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BUILDING- INSPECTOR RECORD l
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNEN BUIT-I'ER DELCARATION
<br />I lEttl, rrm !n& Frny or FJU,y thd I n qmF n m lh. CodrxloR LroE l^ Ior lh. fouotrds I@rtlii70!I1
<br />&!i.* !.d Prordhr Cod.I Aly Cny or ( oufl) *hth r.qurB . Fni to odtud, .ha. inF.orc ddmlil or qrn uy
<br />nruLlue p.iir ro 'r3 suec. .lo rcq{n6 rlE TlPltd lo. such Fmn lo frk. ttsEd.ri.lmr rh. lE or 3lE ir li.a!.d p{lld
<br />ro rlE FoviioN of rlE Co do.r Lic.Mn l,w ((-luF6 9. comdins enh S.dion ?00o of Dvsio! I of rlE a6'n* ,nd
<br />ProEsrN CGj.) or th.r lE or ric t.rmF rhqcnoh xd rh. b6a lor rh. .lLs.d ddFbn Any lnrbrion ot Sdion 701r 5 t! my
<br />a$li.a for r Frir rubjcls rh. lpplicdr ro , civ il p.n.h y o f rcl mE iha fiv. hodr.d dollu. (t500)
<br />I. a oM6oarh. FrFny. or my.mploy€6 sith wrg6 a tb.t slc colll!.Nlion. sill& lh. eort ed lrt sLad@ a nor
<br />inrdlld or or6.d n sb {Sa ?0{-1. BBrd od Pn'fsioN Cod.: Th. Contr.tor'. 116r Lr$ &6 nol .p?ly tr d otrn6 ol
<br />rh. I'opqiy *h' tlild!.r !rpr.v6 tlEatr rd s h. &E uh *!rt hirocll or hclr o. rhDush hi5 o.lE ou ntloy€,
<br />FoyiLd rhd ruch mtnrqdB e d insrldt n olid.d tq dG lr, b*6s, rtE boLh[.. iBgrotd L $ld snhr om )w
<br />ofs'r{lLrrE dEo*rq tlllilds *ill har!0Eh!d6ofrmr!{ du lEorslEdil @l b'r or inFnE ttE FDFty tor E F,FEol
<br />L d otr E of rrE F.Fry. m d.la,v.ly .odrrru{ *,'lh hcd6.d cod'.dN to codtud
<br />'lE
<br />p..rd (Sc. 7olr. l}au6
<br />6,rl hlfsm (td. 'I h. contdor's ticru l-!s &E .or +pl, ro s or 16 or p.ordr l lE build! or iEprovd rhdon.
<br />ed sh6 o'nel'lor ruch Foj.tr! *ilh 6 Q'mrro(n lrqEcd pmd r.rh. Gddor! Lkru ks)
<br />ldtr c\.n'ln unJ6 Sdnn
<br />Drlr O*nrr
<br />$oRriFRs colrlitNs,{ l l(rN
<br />Dl:(r &tf.lor
<br />I hc.br dtftn otrdn Ff,ilrl of llJur. .n. olrh.lall,\\
<br />'n8
<br />d(lrdn,6:
<br />I h!\r rd *nl mltllu ! Cgrificn. of CoMt ro s.lr- lM,c f( ntrrlo- .onp.dh( 6 FviH ao. b! Schn !?l,o of rn
<br />t hn (-o&. fo. rlr Ff(llrffi. of rh. lo fo. unEh rh. pdnn i! s.d
<br />I hlr. a.d s'll nrmt.in q ork6' conp.Mr|rn 'Nurftc. s r.qutr.d b, ser io. 17(x) of
<br />'h.
<br />lio. (.od., for llE Ffi]nttec or
<br />rh. r'o'\ l,r *h(hrhB Ff, ! eEd M) q.r\d'rrmFdrbn 'Mtuc.cME rnJ[l(\ numbdr.:necril
<br />,:^,.. * 40GlJ;;t+81t,,,,.. 1 '- zb- l4
<br />I cdrfyrh{ in rh. Ffol:mc. of th. wo ld$hrhthi!Fnn is iesu.4l slEll nol unllhy dy Fs. i. my m nd
<br />e B ro b.{m st d' to rh. Nltd'6DFB.lnn l&r otcdifomE ed Cd rhd rll 3l\tlrd heom $bi.$ to rt:
<br />10*6.\,DFElsnFovi'ioEotsrrionl7motllEl:torCod.IJEll.fonhunhlimply$nhdrrF.rthE
<br />$ARNlNc lxluE 16 *@ s.rl6 omFM$n 6\6r!. ir uhqtul, ed srdl rubj.n & dpbtE lo oihnd FEIE tnd
<br />cn n.6 up h oB hu.&d thoLs*l dollc (il(xl,0(x)), in.dlnbd to rlE co( of comFNlio^ &nuc6 a Fo\rldl lo.
<br />'h.s(rb6 1076 olrh.lrb. Qi...+.-------z-..------3- lo'
<br />lI(:Ets[DloNIlAlIax
<br />DICIdS{IIAN
<br />I hB.by omnn utul6 rBdhy of p.rjury thd I dn licm*J !id6 pNvision ofChrr,lF 9lcootrfti.s *irh salion 7000) orl)iviin,n 1
<br />of rh. Bulin< d PNf*io6 cod.. d my lid* k in 6rll for.. drd .llal
<br /><{
<br />CA![Ia!]SIONI!!DI GiGEI(I
<br />I n(.hy arrm utujd rEn h, ofD.rjur,lh, rfidc i! ! coBrrudiin Lndiry asfry lor rh. psromdc. oaih. so.r tu $hi(h rh!$ Frnln i!
<br />issftd (s( 1097, civ a )
<br />afrl.l(AtrlDEclaSAua!
<br />I ho&, lrln unrLt Fnllty ot FrB r- oG ol lrE folt,tr h8 &(k[d io6
<br />I>mlnion Pdmnr-Alb.rc No'ifEariro l.d6.l R.3uldirN {'lnk 40. Psr6)
<br />R.qun.rl lnr6 of N.rifrdbn
<br />lcdiryrh0t rh. f.nsfll rclulrt.d rc!dd'4 NlEnrl r.Toval d. nor ar 'eahlcn)rhBpnlel
<br />lcdiarrh lh,vrEadrhbaprlicarionddnir.rh rlEahr!. infonnario. is cotrd I ll|r e lo Nnrply *ith all (''lr lnd ( i,unrr
<br />ordtr1a6 dd srar. l.ass Ebti+ ro b{ildi,! coaixdn,n. exi hn.b} rurhorn. r.F.sr n6oalhhCitydd Countvl,) o,ls !F,nrh.
<br />abo\c mfllln J nNlrd' nn iBrdlFn pulx,6 ?-
<br />,tpt,licrnr or,tsor sirnrturs
<br />LU- 1cww t+u -lt
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lns u lation/Energ 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 />Flood Zone Certif
<br />FINAL i/L ,14 5'17 .,LLEiY <d
<br />Certificate of Occupancy '
<br />Lic.Mcrs b
<br />D.,.. n- V'
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<br />I
<br />I
<br />I
<br />Notes, Remarks, Etc.
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