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BUILDIN .INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DET,(N'T 'TION
<br />I hd.lr !flirm un& FEh' or Fjur' rnd I m .\m$ fmm th. Coddron' l-kG. ls lo, iE rolb$iry r.en ls< '7011 5
<br />ttNir$ dd Prcr6i.n ao&): Any C -Y or Cou.ty *hich r.qoir6 ! ponir ro .odtu.r. .h6 i.IPror., rt@olth or qmt Mv
<br />rtudr., F$ t. tr. ilswc. tL. r.qun6 rn qPlrst for $.h Fmn lo 6k ! s{n n {do6l rh, lE or JE i! lict*rl lil,ld
<br />nr $. trrniod of E (-onrrxttr 3 Lic.G.n l:q lcll.rrd q, Commtrins $nh s{lhn r0(ro of Dnilhn I olrh. Bdin6 dd
<br />ProfdlnrB ( 0d.)r lttr l* or 3h. 6 dmpr rh6.from Md rh. hds lor ri. nk*.d.tflFbi Ant rhl.thnofsdln. T0ll s bl.n)
<br />qDlt&l lor r Fnn sut+< r rlE .r,plic.nr !o r .n il padlt of ml mE lh! n\. hui&al dollB (l!0o)
<br />/ l. n:<** "r,h.F,'ra!. * m\ mnlo)6 \nfi \ rad 6 rho r'k o,mFFdhn. \'ll J. rlr qrrt !d r& cMw E mt
<br />inrd&i or olr6.d for ulclsc 7(11.1. Busin6! 6d ltofdioN ( o& rh.(ontr..lo.!l.ic.M|isth6normplvlooosMol
<br />rlE I'nrny \ lD tliLlh or nlpror 6 rhdo td sr. dG kh rnd hiroclror hclr or llrou*h hi3 o hs ori onpht6.
<br />r.ri'lcd rh6r .u.h imrrovG6lt G. mt i ddqr .r olrddt aor sL lf. hot6'd. rhc rriLrins .r imtrd'oE n skl $nhn onc w
<br />of mtrpkn( rlt ()etr Boltila q rll h6. rtE hdd ot F\rts rrd lE m CE dii d hlld s i,+.o. ,E F.rdv tu ttE F,!.3 ol
<br />L s o{ nd oirh. ,rop6ly. m .Klurir.ly .ont.cl ins n h li(.n*! .ontsroB to coNtrucl lh. ftoid (s{ 7ol4.I]!r'n(
<br />dd hrk$ C.d.. l h. Conk*M s LE6]G l,r'd.E mr 4rl) t' .$F ofF.ld! \rho n{ild! o mpr.r 6 $non.
<br />a.d sho.ontElsfnrsuchFoj.dss{ht(ildnrlorlr)licmvrjpuEnnrrorh.(onro rsIicd(hwl
<br />lan.\cnrpl urd( S6ln\n
<br />Prh, /a7-2.>--11 **'€l*g?,.?ffi"x
<br />DECI.A8AIII}!
<br />I h6.r, rmd uoda Foh) olFJUr' oc oarh. lolbtr f,s .k<lrrn irE:
<br />Ih!\r,i*illmint.br(6ifE!1.of(ocdr!os.ll-lmr.forssrtd.omFdirr.sFo\iL{t,orb}S.t1rn17(.frh.
<br />I itor ( o&. lor lh. Fiollrm. of lhc s.l for u hi.h llE tsnit i5 isu.d
<br />I hlr. trftj \ ill o!,nr.'n \ 0116' c.mFNl io. iNUBt.. f,r r.qu iEd ls sal i.n uoo of rh€ liutr ('od.. lor lh. psfonMcc oI
<br />rhc {.rl for *hich rhn F6( i5 is.d. My *o d'cotrEsri,n iNutM. cmd enFnr) numbd t.
<br />I{,lt! Nunrhd: ErI'r6b^^,/r (Jrd]
<br />'harm
<br />rh.rrf.minc.olthc* rI for*h'(h'hisFnn ir ir$.d.I.h.llmr 6ploy ey F3oi in.nvmeE
<br />r' 6ni b.(om 3uhFl rort ubll6 .onFnrnhn htr! of Cllifom( . l4r thd ltl Jhuld taom sti6r t rlE
<br />$dkql compcB ion I'or arhn. ol S.d nrn r 70O of lh. l.!br ('od., I shrll. lonhsirh conply *rh lbs p.ovlrirB
<br />\vARNIN(; F.iluF h su. rrrtd s.q.sx,n co'd.*. is uilr\tuI- .d irll 3ubj<l u dlhtd ro aiIiMl Fshi.. or, '(ivil nnd ur ro ... hundrc'l rhourdd dollei (tlm.(x)l)). in iddntu. h rh. .on ol.omt nittion dsr*6 a ltdvidat r'r rh'
<br />sd ion !076 of rh. tltxr Cot. 116.! ri drorrrt'3 fc
<br />,,.,.7-2t-lq I
<br />DE(IISAIIA!
<br />I hodrr lffrm utuld paalt of pqiury rhd I ab lic.tu d ond6 Provnn . ol ('h.Il6 e (com,nd. ins wnh Sa'lion 7000) dr Dilni'n t
<br />ol rn BB|,B ind Proa<GG Cod.. id my lt@ a in turl for(,n.fid
<br />qallirauflaNr[BulcagEd(I
<br />I h6.ny ,mrn utrJd FFllr, ot rdJu, r_ rh.t th6. i! . .onn ruc1ion Lnding .8tr1 for th. p6lolmmc .f th. work for *hich lhir p<iil i!
<br />s!.d (s6 v,97, cir ( )
<br />APPLI('ANT DECI dII,IIION
<br />I hdd'y afrn unJd p6.ll, ol l,6ju,,- onc ofrh. followin| dfrlaraliont:
<br />D.nolllFn PmnlA.tErN Norifi.arNn F.d(i! R.suldrrn! (Til. l0. Pnno)
<br />R.qunal I clr6 or tidtf(dtun
<br />t rdif, rhar th. ardftl ..suhtuE r.rEdins stElor rdn,l n. mr tpPlEihk lo rhn pm.Jcd
<br />4 i.?,",*, **,.u *".pplic.iio. a'd ir'r. rh,t rh. ah'r. inr.m.lrcn B (ndr r '*ra n, cooplv *nh.I ( n).nd ( oun}
<br />ornmEG srl Shr.l:s. F!ti+ r. tlildiis .olBrudio( al hd.$.orL.P. rqrmrrn 6 olltis ( nv Dd Coul, rt' ord uFr rlr
<br />ih.\. mdk,nAl l,ord! ror iNp.flinn FUTITE
<br />;,,;;;;^;,.;;:;:7,lkii oV@,, e;rt eJr ".'. 7-'25' 11
<br />p.mr,er.n.rprin,,: Dkotso oifq"o ? ine/q
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lns u lation/Enerq y
<br />Drywa ll
<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 />F|NAL /D /t -// /7 I --z--f/L ,, /)?
<br />Certif i cate bf d6cu 6aniy
<br />Notes Remarks Etc.
<br />n
<br />(\.?,,/1-/)/
<br />Flood Zone Certif.
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