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BUILDING. INSPECTOR RECORO
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER AUILDER DEI,(ARA'IION
<br />I hn.rD ltfm u(kr p@lry r)l FJUry rhr I m.rdF trrh rh. (ndralm l-E€etwforrlEfolh*he,a{(s{r7or|!
<br />li$ns xll Profeon (-dL) Anv (-n, or Cod! *hkh r.quir6 ! Fni b ...drud. dq. inFore d.rtul.h or q{n m)
<br />ntudd( Fbrro tu M.,!k hlur6 tlr lrplian for$.hFmn ro 6kr tirn dslrold lht lEor 3lE ! lrdx.n |nllld
<br />lo 1fi. ForEnrN oftlE Contrsld t l-rsEd l:r (Ch.Fa 9. CoEmd'ns trnh sdion 70o oaDi\nr. 1 ofth. ,rcrn6{ tnd
<br />Ptuf*ioB Cod.) or rhd Eorrt is.tdt, rhdctom -d th. b.ia fd rh..lLr.n dmprio. Anyrioldionofs.ai.nT0rl5 tD M,
<br />aprlE nr for dFmn rubjEt!llE llplicrnr1.,r nFMhyofmr mor.lhe li\. huhddl dollrs (t5m)
<br />\tl,s.h6ofth.Forn).itrmr.mpl rGnrhqtrs6srh.irhl.c hFa$h"n.q'lltl^trt{trtmdrh.ntudG6^{
<br />'n,-rlql nr (fiald (n slc {Sq' 7Gr,., llulin6 ud fts l6tions Cod. 1fu ( i'nt.d.a! l-i(re tiw do6 nol rDplv !o m o\vw or
<br />'hc
<br />pnrrdy who blit:G or imlrovG rhosn, drl sth &6 such m* iins.l,o. h.GlIor thmush h$ or hdoM.mrlof.6.
<br />,mv'ddt rhar 3u.h inFs\omh e mt idodal d ofia.d fo. sk l( hdwo6. rlE hiLlin3 o. unprovoEd ir eU *irhfl.n. ,d
<br />ofcompk irG rlE()*6 Buills * harc rrE hrds' olFDrir{ tht lEornEdn d tu! or inp.Dr.lh. FDFy for lh. nurlr* or
<br />L a.*c ofrlE FnFt). d.r<16'!.1, .onL&ring *nh lic6B.d codrdoB ro odM E F.jd (Sa ,(lll. 1t6,l6
<br />dn rhk i, Cod.r t h. Co.rdorr Lic6( ks &6 mr rpply ro e o" D6 o r FoFl!., \ ho build! or inprord rh6('n.
<br />..d lha @'fird3 fo, ech Foj.il. r'nh ! Grd*to(, ltq&d i@ud ro rh. ('odd '3 Lkae llf,)
<br />,rrr',r-"fLW
<br />DE(IAa^.IIOI
<br />I lr'.h) n16rh undcr pin!lry.ftEju) {!ncflrhc li)lltN'ng dr'.lnrErrtr\
<br />I haE s,j f,ill minrain a (.n iftrdl. of ( 6ngr to Sclf'l Bur. {d qnl6 co6,F6d dtr a proliddl fDr br sErnm r 700 o, lhc
<br />lnbo. CGL lor ih. pafolr]le. oI llE *o.t aor s hf,h rt Fnii B isu.{
<br />I h,\. .nd *ill mim.in *orh6 c.nrEMhn i6dm4 6 r.qur.n b s<rhn ! 7(xl ol lh. l,boi Cod.. ror lh. FronlEft. of
<br />rlE mrt fn f,hkhrni! FBi it sEl MtsMt6 onFdio. rurffic ffi dj Flay nubq e
<br />PohyNumb.r. lapr6
<br />X I .drfy rhd in rh. pnfome(G ol'rh. {o* for qhEh rhis Fmil is nsucd. I rhlll Rn @ploydy F$n r rny meF
<br />i, e r(.boanc subldr h thc tr 116 {mrsqr '.. b* t or clhromq Md !*r r tu ,f l shorld b..om. rubjN' r.
<br />'hc*olt6 comFs.r'on previsioa or sdrirn 1700 oarh. Lrbor CuL. I Jull, lodh$ nh .ompl, wnh lho* pmvilionr
<br />WARNIN(; tuhr. io $-(c $o 6s .onlpdstion rorm8. G unldtrful. ed shnll luhjdt
<br />(nrl Iin.r up ro on. hun+.J lhrend &nks (llt[].mo). i. addnon danaxE !! lro\ilal ntr rh.
<br />\Ntun ruTo nfrh. ti (aJ.,inrddlRl
<br />,,,.. 7/,2 /t> r.r- -/-
<br />Dt(t\t{\ ()\
<br />I hg.b'v lllm un& FE]ly or FJUry lhd I m lics.d undd Fr ntn DI (tuprd e (.tffiirB wnh Sdr,. TLDLrl ol lr\ son l
<br />of rh. B6i!B Ed PmfsirE ( c1.. drl my licN i.i in tull for.,rl.lTd
<br />l-R.s.(l s:Lic.G. Nutr E
<br />(o f,u(froNl.IlDtrrilcEttr
<br />I h6.ltv .Itm un|.r Fdy or Fjury $, rha. i! . @dtucrioi l6rt B +dr f.r th. rEfoffi ot th. n ork tor *h(h rhB rbnir i!
<br />'sud(sa 1097.crr. c )l.n& s Nm.
<br />APPLICANT T)ECI {IIATION
<br />I h.d, rfm otuld !orn, of pdjury onc of th. follo*in8 dalaarhB
<br />I).moliion Pmt$A3b6ros Norificdnrn F.ddal R.lulari.N (Tilc,l0, Pd6)
<br />R.quiEd r.(ld oa Nolifi.dir.
<br />V Icdiryrhd rn r.rrr.l,.suhioB rcsrLlin8 st6rG lmul s. fr,r lpf'lic.bk k, fin Foj{a1
<br />6hr. rmr6n.n FoFn\ tu !Nrr1
<br />Appli.. r or ,\ldr SiSnrtu(
<br />l,rnnilN.i,r(pr r: fia" lq r
<br />.urlFrt. Errsirn 6 o f
<br />o comp\ \irnlll(-'rri l(innr)
<br />'hE
<br />cirl .,'d ( ounr, t,/,6 uF6,tE
<br />-" zfta/ t
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subfloor/Venulnsulation / /
<br />Roof Sheathino 1r 1 ).Ve,LLL'1*X
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath ?lo/ <,1 -Rca1fi
<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 />I
<br />FINAL 7q 7t /JL,12 (-,'
<br />Ce rtificate of Occupiffi
<br />Notes, Remarks, Etc
<br />Set Backs
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<br />//) //O,
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