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I BUILDING. INSPECTOR RECORD SITE-WORK DATE ID/SIG.COMMENTS OWNER Bt'II,DER DEL(AI{ATION I hd.by afiirm und6 p.trihy oI Fjury rhd I e crmpl tum rhc Conta.roN' l-i.@ lrw aor lh. fol[)*in! rc&h (S( ?0]15 Bsins d,n Profdhn cod.) Any ('ily or (-o!d) $hkh ..rrun6 r D-mn h codM. da. imForc .brclah or qun st. 3lrudG. rE lo n! 6ure, dlo Gt{r6llE 4lrlrel for ru(h Fnn h 6k. risn d na<6n tht lt or JE b lkq!.d pllld lo lh. p$rbioB of tlE ( nnlEclor! t-i.63.d tr* ((ner6 'r, (-ommtr'nr $ith Scclion 7m0 ot Drrl{on I ol rh. Bur'n6r dd Pmf6sbnr Cod.) or lhlt h. tr shc i! crmpt thd.fror rd th. bsn tor lh. al!.s.d .rdprnn Any viohb. olS.dion 7031 5 by any aprlrcail for 6 psnil 3ubjals lh. q,pli(el lo ! c,ril r,.Ehy o I nol moE Oe liv. hudr.d dollei ($m) L a ow of rlE FDFrt. or mr mphlc *ih $rg6 6 rh.ir $k mhFdioa * l & rll *ut !d rE rndG ! Dr ',nor&l m otrGaj for $L {Sd.7(,4,1, BuilB dd PNtsioB Co&r Th. ( oltr&roi. Ln.e lrw &E.or +pl, to d o$ffi oa rh.pr.pdry whot ilth or imFbvd rh@tr ed who dr6 $.h elt hi@.lf or h*lf or thouBh his or hE om mploy.6. prcrid.d lh.t ruch imFsEld! e ml idod.do.orod for EL ltnosw.rltl ldi'B tr'{sE6n Bsld wihroE }a ofonpldbr tlE ()..G &iBa srll l$! *E hnL' ofr.lvits r lrorslEddd hrld or hFow dE F!Fr) li,r dE F,Feor L a owD6 oflfi. |,trpsly. m.rclurivclyco. rdint wilh lic6.n conrrndoaxr sNrru!-l rh. Itroj.d (Sd 7044, a6'n* .rd PNisn. Co& 'l h. Contrror'i l-ic.@ t $ d.6 mr rp?ly kr e o$no o f tropdy $ hd hnild! or inpr.r6 rho(,n, ed $ho mffi!f sh Foj.dJ tr nh . Condon3) li..tr{n oEd to rlr Coln,x!* 3 l,rEe lln ) I M.rmpt untLrSdlion Ii!BrE8S:(C!UEUSAII0! IEC|JAAIIO! I hdcby rlfim unds F.lry of p6rury oc ofrhc tnb*.ins d..hdrFB: I hr. !'d *ill riat.h . Cqrifrlr. of Colgr to S.lf-lM. a.r $rt6 comrEEiion. s FDvid.d lor q- Scrio. :17(xr .f lh. Llbor Cdlc 6.llE Fflm of rlE wd lor *ni.fi ilE Ftur i 6u.d .l h.!r rnd will m!' lin wort6 comF&don rBmncâ‚¬. s r.qutr.d by Srraotr 1700 of rh. lrbor ( od., tu rh. pdome. of "-::' i\;:i'tr;" ni;:*)i; ^ "H";:)"' *"* * ,! (,\trr$ qbu,E/+ Qff ir/p \r es 3. ) -i{ I cdr'ry rbr i. th. Frotuc.f lh. nort tor r hrh lhE Fn is suql I null@r dpldyuyFs n.n! naE $ 6!o b<.d $ttd ro rh. $ort6 NnFdir h*. of (.lifomq.d +re rht if I nsuE bdoE tubd 'olL$!rt6 lomFsrhn pmviiioB of Sdion lT0o ot rlE bbor (iaL. l shll. adhq'nh comply *nh rlEs r,.\ i3ro6 WARNINC: lailuc ft' su. *oltd enpolnn'. cov6Ds. s unl.rtul, ud ihall 3ubj..l d @ploF t. dininal FMhi6 md cMl nn6 up lo oE hun&.d thoG.nd dou6 {lloo,mo). in lddnion ro rh. coi oa.ompasrion. d,h.*6 a provid.rl Lr lh. sdiio. 1076 ofrh. hr Co& i.rdd d drory'3 rc "4/r/".,. $- 3o - tz r rcrnieoiuf,[ c'rbr Drcla8fra! I lElby lllm undd !adr!. of pojury rhd I d Lcdrs.d uftk Fol tnn of ( h.rts 9 (onffiiis *nh s.<ln. 7fr{)) oa Diribn i of rlE lldilB $d PmldbN C.&, !n h} lkG n s flll nnN dd.fra' /oootq{7 $-9o'it I ho*r .trm u!& Frlt of Fjury $r lhq. ir . o'EnElirn laxtitra rgdy tu llE Fftu olllE rst hr *t!th lhi! Fnir ir slcd (Sa Ir7. Ci!. C )La&i NMC: AIIIICA.ELDIO.dAAI]AN I hdSy floim und6 r<ndlty of pdiury on. ot lh. tulowinr ddlfd ninr tlmoliion Pftrts-A3bdos Norincd nr. r'.ddrl R.suldi.n!(lnk{0, Pdb) R.qutr.rl rddof Nd'adbn edElos ronov.l.r. nol arplr0ble k, IhD |x,jLrl Itd rh.atF\. rfonn nni!lmrl IisEloN',pbtrnh.UCnt.nd(n! !or ari hsd) aurlsro. rqr*ndtr6 of rh's Cny ind (i,umJ_ ro 616 uF)nrh. aboY. ,Mrtrn.d pmpdy nn iNp.dion Applicrnl or ABml sh..lure 51.n t4,,d5 $'3d fi Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Roof Sheathinq Shear Wall Framing lnsulation/Energy Drpvall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif. FINAL Certificate of Occu pancy Notes, Remarks, Etc. 7 1 I I Subf loor/Venulnsulation I I I I I I I I I I I I