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BUILDING. INSPECTOR RECORD
<br />SITE.WORK ID/SIG.COMMENTS OWNER BUII,DER DEI,CABAIION
<br />, t rcby rllrm und.r Fnslry of F,Jtry lhn I m crcq't fDm rlt Conrerm li.nE Llo nn rh. folbsnrS rc.$. ( Ss ?0-11 5
<br />BuriFr rd E f6ia. Cod.) Any Cny or ('drry $hih en!i6 . Fnil r. s'n{n r- ilrd imFoE. &mlih or FFn -v
<br />{tultrr., ,'m r. irs (rum. .tr' rcauiEt rlt qnltMr rd .uh Frrll h nL ! risEd {arm.r lh,l lE or {E ir livh.td lu$.d
<br />r. rhc rnrvnn,nt of !t! Co.h.ttr\ Li.cn*d ljw (Cnrflcr 9. Conmtulng *nh Salion 7(xt) of Oivhi'n I ol tlt Burircsr md
<br />t'iDfr*i,nr ( od.l or rh.! lE d shc ir .rcryr rhscftoi dd rh. h.rir fM rlE rllcScd cr.n{ hn Anyvinblhn.tSdirnT0.ll5by.ny
<br />+,rlr.nr f.r r rEmn {r,Fk rM +Ilk..r ro.civrlJ,.rlly{l ml m)E rn$ fiv. hudEd dollur lS5(nr
<br />-1,
<br />nr owmr orlh. tn,Fny. or my c,il(jlo)Br *ilh s,F.s $ rtrn $k !omd$ri'n, *ill d. rh. wnk !d llE {ntr@ ir rn
<br />id.ndcd or ofitrcd fr $h (Sd 70,14, alrim1t lnd Pmfc(i'n! C.dcr Th. (tdrdtor'r Lians ljr &B n, qlrlyro.no*mr of
<br />rlE Frtd, wlb bddr or inprorB rotr ]n *lr' &B ttl slt hin€lf.r lErel, or lrmulh ht d td orn..rllhrsr.
<br />nmricn ifi.r rkh i'rtn wdl e { -r.d.i d oliml lor ql. ll lru.k, rh. tllHu{ n irtnMd k -U !aha. oE )tr
<br />oloq,bi,n. rtE ()s'F Auildd rillh.E rtE txrd.n nfF.\inS rhd lE or rlE dt mr h{ikl or itt'nE dt lltldy ftrft I[lIrB of
<br />-l-
<br />8 orfu of rlr FFdy, rr crcfu.nlly o,rErog sirh litn*n odrrrm lo {' nllrliFrFllsa 7or'r, A6irs
<br />rnl Arf,.iir Cod. Th. (bnrErd t Lk.nr! l,* der n{ .mly h s o*F or pn,Fdy wlh huildt or inDmt1 (h.Kn.
<br />end qh, onrell rir such !n+.l{ wiln ! a.nlGro(!r ti.cn{i l)ursuan' ro rh. O)nhdoir l,i.cn* rle)
<br />-.4 &PC ror rhi1rctsfl
<br />l)olc, (rsn.r
<br />ttoru(rilr\' ( :onlPlNs^iloN
<br />DE(IIAA ]!
<br />I h.r.htrtltrn,un&rF' ryolFItrv.mo{rhl,'lbe'ngd(hrJri)n(
<br />I hrvr trnl will nun ain . Ccn ifrilc of Gnr{.t k, Scll.l nrud ld *orlcB .omllcnrrr ion. i\ llnridcd (n hy S.crio. l7(X) or rh.
<br />Irtrtr G .. rir rh. Fn,*'ffi. oa rlE *nik li, *htll irrc Fnnir k irskl
<br />Ih,wr l rilldinllin Ftl.ri cortEmlir inruaft.,.r Equn.n hys6ii,nlrmor E lltrrr Cod. n EF
<br />rh. w.rk r.r whf,hrhx m,nirir t\erl Mv wor ldr' onrRn\d tr,n rn\urllTonkr J l FIE\.untxr m
<br />,* \ *-v*A-Vt CO-r Lr,,;C6
<br />,r"r-
<br />-l
<br />ccniry rh,r in rh. tErr(tfrN ol llE x, ftn $hth rhh Frhir iq t.Ed. I $.ll r .tr+loy ,FmninrnyME
<br />i'stolEsEs$Fll.lt.rttdtonpc.dbnLrr.f(ilifomi...id.srrhor'rIslDuldlEomobFr.'rE
<br />mrt ^' $mn nsrt'n pNviirN olsdrion l70l)olltr tihE C.d.- I rnlll. ronhPirhsmtly *irh rh,* pmv,ranr.
<br />WARNIN(; lailur. t' $uE roik.r! omlr.slion
<br />.nil fiftr oI ro or hurrlEi llx,lerd d.ll,ri (tlfi
<br />sd$ 1076 of rhc Lni Cnd.. ini.r.{ rild drlmy'r
<br />.nphFr ln simiMl lEdlrir .Dd
<br />rir. iLmlfr r! Fotd.d Lr llE
<br />blLllzt
<br />u-(laru!.l-\
<br />I h.rhy lflirtrrund.r Fulryolp.rJlrry rh,t I .n l,cnri urkr ,()vni'n .f CrEpid 9l(hmrinS
<br />ol rhc Bu\i'*srrnd I'hl.rsionr aodr. ord nry liccn\e h in ltrllnrrt rtol cflt.i
<br />, C/D ,x.nEIr/n ^*-)<' r--FtVU
<br />lr.rlrta!!-uorlJJ]a!-rcf,)lr
<br />I hcEby lfftn undc, F.rh, or Frjury lhsl lh.E n t colntul i'n hnding .8.ry for l,L Fifolrl@. ol rrE work for lhkn rhir Frmn ir
<br />ir.!.n (sa 1(,9r. civ c.).
<br />lrn&r'lN.m
<br />-
<br />Aftlrlllil.llEllJEallar
<br />I lrtd, ,llirh und.r F.rXt ol lErrury om ol rh. I(nb*r8 d(hnt iaF
<br />I)cmriri,r I'crnirs \hr{os Noliic6rion Fcd.rsl Rc!dlatiin\ IIitlc l1r.I'jntr
<br />Rqur lr(dol f*rifdixr
<br />rrtinl'fr rl{{'^ r(tr.ulx'.,ni nf|l'.$['r' rhr\ fn](lr
<br />hft rftrldrr n cor.d l.gt h o.rl,l) srn rI Cnytln (i{n'y
<br />irci ofrhn Ciry.,n Coxnryto616 u|nn llE
<br />. inr nu Ltrtr.(lt)r)rrrt |,tr trNt).\
<br />,tpDlir.ol o. ,ta.nl SIANI{n
<br />{
<br />-,. -91ct 11
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Rool Sheathinq
<br />Shear Wall
<br />Framinq
<br />ln s u lation/E nerg y
<br />Drywall
<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 Certifz/U6flr loLhll_l0-21"1\* )t-hiv
<br />FINAL t6 -71* l1 U,Wld
<br />Certilicate of Occupancy \
<br />Notes, Remarks, Etc
<br />DATE
<br />a )/
<br />lxtrdcls ddrcs
<br />-
<br />!h:r I h.tr Erd rhn .frlf,.trr ud.r.rc rtj
<br />.friSrar. Lrq( nhrinA tr
<br />Set Backs
<br />UFER Ground
<br />Subf loor/VenVlnsulation
<br />Ext.i lnt. Lalh
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