Fml l. rit r !l! .] {{cmnr rh, rE or dE s l.u<J Nd.i <br />b rtE F)yL.$n! ol rh. ConrBioi\ l,N.<n U* (Ct{n.r 9. G,hmtun! v h Seinn 7u, ol Drtrnn I or <br />'h. <br />au.Ei. ttrd <br />Pn,,isn,nrCoJ.)orrht( k.rsh. ri.r.mpr lhRrhm ud lhc bl{r ltr lh..lhscd.i.dtii.n A.rvnrkrnnorSdlonT0llStyriy <br />.mlf,.nrktrrFmnohFcrrE.pplElorro..'y'lFEliyoarnr,torhr,rvchu rrcnJollr<ls5m) <br />_1. a\ .wnrr ofrhc nnrFny. (r nry.nrPl ')rc! wrh w{.1ri th.ir q'1. .onfcnrdi,tr, w,I &' rlE M)tt dJrl rtE nBrm a fti <br />dorLl orolLrql I(.1(Se 701t. Bues.nn Piofc(F8 ctrL: Th. ci\dr-rn'.lr.rs Uw(Ixt r{r,rroro*Erof <br />rh. tsrin, *lr) ho,ll! (, otn&r ttrc,n. .nr wh, *x Bh u)* hmr(la or h.Rll dr rhNulh fiE q h.' o*h.r{ll,r.i. <br />povkltd rhir ruch in!$Emdt e nn hlcnL oroltar.J itr saL ll, b*.Er, rh.ho uB.r ntmwrd sv,U wihmM. rts <br />orcdnpLrbn. tlr OwNr Bui!.r *Jl h.r rlr hhi.norPrurr{ rni h rslrJrldl{ lorurlmE[EFld,ft,rrrFitF,.ol <br />-1. <br />rt owxr I rh. nnrFd y, s .\clunv.ly .onr&liry u.h ltr!trrJ .odrkhi ro $n{d.r rlE Imi.i ( S.r 7(ll,1. 3urm( <br />.r,J Pnlk<s.(lrb: Tn Co,rrre,'! l-f,..* b*d&r nn {?1, k, uo}RrofF.Itny*h! horl.l!o. mpN(r ih.tsr, <br />,nd wtb $dnG n* sulh F)iek w h . c('nlnlro(e lutrr! puFud nr <br />'h. <br />ConrtLlort l-Enc llw). <br />_l m .kmF utoLr S&lir <br />lloaf,IiEs:-colltEN.tarIa! <br />IIECIABAIITE <br />I ltrrchy allmr undcr ll(n!lllol p(rjuryoN olrhc l(n['winr ,lc.laruinn\: <br />I h.rc .flj *rll dd{u r C.n i,r. o! Conrni b S.ll.lnsuF lor wk(( .onqE.d$n. .r Fuvrl.d,r, bt Seu't l7tr}ofrlE <br />tlhi Cdh, n* rh. lEnnroN ol th. wofi (r whih rh. Frmir i! !\o.J <br />I h.vc .ft1 e rll s.mr.'n woi(n lr,nFnnri,n 'hsuhn., <br />( rqlud hy S{rrr t'7u} { <br />rh. *o,k n). *hrh rhtr Fm ,r (rkd My work.6 6ntJEnrari,,n o{uram. c!tri.r uri FJ <br />!l rh. liu (i{.. nn rh. PcriM ol <br />..,,,,.., . s}q+g Cotv'tpovl 6 F,S,n s Fun) <br />"r"rnEo,n*.,2-l- <br />IL.nrryrhdlrlhcnr,omBc.rrh.wor*ntruh(hrhtrFrh s Ktu.J,I rh.ll ft c,Or,yrn,lEhon n.ny ronmt <br />r $ (, h.(otu rxbF(r ro rh. s' 6 .onllEnsrrr L*t or ( .ILm,, 2fi1 r3R. rh <br />'r <br />I llhull h<om ruli.{r ro rll <br />rort6' $ri{Enq.n. F)qi.nr or Ser ir .!'7(t} .l rh. Lhr CrL. I rh.rL lifhu.h ('qiy v h il$r ptrrtli,nr <br />WARNING: Fr ur. (' M wort ^ !r'mF.{ron (r,rn3. s unh*ful, [r! \hrll \uhid m .r'J'li'ytr lo srMr] FMl.! rBl <br />rirrl lim! uf n' om hundEd rh,usd dollst (lld),(xx,). h alNlirion h rh. (d{ of crmFn{lDn, d.nuAct rt floviicd n)t th. <br />sRfu'n 1076, rlr l,h{c'rL 4rcrcr .^l duEy'r l(r.3- \j-lq e2_ <br />OIIIJIAIIA! <br />I hcrchy allnn rorcr p.@xyor Frjury thd I am IMn*d u*l.r pnrv6$n ol Chrfl.r 9i$mmncr3 *rh Scdirn 7{x$) ol l)'vton:l <br />ol rh. Burtrs rnj Pn,l6!r'nt CuL. lil my h.nc ( o illl fo^! .ri clldr <br />c3q qseSt43 <br />,,,,".3^13-lq * FraaV- \rtae-agAZ <br />CONSTRU[-TION LL\D!N(I ACEN('I' <br />v <br />I h.Nhy afflm undcr Fultyol p.rury rhd rl*r ir r dNo.rrr. LnrhS +.ncy lilr rL pdnmm. ol rh. work ntr *hi.h rhs Irrn s <br />trrkJ (Sd .r{'97.Crv C )knlcarN.m:- <br />APPLICANT DECLAII TION <br />I Hry .riim uftlcr rEn.lr y ol lrrFr, oM ol rl! tull)*int &{Lr, i,.t: <br />D.mllnon Pcmxls-Arh.(os Norrncak,n F.deral R.sul,t!,n! (T l.4lt, Pdt) <br />R.llulrai lJns or Nriarrrr <br />l..n y rhd rh. l.Ll.rd dtulrrk).s N3$dDg r\tx\kx (m)v.l m n !{)plErhk t, r h( pn)r.t. <br />Fyl(.nrlyrhir Ih!,cr,{.trh 'nplf,arx,n url (,ic rhar rh. rh,vc 'nl,t ri)n 6cotr..r IsEret'mnflyw(hallcryanjO'trnry <br />orlhrtu.s.nd Srd. tjw\Elrut k,bxrd'nf con{oJr'tr &l h.r.hy rulhruc rpr.E tuv.l of rhr Cny rtol C.uniy tj enr( oF,n rh. <br />rllrE mnr.Ed FrEdy i!tr NFdrn <br />,1ppli($nl or As{nl Si,rriture a,nL p/) <br />')<-..qv1L <br />IIETE <br />\q <br />knLis AJd($: <br />- <br />,",.- 3-\3-\1 <br />')11