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SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subfloor/VenUl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drylvall
<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
<br />Certifi Oc c u
<br />Notes, Remarks, Etc.
<br />BUILOING. INSPECTOR RECORD
<br />I hdcb lmrh unda pd.lry of pdjury rhd I dn .r.mrr F6n rh. cor racio6' Lic@ liw fo, rhc lollowiry r@. (sd 70
<br />asin6! rt PrcfGbn ('od.) Any (- y or Coudy Nhi.h r.q!n6 r Fon k' codru.r. tlrd. mpiole rholLh or EIEn
<br />rlrudEq Ffl to ils 6Mc. &o rc1ur6 lh. {?l(el lor ruh Fni ro liL. !'aftd ndmr rhd lE o. JE ! licdkd
<br />b rh. FoliioE of r (tnrdoir t,icc.!.d L!* (Cn4tq c, Conmcina *nh s<rio. 70fl) of Dilnbn I .ailE Bur6 ad
<br />Prcrdiotu Cod.) or lnil h. or sh. n .ropr rhacnoin dd ih. hdi! lur rh. alksa! .rmption Any viobxon ots(ii6n 701 I J by dy
<br />q,pltdr litr i Fmn rubjac th. rppli.el lo . ciril Farlly of not mr. lhs liv. hu.<!rct dolle! ( l50O)
<br />l. 6 o*G of r FDFny, or o, orLt6 *nh *.s6 s rh.r $k oEFdNn. sil! & tlE *rt rn ir rndE ir dn
<br />inrdt l or ollsql for xl. (Se. 7o.l.l, tt{siK 6d Prcl*ioB Co& TlE Codr&r6l.3 Lte t.* rb6 d qplt to e os6 of
<br />rhcFor6ry vho buil& or iniFo!6the,\ nd who &16Mh s hims.la or h.*lf or ltftu8h hi! or hq own .oploy6.
<br />provid.d thd rucn iFrrellErls c d inlsd.d orolI*d ror st. lt fio*Ed. rh. tx dilB u' 'rrp.o\E1d it $ld qnhi. or \6
<br />ofcotrpkD( E OrG ttuiEa rill llrr tlE h!dd! or Forr\s rhd ,r ( slE dil ar hnB or ,Ip..r! th. FDFI! 6r fi. F,FE or
<br />l. som6 oflhc r,\rpdy, d.r.lui'v.lyconradins wnh lic@.{ co.trtdoa !o.oE dcl tlE Fj€cl (SN. ?0t14. B66N
<br />.rl PDfsir. Cod. ]tu conrEror'! l.ic.M tls &16 mr +pl, k' e 0*16 otr,rclqry sho blild! o. opNa ih6on,
<br />Dd u'ho codle fd rsh FFj.a1! rnh. Collrrlonr lEosql rr6un rorh.(ttudd'r li.M Llu,
<br />I dn.\onli und6sdnt
<br />I).r. ()ird
<br />\1tBLl:&t(1lutrN llar
<br />Dljgrt&tll9:i
<br />I h(.b) afin rund6lEdh!oiFllDon..fth.alnlr(4dc] i\trr
<br />I hr\. od w'll @imri. i Cdifi..r. ol c.Mr n' s.la-tM. fur $ 0116 ompaldion. 6 Fovil.d aor by s<hof, 171rc df rh.
<br />lrbd C.d.. rtr t& Ffolrr@. of rh. krt fo. $n(h rh. Fnn 6 6u.d
<br />I h.!. .trd rill m.rntain \ork6' c.mpssation iNrmcc. 6 rcqutr.d hy sdr tr,n r 7{xr ol I h. I ib.r Cod€. foi lh. p6ronnd^-. or
<br />lh€ Mrk tu s,hi(h thE ps'nit is Gu.d Myworkd ('nFsalidn iNur&.. rei6 drl polic, nunbd tr.
<br />l..nfyrhd in0EFL,r114.of rn sort for wh.h thG Fmi i! iitr.{ I rhdl no' gtrpl.y ey Fs,n m e! mms
<br />b a to b.t!m $bd ro tlE $o16'onFEdbn LE of CrlifomL !.d ts6 rhd ill dEuld b(om $bj.{ to
<br />'h.*od6' c.npadi.n Fol ErB ol s.d bn 1700 of rh. t,tu Cqj.. I 116ll. fMh*nh ftmpt wnh rs FrvilFB
<br />WARNIN(; FliluE k' $u. mrld' .orl,qsrion ..v@!. i. ,nLwtuL Md lhall rubjcl & @phF lo @@l F hi6 sd
<br />cNil fin.! up ro oG hundr.d rhoMnd &116 (tloo,un), in addhio.lo lh€ clrJt of comFNtion. ddus6 a prDvi.i.n tu !h.
<br />SelDn .t076 ofthc l:htr Co<lc. irr6!, !d onto ! lc
<br />Ihrc_ ap0ll6r
<br />I I('ENSEN CONTN,ACTOR
<br />DI;CIdAAIIQ!
<br />I na.t'y.mm urrd Frhtofpajury rhd I e licqs.n u kr p.oririoi olourts q (sn1r14in[ *nh sdr.n rmo) oIDtr lion I
<br />ol 0E BclJtB rnd P,nl*i.c co&. in my lkff B ir tull 6N td cftcl
<br />cqNtlaucllqltJ.liNDllcac!!(I
<br />I hc.by.Ilm undd Frlr) olF)urythr Er t r.ordruclion Ldllslsdy to,lh. Ffoll1le! of fi. w* 6r sfiah lhi! Fnn ii
<br />En.d (56 l097.Cn C).
<br />t .&. r Nm.:
<br />AIIUCANLDICIA8AIIS'!
<br />I hd6t arlim undd ,)c.ah, ol FJu, r- on. ot th. lollouns &clear nrnr:
<br />D.mhbn Pdnite^rb.n Nolifi.dhn lr€ddal R.TlhtioN(I l.40. Pdl6)
<br />Reur.rl tlta ol NdrfEdion
<br />I.drlrrl r rhr ldoil'$uldk,n: r(! l'os nx.r*rsn!\illrrrrrfl,L'(l,l. n) rhn t,'(!..r
<br />I cdrarrnd I h$c nj thB apdE.r'oi ,rl ed.ln lh. .ho\. ,ntorn!fun ir..r&1 I a8le ro compl, n ilh tll Ci!., and (iunr!
<br />ordiMRs sd srr. li*s,.ldrB sn hfth .dhon4 (F<!dn 6 ol rnt cfty ad counly lo 6rn u[rn E
<br />,. mork'nqj FoFi} ntr
<br />,r 'li(rnr r' ,lxul Silnrrurr
<br />ameJ =F<<A fi*t1t'Pt
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