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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE rD/stG.OWNUlR BUILDER DEl''ARATION
<br />I h@by arIm unda po,lly oa pqjury thd I M dopr n$n lhc aonlrrcld, l-icdc L!* aor lhc lollowos r4rn (sn.?oll t
<br />tllliEi .rt Prc&sb. Cod.) 4., Cny or Cod) $hih Eq!n6 . Fnn lo @dtu.1 !hs, iiFo*. daelih or EF {y
<br />.rruclu., Fior rtr ilr isuma. rb. r.qun6 th. .pplicd aor ruch Fmn ro nl. ! .isrtd {,,lmdl lhd h. or d!. b licas.n p0rua
<br />io fi. FsrnDc of E Contrb! ti..r.d t w ((luFd 9. Co@'.B *nn Sdrhn 70m of lrvirion I of llE &!trB ed
<br />PFfGioN Codc) or rhrt h. o, !h. ir a.Dp thE fiom el thc b.!ir for rh. llt g.d ddFion. Ary violrlDn ol ScrD, 701 I 5 6y y
<br />stlist for r Fmn $bi6rr th. .p?lt&r to . dril FEtt of mt mE rh& liv. hun<i.d rloll6 (l5m)
<br />l. s ow oath. Fopsr'. or ry .mplo!6 * nh *!s6 s rh.n $b comFsdbtr *ill do llr {6rr dld ln. rMG i mr
<br />oror&l or ofiqld fd $L (56.704.1, Blrit6 &d Prof6io6 Cod. rtu ( odrer'r Lk.B L.s {b6 nor el.r! lo d o{c of
<br />!h. Fltqiy who hild. or ir$.or6llE6tr !d *ho &i6 sh "oII himclf o. hdlf or lleuBh hit ot ha oE @plo,6.
<br />Forild rha {cfi imEDrElEB E d noi.d motu &,r rL lf.lns6s.lh. hr diry or inrftraEr i! sld eihh tr }{
<br />of.otrpldiorl fic Ow.6 Builds *ill hlE fi. hrdar dfFoirg rhd h. o. sn dil ml txiH or rpotr lh. I,irEry 6r trE FtrPor ol
<br />L s.$G of tlE Fop6rr. m crcldn., contr&1ins qnh li.as.d codr*'oR
<br />'n
<br />onrtud rlE thj6l (S( ?ol,l. t\6ilB
<br />.d Pillsir Co& Tlr (onhcto, r Li.tu ll{ 1106 mr .!l) l) ro d 0$.6 of Fop.nr $ho buil{k or irprord rhqotr
<br />and who Lonaod! tor euch prDjdr wnh . CoilEclo(r) licN.d Nrs@r ro rhc ( onmcntr-! Li..g l,s).
<br />l n.rdnpr unddSslon
<br />D.t. Ornd
<br />IA.Btrla:i:(OnUMAll0!I|Igrl&Ula!
<br />I hcr€by alinn undcr pcflalry of rqury o...f rh. (nhe'4 d(lar6rioB:
<br />I h!1. dn * ill dinbh . C.irilr6t. ol Consr ro sclf-lBu,. aor \sddr conp.N.no., 6 For iLd for tr Sclnrn 1700 oa lh.
<br />t,bor ( Gle f.. lhc Ffmc. of th. mlt for *'hth lh. Fni B nsu.d
<br />I hd!. and u 'll nrinrli. *ork.rr' .onp.Nartun i6u6n.., &! rcqond by Sdn'n l7olr of lhc I nhor ( odc. lor rh. Pdfonnu.. of
<br />tj.h rhi! Fnir i! isrd M, *sld ompddion ie,ft.{ai, -dI[ltyluntd e
<br />I:\pn6
<br />I cdrtrhd in rh. ldf.nnmc. of thc wo* fo! f,hich thi! Fmn n i!s!cn.l sh.ll @r molor,., p.non in !f,y od6
<br />$ B ro tror ubi.u lo r,E *qr6'6.rFs6. Ls oac.liaome Ed.*R ltr il I iEuld tEroft tuti<tr h tlE
<br />*s*d' oorqsto. Fori.aou of S.dion 1700 ofrlE lrbo. ( od., I ihlll. fonh*ilt sryly Enh ll.s ro\ i.irG
<br />\ ARNlNcr r.ilK b su. sut6' comFEditn co_v@r. ir uLstul- !.d {all $bF1 s atrphrs b qiEirl Fu!i5 ard
<br />.nn nn6 up n, orc hu.&.rl rfio@d (hlla (tloo )), h ddnnn lo rh. cor ol.ompadion. d.rE*6 a pro\n d to.llt
<br />sdnn! 1(176 tttlclilo. (r c. iornrsl
<br />^", //22//L
<br />tlf,l-Lr&ur]-:
<br />I h6!ny .tfrm on& p.Bly o I Frury thsl I @ lkorel und6 Fovirion of chrprd 0 (omrfficin8 s ilh SalFn 7000) of Dn ilon I
<br />of rt BurlB d Prcr6io6 Cod.. !d ny Ircd 5 m nru foc !'d .fid
<br />o
<br />*,"7</27/tc
<br />grrtrauclllJal,l:llari-6crltr
<br />I h<ct'i. !,iim unld Fulr of Fjur,l thd lhn. a ! onlntudFo Lidins t8i.y aot rh. Fturruc. ol lh. sql for rl hrhit Fmil k
<br />ir"f,d (SR. 1097. Civ. C.).
<br />L.nd.i, Nb.
<br />--
<br />l..nld'r Add,*: _
<br />artlJca.uurEclanauax
<br />I hd6, .trm udn Fnrt, or Frurt ok oarh. lolLe
<br />'nE
<br />(hlI io.r
<br />l).nolitNn P6.ric-Art6rot Norlicarion l;cidal R.lul{iotu ( rtb 40, Pd6)
<br />-RcquGl
<br />I dld ot Nor'n.ai..
<br />I cdia) th{ rlE f.dd.l ESuhtk 6 r.srdiis 6tEto! rmtnldc frn 4rlt.bl. to thir poi(
<br />-l
<br />cd", ihd I h&. .dd lhs .p0lr.Iior rn $al. lh.i lh. .to\ c ifonii.. . .Md I +ra 'o
<br />conpD unh . Cn) .nd Counr)
<br />o.di.tr6 sd Sbt. L!". Elsrins ro burldins coNrrudn'G dd hs.b, lutl'ori4 r.Fsirdi!6 o t rhh City Md Cou.ty lo 616 ulDn dE
<br />rb.\ . 66h..d l,oFnr' lor inrpcl
<br />.\tpli.rnl.r ,t*rlrt stn.lurr
<br />74 l9-,-
<br />,,^,./2,/4ze
<br />Set Backs
<br />Forms/Sleel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loorA,/enUlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing PAJ.jf,-L-11,/1
<br />ln s u lation/E ne rg y
<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 />Engineer Final Report
<br />FINAL 3-A-t1 VLltt)
<br />Certificate of Occu n
<br />Noles, Remarks, Etc
<br />COMMENTS
<br />Erection Pads
<br />,.t{./,0
<br />Flood Zone Certif.
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