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DATE ID/SIG.COMMENTS OWNI,ll aUIIlr a DI,:LCAIATION
<br />I lEEby afrm udd Fmhy of p.rrfy ih{r I $.r.mfl lNo tlE (i'drrod' liur ljw tor rlE folloeir8 G.bn {s4.70]1.5
<br />Bu(Er ,n Eor6i. Cod.l Any Cly d C@dy rhah cquc r tffi r. ..dM. rkd, ,rfmE. &mlirl d r.F! ,y
<br />n ruE,Iri,hns nore, rl$ rqlEr rlE,pti.d tursNhFmd n'6L!,8rdtri.r rhrlEr'tEBlrtBd Fr-d
<br />rorn tmvnir^\ ot rlE C. r&in! l,i..n.d lr* (Chrr.r rr, Conrftrcin3 rnhScrbn 7(xxr ofl)iviri.n l oIrlE BsiE( rnd
<br />Pbr.nnN Ccl.r ( rhi tl d ar E.r.r$ rtftfn,$.rn rh. h.sr ({ t|t dl.td.r.n$rx /uyrDldionolS..tio.T0ll5 hyry
<br />ufiif,rnr for n lxnnir 'lbFts rlE lpptt.d ro r dv rl p.Mhy oI mr mr. rtur lir h{drcJ dorhE (45{xr)
<br />_1. . .xrr .i rlr F,Fnv, d ny .rpl')..r wlh w.F . rh.r 6L or!.dr4 will d' E xrt rn rlE tlNE ir n
<br />'darbl orofi..d fd !L (Sa 1x{, BuriE.r.nd Prs,6irb Ctl.: Tlr C. nidtlj5rIr*JGml+P1,roD.rGo,
<br />rtpF'Fny slD hrild! or in{mhr nEBn crvl vlr d6 sucn kxl hinull or lEclf or ilEugh hir o, ls o*n.nplor6,
<br />Forn dth, ikh inlFnEr e d ir.d dol|r.d tn sl IL lr&tr rlr t!i8!l,n lrt cd ir 3'ld wilril c laofcniriiq rlr G,p A{ilr, rin hc dr hrrrh or Fivin! ltr lE d ar dtl d{ hlilt d rFrE ttr p.DFr, fr UE FIF:E of
<br />L.\owHorrlEFIdy,rh?r.,u$?lr.odfti'nswtrhli..qlndturst)o.{MrrtEFrFl(S..7(l[r.B!\rs
<br />rnl th{asn, (isl. Th. Codh.nr'1 Li..N. Lra d e\ h rnply !, m *,H ol nx,p.d y slI, hurlJ! or mDn,y.r rh.ra'tr
<br />atul *h .onrdr ntr iuch pn,rch p h. (iflBloda l..trlrl puhud ro rh O'drddt Ltcd ll*l
<br />lrn,.(m trnd.rs.dln ,B &PC forthBd.nr
<br />)tllt6cBtsDllluallr!
<br />DI(IA.EAIIII!
<br />I lxrch, .fiirm und.r Fr.ty of IE lu.y oft .ih. foll*Dg d.(Ldr)B
<br />ll'Jvrurl *rlloEtr ror(tnrr'(r..t(i,\.nrr,5rlr i\trr ntr tr u.lor .rnl|xNdk,,. s pn'vll.J ft, hyS(rtr,n:1700,'lrlr
<br />Lh{ (i{h. ntrrh Frf,trmr.,'lrh. *o.\ l,trrhrhrtr 0(Dir s i$tr(l
<br />I lrv. trt Ull Nd nn wort.h co.qrerDMsurln., r EluiErl by S..r rm :1700 o, rlE lrlxtr CdJ., n, rh. pditut of
<br />rlx *orl tur whrh rhii rtrmn ! L.sld. Myworl6' lnn{Esdirn iNur.NMH ullx,lryour*Ere:
<br />_l(n yrld 'nrL p.,forn!r. ol rlE wolk fD. *l,ich rhir nnmr n 6rucd.l rhrll mt .npby .oy Frbtr in My d$Nr
<br />$ d i. b.oE lubj.cr ro rh. uyI6J o!{EMon L*! ot(tl,rome. lri rgB rh! irl *nuE teom !!nrd 16 rb
<br />*! dr $qtuiM Fuv(bE of sdrsn l7(D ofrh. Irr, (ir&, ! J.[. rdhv.h.!rI,l, *irh rho: F*abB.
<br />waRNtNG: rrituE (, .dE q'trt.6 d,tqEtudxr oEog. d unt llu!. afll rhrll .uhFr e .n{'L,Fr ro Ldi l FMiE lrrl
<br />civil fin.j n! h ok huir.d rt ufind doll$ (tl(r|,(llo), n rdd hn ro rh. .n{ orc.n{En$!ion, dm8.s r pmvn.d ror tlt
<br />Sarr)n :(r?6 .f r& Lhx Co&. idct Bl rl(,tyi f6
<br />urrBtE-caMaar3la
<br />DECI-AIATTON
<br />I htEh, rlltmuid.r p(MhyoIFrjuryrh.r I rn li€nr.d uid.r ljlolsiin{lCnipG, (.DmErcin8 wnhS..r,n ?(Xn) oll)ivtrhi 1
<br />of rlr Burfti\ &1Pn,tusim CuL. ul nrv lt.rc n D tuI n,c lrn.ll(t
<br />Drr._ Conin.ror
<br />caBrrttlclrQN.LlNlllgJirlg!
<br />Ih.Ehy3l'lirn,u l.'FUlrrulp.ri ryrh,rrh.cG:cotritueritr,k u,!.t tuynrr&F.romur.olrh.*or\li,rdEhrhsFn'i is
<br />!{((lis.c :xn7. cn (-l
<br />Attuc6!tr DEcIaBAru!
<br />I hd!6t.IfmrlBt rp. lty ot FrP.t oE of rlt fulb*mt HLLd i,nt
<br />t,.mrirn P.mdlA't tro' Ndlftab. F<LnlR{uLrio.! (T{L (). Pd6,
<br />RauiEJ tJn.r ot t{rfkrion
<br />_l..nilyrl rlklal.rulE[ul 06 cSrilxl8 a$cnor Enr,vtl!ft i l,rlf,5hLk,rhF pn,r.!l
<br />_l (64 fii I h.E Bl rtlr +pl-di6 ,rl r. ihd rh. .ho\r inlotuir n lrlml. I .!rE ro orpl, vlh .ll Ct, rrn C(u,
<br />lnirl t.\,' sri.LawrFklBn, trnLln,I by ruthrE rF.rd v.! .r rh!1 C[ / rnd Coudr ro .nrd !lr,n rL
<br />rlirr lnrkrul fxlF- yl(n 'n\n(.rr,n
<br />{ pplicunr nr ,tt6t SigDl ur og u.Zo
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />[\,4ason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Reporl
<br />Flood Zone Certif .
<br />FINAL
<br />Certiticate ol Occupancy U I r-"''
<br />Notes, Remarks, Etc.
<br />Rev 0u-07.2015
<br />BUILDING. INSPECTOR RECORD
<br />SITE-WORK
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