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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE O\f, NER BUIT,DER DEI,CARA'TION
<br />I h6.hr !r[m un.l6 p.Eht of tE]ury thd I m.rm0 frm rh. d' doN' I-ic@ h$ for rh. foln'{rry rar)n (S(.rlrll It
<br />BBoRr !,rl P,of6ion Cod.l An! Cn! oi Codt $hxh r.qutr6 r Fn, h c.dtud. .li(. inFor., d.ml.t or GrEr d\
<br />irud@, riFr lo (: sue.. .b. r.qun6 lh. ppltMr ld such Fnn to 6k . n8..d sldml rhn lE or shc ir licdFd puNi.n
<br />lo lhc Foviions oflh. aontdLlr s Licdsd lr* l( h.trd 9, ('{'nm.n.ins sirh S.ciion 7(r(m oa Division I oflhr I}usin.$ ind
<br />Pmfek'n! Co&) or rhrr L or.hc s dopr rho.fron ed thc hsir fLr rh( all.s.rj.lmprin A.' rnlbrn.ols.(1[n',0!15 h) e)
<br />rltlt.ni for a Fmd rubr(R rh. rrf lkr.! id . .ir il p.tuh) of mr tuG rha 6r r huid.J dnln ( l5m),a-
<br />lalf I xnnrttncrorEtt. rm) cmn,n,6 wih u 686 s rh.ir "n. Nmp.n$ti.f,, will.h lh.*o*od h. snf,luc ir ml
<br />-mdrlRt lrolTn d lnreLls( 7tq{, Bs'B ud Profdiocco<t lh(Co r*ois I tlu ljs &6nolppl} touo\Not
<br />rh. FDFy u'ho t!&il or irlror6 dEq- !n r b &E mh *o* h'lMlatu h. lf or rhniu*h his M hd .*n mphr6.
<br />Fovidcn rhd r$h inFoeffis m mr idodal oroffd.i for sL lf, nu6d. rlE ia'Hi'{ or nr{ro\d n $E tr iihn orc ts
<br />ofcompkiotr rhcown6 Buildc willh.* rh. t!r&,orF(,vifl{ lnd h. orrhc did rr trildor i'nlroE thc Ir1 rEry ror rhc flqirs or
<br />l.6otrE oarh. IioIEny. m .(lusir.l' .dnkd ms trdh h.mr.ri rcdrkrnk,.odrud rh. Fr)<1(Sd 7(x,1,IIBm6
<br />d }hfi*.n ( od.: I hc Co.kacls's l-icor. Laq do6 nol apply lo dn os ns o t Fop.ny $ho builds or nnrrorcs rhqNn.
<br />d sho co RlrtusuchFqds"ihrGlnk.dodr) lic6B rj N,sMr hthccont.dori t.ic4. l,s)
<br />l rn (\cmpr trftjd S(lhn
<br />? -os--(+""*.
<br />I h6.ty.illrm un&r Fnah, olFrury om olrh.foll.*'ns
<br />I lu\. ed $ill ruint.in r ( diak8lcof ('..gr ro s.lr-lau. r{n sort6'..
<br />Lltor (irL, am
<br />'h. Flollffi. of rh. {olt f unih rhc,6rn ir 6u.n
<br />in.6 rmyil.d lor hy sdr 'o.
<br />r 70o o f rh.
<br />lls\.aod *illm0nrlain sortstr comp.nsalion insuritr.., a rqrna blSdrnn 1700.lrh.lrbo.(i)d., turh.pdlbnnmc.o,
<br />rh. rort rorqhichthisFnn nisd MvtrorlG co'n .M6n i.surmc. cmid en polic) nunbd6.
<br />Q?ca,ry rrrar m rr,c pcromr. of rb. {D,! for shi.h rhs Fm{ R N.d, I *alr mr 6plo) !n} F$n n.ny osF
<br />e N !, b.tnm. luher ro rhc s.*6 comp.ndnJn h$i oacrlirodlr, rnd,sr& rhn ilI stuud tE{onc !u\<r io rh.
<br />{0116 compctrsl io. povisioro ols..1ion I7ur ofrh. l,t r cclq I 3lEll. lod hu ilh .ompl, $ irh thor pn liiioN.
<br />I+ARNING F ilut h Fd. $trt6' mnF6aion !trF.s. i3 unlNaul. ind {ull eubjdl m ad)rs ro cE ,Ml rsuhE ind
<br />cnil find up 6.ft hu.d.n rhonend.hlla (ll$-tuO. m !.ll x,n ro rh. corl of conpcerron, rhtrus6 a rrordd for rh<
<br />S(iion !076 oa rhc , ahr C6d., mFd Md Nrl{rE) s fG
<br />llECLrSAIlAr
<br />I hd.b, Atl''m und6 r..ahyofpsJurylhal I fln li.dNq! ondd [ro\i3idn of('hapl6 e (com
<br />or lh.ll$inssJ Prof6io6 (-od.. &d mr li.m{ B
<br />'n
<br />lull nft. a.d.Irrr
<br />sirh \(r.n Tollrr.l l)n ttr,tr r
<br />0lirButtrotrtl,lDlrc-acl;!(Y
<br />I @ .llm und.r ll$lry oa Fjory lhd th& 6 5 codn<rion ltndin* retrt f.r rh. Ffol1ffi. of rh. $.rt lor { hi.h lhn pdinir i!
<br />$u.J(Sa 109r.(i C)
<br />a8tu(/rtrLDl:gd8Anr)!
<br />I hotby lllm urd6 Fndlry ol pgjury on. or rh. folL$ in8 tt cl,id! Dnr
<br />lxnol'lf. Pmn}A3tEbr Nr{iri.dio. t.n r.l R.su!,, nN iTnt {0. Pfi6)
<br />R.quncd Ldr6 of Ndi6.d$n
<br />I (d!'! rhi rh.6d.l,c3ubrF6 r.srdifla 6t cN r.mr.l r. frn T?lirlbL ro rhir Fsjd
<br />@cafi ta t ta'c aarna.pf li(rrio. ar] r!r. rhll rh. ltFrqnlomd ion i3..rcd l urd ro comply sirh all C(r ind Counr'
<br />(irtlman.6.nd Slar. l.i$s rchrinx ro b{ildi.l Elrqolarn 6 orrhis Cily and ( ounry t) s16 uB)n (h(
<br />alx\.,k nndllnltEl\ tu ffBrlon
<br />,\ppliotrl o. Arml Sirr.lur.:
<br />Perm ile n.m. (prlnl ): L A t1 "-/5,(o.u
<br />I r,'t-11
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUl nsulation
<br />Roof Sheathin
<br />Shear Wall
<br />Framing
<br />lns u lation/Energ y
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lt4ason ry
<br />Pool Fence
<br />T-Bar
<br />H andicap Req
<br />De puty Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL 7-21- t7 J)c 5z'b(s)
<br />Certificate of Occu pancy
<br />Notes, Remarks Etc
<br />+
<br />ID/SIG. COMMENTS
<br />*,. - ? -r5--l+
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