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BUILDING- INSPECTOR RECORD
<br />co MENTSSITE-WORK DATE ID/SIG OWNER AUILDPI DEI,CARATION
<br />t ncrchy .ntd ufla.r Fmny ol lErjury lh.r I ad .xcnpt fm,n E C.nlrlclor' Licn{ Ln* ro. llE fouo*ir8 tr$n lS.. r0ll.5
<br />Bulift( .d Prcr...bn Cod.) Ant Ciry 6r (i{dy lhth Bqun6 r rEd t. drnrM. .16. irFDt. d.mlirh { r.Fir Mv
<br />{Mlr. Fin ro irs sffi. rk' kluiE! rlt raDliar ror rkh Fmn i. nb ! {!Ed {ncffir rhd rE ot tlE i liln<n p!.qr.r*
<br />ro rh. F'vtt'ns of irE Conkdor's l-i..nrd hw (Ch.I.r 9. Conftth! silh Sdhn 70(r) ol Divirkn :l oflh. Eurirc{. and
<br />Pbreicxrnr cin ld lh.t lE or sh. t c(trl|)r lltt iiom snd rh. h8k ftn rlE tlk8.n.rc.qa.. AnyvhhhnofsarionT0:ll5byuy
<br />.n?la.nr lor r Fmir subr.<r\ rlF rtf lkmr ro . .ir il n Nt y of nn mr. rh,n fit. huniH dolldt rt5fi))
<br />-1,
<br />.\ oemolrhc pFFny. or ny.nployar sith *!sc\ !r lh.n sk or{f,nelion. will & llE w(it dld llE tlule ii hr
<br />inr.i.Ln d off.rcd fm sL r S( 7l)ll4. Busirs dd Phfd.hnr Cdc Th. Conlncioi { l-hns ti* &Er ml q,!ly lo d ostr of
<br />itr FoFnt *ln trild..r in+.oB Em.rn *tn d(E uh trrl hin*,f ot lE&ror tlwud hn c ls 6*n.nrloy€r.
<br />Fovidcl rh.r lsh lrinrwnr & d arcrlH r olkEd rs qb lt r$s!€, tlE loiSlt d iqr@ld n $! *ihn .n Fr
<br />of..npkrbn. r ol*Br Builr.r will h.E tlE hitn ol Ftrvin! ild lr d \h. dit d h{ild or irymE 0E FtrFry lor rlr FrIb. ol
<br />-1.
<br />a{ or E oa tt I',)|Eny. m.r.hJnNl! .onr!.rine *nh rNnql (onr&1oft t, nm<tur rrE FrFd lS.. 7l}!. Btsitrs
<br />r t Pr!tusin C'di. Th. C.nrrtr't l-i.cn( Lrw dc{ nn lplly ro nn .BF or ,'r.Fiy vls hu rlds ot impror.r rh.ton,
<br />ond shr .onr6cl\ nn luch pn't crreirh.(bnt!.ror(t liccn{'l pur\utrr lo rhc (1'nrrrcroi. l -k.n* tle)
<br />lrn.kd un&' Sdik'n
<br />!!8f,88s:(9ut[!lAlls!
<br />IEITAXAIIO!
<br />I h.rcb! .llirr unds I'<Mlry ol F:Iiry om ol rlt ri,lh*m3 d.(hhtih
<br />I hak ni urll nurnruh o Ccn ifrlrc oi C.nEtrr h Sclfl niur. lin *ork.h' .ontEtr{rioir. os novidcd fd hy Sa liotr :l?(X) of lhc
<br />ljtrtrCdlc.fdrlEFfrnrrcc.lrh.ri,lnnrhihrhcFnnr irtucd
<br />_l hnk r l *rll minrri. workcF .oriltlcnr.ti'n rsuran.. .\ rcauicti 6) krirn :rl(x) or rh. lrntr Cod.. Iin rhc lr{ormt. or
<br />rh.worlrar*hkhthkp.rmnisnrknMyvo cr'conrFn\aln'n insur!tu.cark ar, Flicy nuhh.r m:
<br />--'-,,".
<br />tt-al-tq
<br />I .cnfy rhi m rtE F.f.rflR ol tlr wolt tu *hi:h lnt lEnni n irrn.d, I shrll ft{ .dpkry rny Fsi in lry lMr.
<br />o N h lE$m ruhFl n' rE mddi oqrndbn Lf, r ntc.lrrom6. r,ri.8r 'h! il I rbuld lt('m $bF k' trt
<br />w'rh6r d,rfEneri,n Imvirbm.r S.d ioo ]7m or rlE Llh, (.n ,I rlDll. fonhunh s'mdy riih rhE Imvrii,nr
<br />WABNIN(i Frailur b kuc worlcr' omp.nr0tnrn c.v.ftsc is unh*f!l- md shdll.trbl.d urr.nrlo,€r lo simiul Folrh and
<br />.itil fin$ Il k, oF hldEn rlhlon .rolls l!llx).(Ilr. in 'ddlti'n t, rtE .od of .oqrnsriorl. dmStr r\ provU.n for r&
<br />\.1k,n k...rrli l{h1(itir .'ci{ndJn,1tr.\'. s
<br />,.,*,. I ti4ltq -^;;*"-", -5--
<br />I r('FNgHr r (u\ I mcror
<br />DECIIXAIIIT!
<br />I rEE6, .rrm lndq F iy of Fi{y ihd I o ltr.d uiiLr F,vnbn oa Oq q 9lonmfti.8 tnh S(rr,n d0,.f Divirir l
<br />ol th. BuriErs arn PmGsionr Cod.. .rn dy lt.rc t i. tull lorc ain .fi..t
<br />ct0
<br />,,"," glqlTq
<br />q1\1 s6
<br />g1lSIBl]cntr!'.LllITl}lilCES(I
<br />I hcEby om(nud.t Foullyolpcturr rhar rh.t n r.r,n{flcrhn Lndi.8 r8.rcy t{'r !h. paafortuR! ofrh. wtrk tu *htn rht lEmir n
<br />iriucd(sN t097, aiv c)
<br />AIILITJA,ITUTECIJSAITI}N
<br />I hdrt',lfm!.dn Fn.hyofFrrrry nB oflh ri'lb*in8 Lk{hrritns
<br />Dcfr,hdn Pomik-Arh{os Noli6.{lion Fcd.El Rc!!l io.sl rirt tll). Pan6r
<br />_R.qliftr! tr(d ol thrfdion
<br />I.c rlythd rhc l.Jcrrlrc!trhri,'tr\ rcEnni'ry x\tr(o\ rrnxtrxl c tror,'t)Jrf,rhL r, rhi\ InIcrr
<br />E:l (diry rh,r I lE$ E.d rhktpola.ri,..,isr!r.ll lh..}r'E in(nn i'n k.(fr I .EE ro mry y *nh rll Cny rnd G,unry
<br />{, iEm ,rd shr. lt*r Ehri,a ro hildirEisnrBl_a* .rn ltd, aurtnru. EF*d.ln'6 nt rh,3 Cir y !d cou..y ro .n'd uts.
<br />'lE.,1,,\r trrn,,{hal|rrrilr\ r,{ tr',F.'.. F'?.\
<br />rnpli.nnr nr \!.nr Si!turun ,/
<br />-
<br />,rmri,Fmm. prin,,: tt; At;Iqnd'D
<br />tlzq lq
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Bool Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsu lation/Energy
<br />Drywall
<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 LIztlzo P.fl'{t'oL'El1
<br />Certif icate of Occupancv I IU
<br />Notes, Remarks, Etc.
<br />Subf loor/VenVlnsulation
<br />Ext./lnt. Lath
<br />,*, Au*ri(qh 7vv,uh
<br />,.,un, *,-VL91bW
<br />t
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