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BUILDING- INSPECTOR RECORD
<br />SITE.WORK COMMENTS OWNER BUILDER DETTARATION
<br />I h6.try amrm undcr p6.hy oI D.rjlry lh,l I u dmpl liom lnc Conlr!.1o6 l-icqg t * fo. rh. following ra$n (Sx.?ol l 5
<br />UNin* .nd Prcldioo Cod.): An, Cty o. counry which aqun6 r pdmn lo NBlrucl, !h6. inprov€. danolilh or EF, My
<br />{Mue Fi,r r. itr iM.. rlro r.quiG llE rrpltur for sh Fnn ro 6k. llsxr.d sia@r rhd lE or rh. i! lic6!.d puBlr
<br />ro rlr FrBi!6 of dE Codftdr Lko!.d u* ((tryq 9. Comfting rnt S..lion 7000 of Dynion t oatlt BGind d
<br />Pma6ioN co&) or thn ll or rlE 6 qapl tlEtiom dd llE b..6 ror llE .lks.d .xoFiot Any rhlnion.rsdbn 70!L tt u)
<br />lrplic&r ror ! pcnn subjcls rh. .prli..rn lo a civil pnuhy ot @l mr. rhm fi!. hun.to] &1116 (1500).
<br />l. 6 oqE of rh. FoFly, or my mplolG with w.s6 s lhcn $L mnp.adbn, *ill.b rh. wrl ad dE srnrlG i ml
<br />lrqn d d o,fq.d ror sL (sd 7044, BGiIE Dd PmfBio6 ( o&: Tlr (o .r1m3LkNL.*do6m'+pl'bao*Goa
<br />tlE FoFry $ ho to A d inqD\- fi.o( -d $tn &E sn q* hrlrlf or hd*lf or lhDurh h! q lE o*r dplD6.
<br />frovd.d rn i kh nnForqEt e d ddl doturd f r]. ,t,lh*6q. r&rBlB d inF.\qld L sld\ithhitr
<br />'wolcotrphior tlE O*E B{ilb wilt h!4 dE htrdo ot Fovin* thr li .r 3h. dai mr tlitl or i,q!\t lh. FlFty for lhc Fqn{ ot
<br />l. a o{M olrlE FoFly. m.r(lBiElr co reryrnhlieN.nco tldo6ro colErucr rlE F,j.al (sd 704,l.Ildr.6
<br />.,n Ptok{ Co& Thc Conlrxtor'r L(.N ti$ &E ol rpply k, e o*na of FoFd,_ {ho btil& or impro\6lhqon-
<br />ud wh. o d3 for uh Fsl.dr snh . Coddo(s) lEdBal porlul lo lh. (i.trr.ln'r Li.G lrel
<br />I dn.xctrirr u J6S€dnrn .ll & r'( rrhLs '.dr,
<br />IlltliE&i:(aufEdrdtatpr(Iaxallq!
<br />I h(.by anirm undn p.mny of Fjury on. of rh. nnhwinB &.LIdn)B
<br />Ihrv..dt!illmimaina(dinr.ofcoMrlos.lalBor.lor*ork6smrs!.ron,aFvi<ubrs(rhn1700ofllE
<br />llb(,r Cod.. lo. rlr Fft,rjjm. .l rlE *ort ld vtrh $. pdfi 6 isai
<br />I IBE.Id u 'll m.inrlin *ortd' conF6.lFn 'BEmc B Gquu.d by s.d.n r7o0 oath. Llbor (-od.. for rlE lEt(nl]ffic of
<br />lh. s$k fo! wh(fi lhis pcnnit is is.d. My $Ml6 mnFsarion iN!@.c @in td Fli., nuhhf e.r
<br />I cdiiayihd i. rh. Ffoffir of th. so* for *hkh thir pdnril is Gu€d, I rtau.or dploy lnt F$n in my mn.d
<br />e B to baom. Nbj4l ro th. $ql6' comFer nrn hwr olcalitirmia, &d r!@ rh,r ia t lhould b..om. lobjar lo llE
<br />so.l6' onF6.rion proyi3io6 olS€rio.117m oIth. ljtD, Co&, I lrEll. fonh*nh.omply $nh rlF- pmltioE
<br />\+ RNINC ,dlua ro s@ rdl6 .oDpas6. o\d+. n unbrtuL ! $dl
<br />.r fin6 !p ro oE I'u.dal rhdq.d &lb^ (t100.0m1. r atli$n
<br />'o
<br />rlE cor o
<br />e dI'I)hlE lo (ful FBiE d*l
<br />mFd,on. (hEsd a Fo\v.l.n fo. rh.
<br />S(tFn rl)76 .l th. libor C(\L. mrcd arxl dt,m.'
<br />,,",", * zu.-- Ll[noou-*
<br />DESJAAUq!
<br />I hn iy.fm uftl.l pa,Xy of Fjurl lhn I @ l'€rE d u,r& Foyiliii otchryo 9l6n1lffitrr8 *nt sHi.n 7(U) orDnisFn:l
<br />ol rh. aui,B.nd Pmasbd co&. id ny lkre i! in tull foR! rt.1161
<br />I '(cnscCLL$ I
<br />-"9- eg .7,-(-l-**.. V.,.
<br />CONSTRUCTION LENNINC AGFNCV
<br />I lElby .rm u.d6 FrXy of Fjury lhi llE n . cotu(rudb! lndins isocy lor rh. FfolM. oflh. wrl 6r shth rhB Fmn ir
<br />su.rl (SE t007. ('iv. C.).
<br />AITIICA.NLDISIBAIIA!
<br />I Eq{ .fm udl.r po.n, of Fjury om oa rh. n)lh$ing &rtud ioB
<br />I,.noht, PmnlA*6ror Norli.flbn FdLr R.sul{ioN (T l. 10. Pd6)
<br />Rdtut d lnrs otNorificnirn
<br />I cdift rh, rh. f.d6al r.gul4i'B E8rdi.n aiElos rmt.l d. ml 4'plicrbk h rha FlF
<br />l.di6 rhar I h.i. rad thi! aDIiE&on axl sralclhd lhcabor. rnn,nnn ir..rar I lsrau onrl, "nh EllC yand(i,u.r)
<br />oi(nnrncB d Srd. tjrvsrcldrn*ro buildint conirudtu( ddh6chy r.FMk'n6 oarhi! ('it, rd Counlylo 016 upon lh(
<br />rlr\c Eri(n'c.lf'.tdt aor instErio
<br />$.\n.o--.
<br />c,o ?z-&\-t
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulalion
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsu 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 Z-Ao- )1 J/< Ja J-Or)
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />DATE IDiSIG.
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