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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE COMMENTS OWNER BUILI}EN DELCARAI'ION
<br />I hcr.by ifliin u.dcr ,).nrlry of pcrjury rh l !m cxcn{ fnrd rhc C(,.tn bF Licc.sc Llw liir rhc iolk,win! B.sn (S...70r1 5
<br />Businc$ rDd Proic$ion Codc) Any cily dr C.unly whi.h icquircs r Frnrir h con(fl.l. a!r.r. i'nF)rc, dcmolhh or lqrn my
<br />{turrnr- rir kJ ir\ irsuxNc, als equncs rhc.mlicrtrr ior luch Frnrir b filc s siC'td (.tc'Ent lhar hcorshc n licenEd I rsud
<br />b thc pmlniotrs ol lhc Conr,rcnn\ l-icnscd liw (Chrpr.r 9. (hnrn.ncins sirh Sccrion 7ffro ol Diviion I ol lhc Ausincs lnd
<br />Itolc\lion\Cod.)oirhrrrrorshj iscxcnu thcrclinnr.M thc hni lorrheallcE.d.kcmPrnrn AnyviohrionorScclhnr0.ll5hylny
<br />rrpli.rrrorapcirnirsubjcdsrhcopnliclnllo!civillrcnlhyolnord.rcrharnvchnnnrcddolh^(S5ur)
<br />l- o! o*rcr oirhe pmpcn]. or nry.mpbyN\ wirh wa8c\ r\ rhcir n,lc conD(n\dion. silldo rl* *ork rnd rh. in{hn is ml
<br />inrcndcd orofcrcd tur alc (SLr 7O{. Busirc$ d I'r.fcsiotrs C c 'll.n Conrrrcttr \ t-ic.tr{ l-rw dNs nor onrl! ro rDo*mr ol
<br />rhc F'|rdy *ho hlikh.r i'nFnir\ rhcr$n. nl wh) d(\ such w.It hinsclfor hcrsll.r rhreugh his orhfi owi.'nfloyccs.
<br />lnrvcdthirsu.himpmvcnEnhnrcnorinlerdrdororfcL.dft,uLlf,lrq.vcr,rhchuiuinsornnprn$rcnri\vrltlrirhin.,n.Jtrr
<br />ol'conrphrion. rhcOwicr Brild.r sillhrvc lhc bndctr olpnvnE th( lE or shc di,l nor huild or nlr \t rhc loFny hr rhc puqrE of
<br />Lr\orncrofrhrn'oDcnt.m,cr.lu\ivclt.ofukri,r!sirh11.. \cilc.rrrcrtr\ri.on(tocr rl'r t)r(ir..r(Sc( 7lg.l.llLincs
<br />rn,l *lo co kr(r\ ntr ruch ,,r+$ wnh r (itr[r i.d G ) li(lr\c,l pu r\Bd lolh.(in rr.tr-\ l-i(tr\c trq)
<br />-l
<br />ucrcnrpt ufrlcr Sdioi-. B &PC lorr,ris rc!\on
<br />D,lc Orner:
<br />lV{TRXFRS', C()trfl 4N.\ATION
<br />DECIAXAIION
<br />I hcrch, rflirm ondcr p.idryorl.rrury.rc orlhe tolbwirB d(luruliotrs
<br />-lhdlcunlsilln{inrlin!CcnificrcofCo\cnit,sclfltr\urtuqorkcri..trrcnsrii{,n-arpmvid.dntrhysc.lioD3?loolllEIltrrc( c. ru lh. Nf(mu.cc oflM work lnr qhich llrc lr.nnil i\ n\ud
<br />IhrvcrndwillNJnsinwo.kcrrc.nlrn\ari{Din\lrntuc-r!rrqundbySc.ri.n37(XlolrhclrtxnG)dt.r(,rhc,trYfonMnccol
<br />lhc trork iorshichrhis p.nnir i. n\d.n Mvs,rknr.nmn n{r('.n 'n\urrtuc.Jtriq sndmlit ndtr,h1 toc
<br />fr"*A&alt-
<br />,r"rr*.*, ?2113 snt s26 lg
<br />-l.cnilyrhrrinrhcrrrlanium.olrhcsorklo.whi.hrhi(t]crnririsi\ruc-I\hrllnor.ndoyriyNnotririnymnnNrsor\t)bc.omnrh]cdrorhcworkcs'conD.n\rri{nrhssolCalir{xiir.rtrdrSrccrhnliflsh,ul.lhcdnrt\uhjmrrolhc
<br />"orkcn comNnsnliotrt'rovi\n'nsolScciii.lT(nufrhcIjhtrC(xlc,lshdll.lir htr ilh dnnPly wirh rlx,{ novi{idr\
<br />WARNIN(; Fiiluc t' $curc sorkcr(, compro\rri,,n .o\cBgc i\ utrlrtful. ii shrll subrtl srr .nD[,ydr r, dimirdl Fn{lric\ rRl
<br />.iv,l fincr up ro orc hundE'd lholslnd dolles (Sl(D.(xl(
<br />Sc.rDn i076otihc IjktrCodc. inrcrc( lnd atrorrcr's lccs
<br />)r. nr dirnnr b rhc ..{ion. drtugcs .s providcd rbr rh.
<br />Szk rB
<br />l)[!l.\&llluN
<br />I hcruhy,tfir6nndcr pr lryorFjurythll I anr liercd undcr nrclision or Chnlrd 9l.o,nmncing wirhScdion 70(lo) orDivision:l
<br />oi rhc Businc$rnd Pdisiuts Cddc. dM myli..n\c is in hnl loN ond ctlcct
<br />l0t111Q
<br />o*" S'7v ,l{A6(
<br />caNErBlJcu()nrElDllli-dc[d(.l
<br />I hcrehy atli.n lndrr Fhslrt or pclury d{ lhcrc is r $nslrcrion lcndins lsdi.y rd
<br />'h. |]crlbnMrcc oi rhc *o fo whth
<br />'hn Fnnn i\
<br />isucd 1scc.3097. Civ. C.)
<br />ELICANLDISA.8ATqN
<br />lhcr$ymlnn undcr prndlry.fp.rlury otrc oilhc tolbwir! dNhrnlion\:
<br />lxDmlirionPcnnirr A\hcsrosNorific rn)n Fcdcrll Rctuhrnnr((Tillc4t,. Pan6)
<br />-Rcqotcd
<br />L.rrcr ol Norificari0,
<br />r rhr( rlr li!lc'r1..!ul i, sr'Eri(ltr! r\lr(o\nnovrlJd mrxt)t)lnrlilr I
<br />.l lsc 16 c.o,,ly snh oll Cnyand Coutrt,E-'1"nrlyrh.r I Mrc.cld thh apnlicarion ard sar. rhir rhc rh,vr
<br />{nlnriv* ofrhi{ Cnymd Coutrlylo enrcr uF n rhc
<br />,.," $rY'l&
<br />4dnJnrc\ ond SrJrc htr\ rcldtinE ro huil'lingn rr
<br />Jh^,,,f, n,Fmd r.,rnv r.,,*"2*'
<br />"L"'_11illK,#"4 V"E^zu"G
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Rool Sheathing
<br />Shear Wall
<br />Framinq 6/,//,t
<br />lnsu latio n/E neroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL bn /ff r\B?j .5IPKY
<br />Certilicate ol Occupancy
<br />Notes, Remarks, Etc.
<br />ID/SIG.
<br />Erection Pads
<br />ktrJ., q Nrn.: _
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