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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subfloor/VenUl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<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 />Flood Zone Certif
<br />FINAL _ro_11 a
<br />Certificate of Occu pancy
<br />Notes, Remarks, Etc
<br />OWNEA BUILDER DE-cAA TION
<br />I hatb, .,Im un& Fdy ol Fruq' rhi I m d6q n!6 rlt ( onr.dm Lk6. l,$ tot rh. folloulB !a$i (Se 70ll ,
<br />BBi.6r od P.6fBion Cod.) A.y Cty or Couiy which r.qun6 . p6ri'r xr codru.1. ,1i6, inprcv., &nolirh or r9.ir Dy
<br />nrudq Fiir lo il! isl,e.. dlo Eqrn6lh. +pli.Dt aor iuh Fini io nL r 3i8i.d drml lhr lE or CE; li!a.{ An r,,r
<br />io tlE FbliibN of dE Co.lrdd t Lk.n!.d t * {Clt 916 9, Comci.g $nt Sdion ?0m of Dirii.n I of lh. Buin6 ad
<br />Pmfsnrnr Codc)orllut h. or sh. i! dmpl thacnom &d ln. bsis for lh..lks.d ctoplion. Any riolnhr 9f Sdion ?0.1L b' tny
<br />.pp!.d fo, i Fri $bi6t rlt .t?lic&r ro . ovilp.dlty otmr tur lh! fi!. hu.&.d doll4 ($m)
<br />_L6 omd of lhc FoFly. or mr.mphr6 with w.E6 a rh.n $t.o,nFosl ion. willdo llE wo arlllErrudw6ml
<br />ddrLd n otrs.rl fd eL lsd.ro{, BuriB Ed ProftsbB ( o&: TIE Conn.r( t Lt@ l,$ &6 ml l?ly to & o}c of
<br />!h. FnFry *'ln tlil} o' imFor€ r,E(i, id vno dE *n slrt hiMll or r6$lf or rr@sh hn d h6 o*n anplor6,
<br />proviLd lhll su.h inprovdffi|8 e mt idadal n ofik d lor bh If. h.*aq, rh. hoildinr or irynml ir rld wnhin oE y6
<br />of.qEki(a l,E owE auil& r ill h.E th. h,rls! of FDvi,{ rh. lE or tE did d hild o. d$.oE fi. FoFr! ft, rlE FlrE of
<br />-1.
<br />6 o*n6 of rlE FoFry, d.rclu'v.ly.onrrE in8 $nfi li.dE d co'rEdoB lir oirtur rE FoJ<lls< 7oi4. &B!K
<br />!d Ptoali. Cod. Tn. Co.u.dof t Li.@ t * <106 sr ,pply ro a o*nd of FoF!, *nd hildr or inpm!6 'hsoron3) lic6!.d purunr krrh.conrrdofs l-i..N t s)
<br />-l
<br />d.\@pr uoddSdl'o.
<br />"", /,2--tO'/t
<br />I hn.b) rlfinnutr(l- Fnrhr.lFlNr feflrh.foln'
<br />_l h.r. md sill hri .in wori.r' co6FN.rio. i !r!r.. a r.q!i(dbySsln.l70oofrn l,b.r (td.. for lh. psfotu.ol
<br />llE $srl lor whkh lhn Fni ie isEl M, wuka oflFBa,on iBurm. cei6 d polkl numhd s.
<br />PoliEy Nuhq,_ErrE
<br />_l cority thrr in rh. Ffo.rrluc of rh. f,ork lor whi.h lhi r'<En ir isu.( I rhlll nor snploy .ny Fs. itr dy n1m6
<br />$ 6 ro b<om suttd ro rlE $rt6'omFdio. L*. of ( diroma !d rtsR rhr il I nruB t(om et*( to llE
<br />wo 6 omFrqlion t mrilioc of S.rli.n lT0o of lh. Llt r (-.d., l idl. fonhs'nh Nmply vilfi llDt rmrnioBw Rl\lNC: F iluc lo s@ *orld onFBaior corsic. ir unLstul. ud lndl .ubjd m otloyr ro 6ini l Frll6 di
<br />.ftil ft"6 ur lo oE hudrcd lhousd &Ud 100.000). F lddnion to th. .or of .ooFqr'on, dm+6 a F.rid.d tu tlE
<br />S.cr'on 1076.f rh. Lahn (i{c'.r(6r tud
<br />DI(ITIa,IIIA!
<br />I hftb, .flim ufrLr FEn) of p.rrorr r I e lic.Ml un d Foriri'n of 6 9 {mffii'q $ nh S<ln! 7(xio) of Dir oion I
<br />of rh.l,{sind ed Pr.fdr6B (o&. rld hy litu s in firU loBc ed.tfd
<br />r-ltru Numta:
<br />Cdrn re:
<br />(qltr3lgrolJ.Eultxc.AcEN(]
<br />I tcbr rrm uidd Frty oaFiury lhi llE. i . odru.lh. ladins lscy for lhc Ffffi. of $. *qt 6r itah th! Fmi i!
<br />isu.d (se 1097. ( iv c)
<br />L.ndd r Ntm.
<br />APPI ICANT NTCI I.ITTON
<br />I hc&y !,Im unda D.nllry ot !.rjury om oa lhc aollo*ins dccle.l ionr
<br />D.mkion P@n!-Asb6lot Norirrdi,n F.d.r.l reuLtbN tTnL 40. Pd6l
<br />| lsc lo coBprysnh ill ( ny$d (i'unrl
<br />ofrhr (iryud Counrrlo drd uF)n rh.
<br />^"-ZA:tl2:tL
<br />-R.qurcd
<br />lnlo of Nolificalbn
<br />-z_
<br />tru#n)t
<br />Forms/Steel/Holdowns
<br />sod who conlracG fo, tuch Fojd3 tr{h i
<br />_l havc.d will mi!$in r Ccniar. c orftn5t ro S.lf'lNuE for krtra &'nrp.n!.rnrn, a rrovid.n ror ry Schn l7Lro of
<br />'h.ljbor Cd.. fo. ln. p-fo,rlltr. oa llE mrt loi utah l,E Fmit 6 isu.d.
<br />t.r., t;l-t,'>
<br />l,c er'3 Addrd: _
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