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BUILDING- INSPECTOB RECORD
<br />SITE-WORK DATE ID/SIG.
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFEB Ground
<br />Subf IooriVenVl nsu lation
<br />Rool Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enoineer Final Reoort
<br />I ^a, nl 0 li'tc^ltnnQ*-tft
<br />FINAL h't t'q [..--/)tv.*</-/2 L'J
<br />Cerlif icate ol Occupancy
<br />Notes, Remarks, Etc
<br />( )l|lEta II .trtR rrtiL(',\R1I t()\
<br />I tEr.ht .mrm und.r pcnrlry of Frtury rnd I m erenfl fn,n rh. Co.ud.R Li..M Lrv lnr ltE folloDq Men (5<.?011.,
<br />8uircts &l Pmfcsion Cdc): An, Cily or Counry ehi.h r.quiEs t Fnn lo mNltucl. rlrd. inpNw. &mlilh or Eprn uy
<br />rrrErE, Fir ro irs i!!lm.. rL. r.quiB ttt rpplisr ror h p.mil lo lih r ri8'Ed ndftd lhal h.6, {t i lien$d [E'u
<br />ro rlE FDsr'N of ,E Conrrbas Liu-d Llw (Ch.Iid 9. ConmEDS wa$ Seti,n ,un of Divtbn J of tlE Brtits ad
<br />Pmr.$hnr Con ) mrn r lE or rlE ir cr.nir rwrom rrld rlE h.rb for rlE {18.d cx.trEhr. An, vhLlt n ofserirn 7ol I 5 by rny
<br />.policanr ld a Entor lubtcck th. .ppli.r.r ro 0 .ivil p.mlly ol not mE lh.! fik hun<lcd dout. (lr0o).
<br />-1,
<br />.x owr of ilr FsFdr. or ny.npk )ss with wr8.. x lLn sb @nFnrri,n. *iU d. tlE *dt.d dE qidE ir ml
<br />i di..l rofl.cn fr e]. lsa 7044. BuiB! rn Prot BbBCod.. TIE Co rddt LirM t rdo.sml{9lrloDo{Eo,
<br />rlE FrFry wtE h,ldt d irqmB UEEI !d *L &6 st krt hirel, d,rclf or rlm,!,n hi. d t t ou..tplorlca
<br />,,rcvi|n $i Gn ir{,Dwdrn mr hroi.d dofdd tu sE. lt, lD{tE. llE tliBiie d lrprGrd i:t 5ld dhi* }r
<br />ol6,rtLlion. tlE Own.r BoitLr *iI haw rlr hni.n of Fori.g tur lE m slE dd d b'rild or inpmf lhc proFry ld t E F,po!. ol
<br />_1.so*Erof r FlFry, .m cxctsiEly oirdiirs *nh lilnrcrl6fron ro6tu rlE FoFl (Ss 7oa,a. BBiB
<br />.d hd6si{ C!dc, Tlr Co.rBroas Lt..c t* dss mr rptly b s ovH or ImFn,,ho bsiu. or mpreE Een.
<br />rnd who onUkl for och FDFcls rnh r ald'elo(,ltcnEn rrEuJr k, r Co r&'ol. licn€ L.*)
<br />I m.r.nllr uklcr Sdinr
<br />D.r.:
<br />-
<br />OrM
<br />-
<br />woq(rqs to ParirfioN
<br />lE[ldlatra!
<br />I hcnby lllrrm und.r pcrully ol psiury orc ofllE lollowing d(laral6nsl
<br />-l
<br />h.w.!n wil minr.in r C.nifrl. orcoEnr ro S.lalM fd ltrkd 6n{EMi,n. e FoviLd aor h, Selion l7@ or rlE
<br />r,h., Cod.. f6 tlE Ff(m of rlE wrt fr *tih lh. p6mn i i<!.d
<br />I vfhak !ftt wirrtuiikin *or
<br />rhd work ntr *hich rhis lrrnrir
<br />,k.R .o,p.n{rion iffuBr.. ! rquircd by S(|bn :t700 ol rrE tlbor Cod.. for llE Fforu! of
<br />ir i!$.d. My*orksj omn nr.l mn itrrur 4. cmid Jid,slEy.umhcr NI'f cz t^ rl,-*, <1 n'l 4
<br />ml.r.,,x 4)(77 z7 ah4ae]1
<br />-l
<br />cenify rhlr in rhc pcrformn( ot rh. wolt ror which lhh Frhn is irs!.d. I shau mr cnqikiy r., Fnon in.ny .Mrcr
<br />o s lo bcd,m subatl to llE w*sl @qENlliotr lr$ 6rc.lifomi..rn l8r fi.l if I nDuld tEcotu rubix! ro tlE
<br />mrr6'odtENrirnFmvirioBofs..ri,nlT@Dr E bb.r Corh. l stEll lmhvith @rdy lnh rtD. pmvi.i,m.
<br />WARNINC F.jluE ro ift eortdr' erl|ttr!,rbn 61113r ir unbwtuL rn lh.ll $bFl d cr?k F ro siti.d Frti6 rd
<br />civil fircr u, ro oE h!'nr.d rhousrd &ll& (tlm,m)), in drlitbn lo tlE co( or NdFos'ion. drm3.! ! F.vil.d fot tlr
<br />S(rion :l07a, oa rh. tjbor Cdi., inr.rc$ td .rhffy s fes
<br />D"", 6/ t qf LoU v<./
<br />I tct\5t.D ( ()\11{t( l()R
<br />lElglJSAr(,!
<br />LrcEby r,Irn undcr Frhy or Frlury thd I !m litN.d ud.r lrrtraon of Clurtrd 9 (omErrng *ilh Sd bn 7(ru$) or Davirbn l
<br />or lhc Arrircs ud P!uf.$io.i Cd., drl ny li..n* is in ru roN .nd cfr.cr.
<br />r irechrt R,.,.6iil(to r-**ri'.'r-' /ollQ 87
<br />Sal",-rin^ <
<br />-
<br />Loll
<br />llldglBlJsllq!.laDl8lillirNlf,
<br />I hcid, rr"m usL. FEt, or Fiury lhd rhsE is r mdndbi LDditr8 .8.r, ror tlE F.fornlm or rl. $rd ror fiah thn lEni t
<br />irrEd (** Il9l. Civ. C )
<br />AIILII]ANLIECIJXAIII]Ti
<br />I H, dlm on&, Fndh y or F.jury om or rlE folk,winS d€. Lnthns:
<br />Dcmlirk r Pcrmit..Asbcslos Nolificarion l'cdcrulRcs!hrtnr (Tirk 40. Pun6)
<br />R.luind L.rld of Nrif..lin
<br />_l ccrrly rh.r tl! a.rr.,i E8!l,r.nr E!&1i.8 st sror .wrul c rcl rl{'li-lttk ro th. ptuj.s.
<br />ty'J.dily rhur I havc rcud rhir spplic.rion drrt {dr. rhd ln. .tow infonErioo n comr I rgE ro .onply wilh .ll cily rnd Counry
<br />odiEftcr ud Srlrc L,*r ELti.s t, boitling .onnructutr srl lrrchyauthtrirc rctft{i! iv.r ofrhrr Ciryan! clrntyro.nrs uP.llE
<br />rlbw lMrnEd pmpcny tm iNlx.lbo IUFEr
<br />ADorior or
<br />^ror
<br />sls !n: '-t-/ t
<br />\ , / , l<a,-{4aa1
<br />n, 6'h +/t t I
<br />-I
<br />COMMENTS
<br />SLAB Floor
<br />Flood Zone Certif .
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