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BUILDING- INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS I ndcty.mm loda F.rlr, oa pajury th,l I d.rdpt ftin lh. codnclos t,ic@ li* for th. aollowing l6oi (S€.701r t B6i.d !d ltoldFn Cor,.) ,rs! Cily or Cbun! *hih rctut6. Fnn lo co'rito.i .i6 inFo( ddbluh d EFn dv ntu.rrq FF. ro ns isuftq .Lo rq]rliB th. +plker fo. ioct Fmn lo fib. sirn d idaEl lhn li or !n ir litE d pualr ro rh. Fo{ii6E of dE c.nlElois t.i..c.d Lt* (Cll4rd 9. Conn4ins *ith sdion 7000 of Divilio6 :l of lh. Buina md ftnl6hN C.&) s lh.l lt d trE ir.rcng iha.nom !d llE h6i' ro. lli.lLS.n daFio. Any liohrDn of Sd bn 7011 5 tt cy rpt'ltortuap.ntritsubjcl!rh.appliclnll..civilpoahyolnlmor.rh&fiv.hunr,rcddolle.(1500) I, 6 o$n6 of lh. FlFty, or hr dplorc wnh $tg6 s lfiln sL ooFsio.. qill d. ltE *i( a.d |lt rnrlE ir mr if,rdrd.d or oflqld for rL {Sd 701,1, Dui6 ud ftltGEB cod. 11. (ndt&loi. Lt.s tr* .b6 ml q?lv r. s ow of th. Flpdv who hril& d iqr.€ rlEs( rd stD rkE *[ s* hilElf ot ho*lf or rhmuSh hu or hc o*r dpbtG pmvid.d rtu such ihrm\66i. e 6r intftLd mollsld for sr. lf. h.\6q, rh. tloildins or itDoladr ir sH *nhin oo. ta otcr,'plr.r! rlE (\E BuiB. $ill h.\! tt!. h{id! !lF!ri,B thr h. or tE dd d hnld d nq!\i dE FDFrr- tu lh. F F. ol l. s o*c ofrh. F$!al}. d dclurv.ly (oddi.g $nh lkdE d conlrrG h odM rh. Fq<( (Sd 7o{-I BEns Md hlrhliI Cod.: t ic Conl.i.ro. t l.iccns. L!* doc not .nply lo d 6*nG oaproFrly eho hu'ld. or imProv6 lhcsn. od trr$ o ixs lor uh F1rb!uilh! Co'rEdo(t) lt.n d r{Nuti tolh.(nllI&rors Li.M Llu) I m.rcmpl trndd Sslrcn D.r. osr.r \r(rRxERs ('or\rPa:Ns^ ilN Dl!-la8,lllal I h6cby (iirm otr,ler rErahr- ollElui\ r..ofrhc follo$ns (l(luxrons I h.rc !d trnl tulnle. ( difrcd. of Colgl lo SdilBN lG r.*d omlEsiio.. d Folil.d n)r b}Sclion 1700 of rh. r (nd..ldrh. psi(nrmnc. ol rh. troll tu *hi(n rh! p6.'l is ts\u.d c md N ll nid.r \rortm comp.Nihotr insurancc. d r.qtrrd bj S.d ion r 7O(r of th. I atr! (nd.. ao! rh. FfomM.. o I i isi.d Myuorkd comFdion iNlft. cuir lrr Frl.t nuf,tE t kttt-otti CA_ytgiofl-5(s io/2-oz o I cErrly rhd i.rh.Ffo.lffiGof rh. so* lorrnkhrhi.rEhn ir suor.I dBllmr mploy tr) F$n in.., lMF $ .r ro lx.oDc ubj*r tu th. *o.k6 comp.Mlion lr$* or( tliaomn. dd isr lhal ill thould b..omc !!t'jdl lo !h. Nrrd' NmFsriin PiivthB of S..rbn t?m ol rlE bb.t ('od.. I tElL tonh*nh .omPlt wnh $@ Frvirio6 WARNINC F.rlu.. lo G@ MrId omrcMio. mr6!c. 6 unrrsaxl. sld shdl sbd e otlplots to aintul F$iB .t'd ro orc hundr.n rhoosd dolld! (ll0o.0(ro). 'n aldirrn ro rhc coi of confnero.. dEnar6 &r prorid.d fi! rh. S(ron t0?6 ofrh. trttr Co& ddd lnd il.my lll.!L!&ll!!l! I h.Eb lrm urrd D.trry of pdj6 rht I m kdel urb Fo$5n ol (LFs 0 t.!n]JrBi.g r nh S<rior IxrO) ol Ltkbn ! ol th. Bosind ed lnndNr cod., ud my licN ir in full to,c. ,! .116! c4b b lt4 a 0 lql coNs flll-lcl l(lN I r\DtNG acltN(]t I hd.qL .mm undd tErlry ol pdjur'! lhn lha. s a Ndtudir. lddins lsocy tu lh. pdnlllM.. ot lhc wo* fo. shtllrhi! Fnn i Lra.d 0i< !0r)7, CiY. C, APPI ICANT DECI AIiATIOiI I h.ttry .lIm und6 p.nlhy of Fjury orc of lh. followiry &.LEnonr: rxmhion Pmh!-A3t6roe uorilicd b. Fd6rl R.tuh n N lTnL 40. Prn6) R.rluE.d L.rlq of N.ai6d.n csliIi rhd rh. faLrd rcsubtnE r+tdin! 6tE rosrmnd . ml at'pli.abk h thir FmlRl ir!r[ar lhiErendrhs.tr]i..rk,na sil.lh rheih\eIntun,,drn,ri\c.rr. lis,(k,$ rfl!$rh.l1r' Ynnd(irunrt !d Srd. t r. Elri,B 16 tlildrnr .idrudir En .utrn.. r.F.srdiv6 of lhir( ny i.d Cou yto016uporllE ri(cl a)-,. t\\\b t\q Set Backs I rG. Forms/Steel/Holdowns I t Erection Pads UFER Ground SLAB Floor Subf loor/VenUlnsulation Roof Sheathing Shear Wall Framinq lnsulation/Energy Drylva ll Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Enoineer Final Report ).F lpod Zone Certif .I rl ^zll\ilttt&lbto lt ,.1 FINAL tl llt l4 IlAtltgtt-E g/ Certificate of Occupancy Notes, Remarks, Etc ( rr\\\t t{ BL I r)r RDll( rR \ llr)\ . tl & I'l ntr ihNr0rnr ".,., r\l Ia /t'1 }/,au hlll$tttw(14t"