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BUILDING- INSPECTOR RECORD
<br />COMMENTSID/SIG.SITE.WORK
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Rool Sheathing
<br />Shear Wall -mfr/U(Llzdtg q2vzFramino/'r^rf
<br />lnsulation/Energy
<br />Drywall (.,ur
<br />Ext./lnl. Lath
<br />Brown Coat
<br />l\ilaso n ry
<br />Pool Fence
<br />T-Bar Zhls dzEOHandicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Floqd Zone ,Certit.e-s\U"br4,*4 44Gt 1
<br />nc z-Certiticate of Occu
<br />FINAL
<br />Notes, Remarks, Etc.
<br />Io
<br />-+
<br />()\\'\t,:R ltl -t)litt l)l.ll,( 18 \ I l(l\
<br />I hcrcby aflird undcr I'culrt or Frjury lhar I an cr.mpt Imn rhe c.ntrlttrs t-kctr* ljw for ihc follo'ine rcr{r r sq- 7(lr l 5
<br />srsins. [l Pnr.*i;i Codc) any chy o! (ounry *hich rqunes J rrnrn r' con{rud alrcr' i'npr'vc' dmlish '{ (nrir Jnv
<br />slllclu.c,priltrlonsissuxft..ahorcquncrlhcE,Plic{dfursuchFrnlillofiklsiSrcdshl..f,trllhallaorsh.isli.cn{dPruanl
<br />t, rhc pmvhnnN ofltE Conktrcrois Li.ctrscd L{* lchuM 9. comnFn'nr8 silh scdtun 7o0o nt oilhion I 't rhc lturrn'* nnd
<br />Pturcssions Codc) .r rhir tE or shc hcrc'nfl lhcrcfn,dand Ihchasi ldr rh. trllcscd cxtnlt'rion Anvvid'rionolsc'rion 70115 h,anv
<br />lpplicur l(tr a ,.nnir subiccrsrhc iptlic!trrtJ tr.ivillcnlhvofnor 'notc
<br />thln fivc htr.dreddolldsl$500)
<br />-1.,\
<br />owmr ol rhc lr'.|rny. (tr arycorloyccs wirh wasc\ r\ rhct elc (n.pctrs0rion. will do rhc wort srl rhc sldluE n trd
<br />irknddl or ottq.d fti Jb (s!* 7044. ausincss lnd pbf.ssions codr Th. connlcrr.\ Li.cnsc lj* docs nor lppry tu.n o'n.rof
<br />rhcpn,Fny who huilds or nr{ovs rhNn. md eho dif,\ $.h wlk hinnclf or hc dll or rhrcxghht or her own cnuloy'c(
<br />prni;da ,a.u"r' nnl,ro\$rnts m ml inr.'icd oroffcRn for sk Ir. t$tcvc. rrt hu*rina or iqn'qEnr is $kl sirhinoR $r
<br />lr.onphrion- lhc ()*;.. Buiklq {ill han the $utdctr or FruvnB lhal hc or shc dil ml huikl ot imrorc rhc nmPolv roi rhc rdrlrM or
<br />-1.nso*!(orrh.fmncny,,nciclusiElrconti.rirr8$ilhlicced.onltocttr{bcon{ncirrt,'rojccr(Scc7o{48!'i'"'(and Et assi,n Cdc r[h;C;nlracro.s Li.cnsc La* docs i.r ifllvto ano*tur nllrolcnvwho buildsor nnlov'r thcrcot-
<br />dnd who contd.rslor such pmrtcls wilh ! G'ntNro(s) licenrd pursurnr rorlt controcrofs Lkcnsc l'0s)
<br />I ar.xcnrpi tr dcr Scclion- B &PC I{nrhnr.r"nr
<br />w(lRxi qs' (r(tMPENSATI(lN
<br />NFCI A'L{T(}N
<br />I hcrcby lffirn undd lEnollr.tl.+iyonc ofrlI foll()wins ddlnrarionc
<br />Ihlvcmdwill'fu'ilIinlcenifi.alcolconscnltlsclIlnsurclor*orkqlcotrlf,.trsdnln,as.trovidcdlnrbyscction:]7u)ollhc
<br />Llborcodc.lbrllE pdrroinrnccoilhc sorr for whichrhd rcnnir is tsucd.
<br />Xlhavcanilsill uinkin sorkcn co.rlrnssl io. irrsutircc- us rcquncd tv s$ri 37UJ ol rh€ tjhor Codc lor lhc Irfitrnir' nr
<br />Ihc work f.rshich rhis pcrmir is issrcd M, workcis snDcn\arion iNumnrc cari$ a Fli'v numbq Ecl
<br />U5 F,I'D
<br />So *L lo a
<br />.LltnifyrhnrhrhcprrfonnrNr.flhcsorknn$hi.hrhnl. nir i\ is\!cd. I shrll nor c l'li
<br />i' r o *....orc ",r,1oi r, rtr ".lrkds, .onrF r\rri{r lxws .l Crlikmh rDd rAr'c rlrnr ir I rhotrU hcc'm \uhjtcr t) rl'd
<br />workcr' coDrfcnsrri,rfrovi\ion\ofSc.ri.n:17(X)ol rh.lnhrr aixtc l drll. k'rhsirh'otrrlv w hih'sPo(i\nr\
<br />s.crion.l{l?6 otrlr trhtr c{ c, inrcrc{ rntl r(o'n.v's lic\
<br />",,.,.t/S/r2-
<br />I h.ruby rllinn urdcr ptnihyofDcriury rhrr t N li..n*t xMcr Pmvision ofCh(lrcr 9l'onrnEncing wirh Scclinr TIXX)l
<br />ol thc Bu\irrc\sr Pioft$FrNCod.. r,xl ry li.cn\. i\ i,r f lltur.c aNlclli.r
<br />{6t
<br />o^"' 4 I
<br />coNllxllgulll!tNDlNclcl,li.cr
<br />lher*'ylfinnUndcrpcdllynlPcrjurylhdrhgct.con{nl.liolcndinga8crcyntrlhdPc.i.rnrlEcollhcworkf.lwhichlhisFnnnt
<br />ksucd rsec 1097. (iv C ).
<br />AEILICA.NTDECIIBAIIgN
<br />I hcnby strtrm undc. Fndlly ol lcrlry onc oflh€ louowins dslff.tions:
<br />D€mliriun P.irnnFAst**ros Nolili.ario. Fcdcnl Rcs! l,r io.s (Tir le ts). Pd6)
<br />-Requircd
<br />t ller or Nolirrcadon
<br />I anilyrhd rhc fcdcrulr.sxt ions rcseding,\trslos tcmlal m not aplli'tblc lo rhis Pucd
<br />-l
<br />ccnify $, ! hrvc,cd rhn ryPlicalbo dxl slalc rhd rlE abvc inrbrrorion n corar I rgre lo conllv wnhlll Cirv lrl{l Colil'
<br />ora-inm$'rna sm rrws rcrarind io buildiis.onsrrudioi. r.J hcrcby aurhriz rcprcscnrarircs otrhis cilyand coury ro cnrcr ulx)n rhc
<br />nhrvc nrcrlioncd F,Nny lnr i'npc.iiotr
<br />*,",. ?/5/r8,\pplir.Dl d \!un Sixn.lurc :<
<br />ITAE4'pl"sstt 14L
<br />DATE
<br />Set Backs
<br />,1 /,1'tK4 lffuoniqba5 n<-7)l1l{1
<br />/ ---
<br />(,.",,' lffiAe Co $ P bP s AflO|j
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