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BUILDING. INSPECTOR RECORD
<br />SITE.WORK OWNER BUILDER DEICAR TION
<br />I h*by alrrh unds polly of p6ju.y lhd I n dmpl 6Dm lhc codn rd^ Lic@ b* for rh. aollowmS r.dn (S;d 70:! I 5
<br />Bulinds !d Pol6sio. Cod.) Any Cily ot Cou' y which Eq!t6 r Fhn lo coni cl, dlq. inlrove &tmlth or l9.tr uy
<br />r.udE Fs lo ilr isw. r&o E+i6 rh. +plkd ror r*h panor !o nL. t's..<t naandt (ht lE or rlr a li.aE<t FI$&i
<br />h ln. F!6io6 ol dE Cofudd! Licorod t.* ((.luFq s, Comdins rnh Sdrn. 7000 of D'viiion ! ol rlE Bu'r6 sd
<br />ftoGsioE Co&) or thd h. d nE b .rmB fi€.6om ed rhi Lr hr $. .lLs.d dd8ion Any vnhion of S6rio. 70! I t by ey
<br />alplicdr fo, i,@nit bj6s rhc rp?lic6t ro !.ivil p.n.h, of nol mr.lhm fiv. tun&.d &llE (Xt00).
<br />I. B ow of6. FDFit. or ny onpbrG *nh *!s6 6 rlEr $L shFEdirc wlll &r tlr qflt rd d! nrurc ! d,r
<br />trro'd.d or olIa.d fm sL (Sc ?041, hllilB xd PrDf6i.d c.d. Tt cod.dd'3 tie t^ &6 mt +lt ro m orE of
<br />rh. FDFiy $ ts hrild. d !t!.o6 Om.. id *,!b d(B ndr tr!,t hielf !r hE*ltor ihreush hE d lE oF Elalor6,
<br />provid.d rhd s(h idFovaE$ G Dr inrEdcd orofiqEl frn r]. lf, ho*6q, E hlilr[u m itrFor.td ir Dld whnin o.. 16of.upliioll. lla O*na B{itb will h.E tlt bir&o ofprwinU lhd lE or sh. dil mt boild or iq,rcvc fi. FDFI, hr llE FrFu of
<br />L aol^cofr&FDFi', d dchsnrD codrxr ins wnh lilcBd codrdoE ro codrud tlE Ford lsd 70t1. BGffi
<br />ltri Eoke (td.: Tn Conrdois Li.dr. rly do€ ml ,pply k! 6 o*nd oa proFny * ho tu,ld! or idprov6 rhdd(
<br />d.d sh. o.rDc13 for 3uch Fojd. wnh a Co reclo(,licd.d ruRunnt rorn.Cortaclori ticw L€w)
<br />I m.r.mF unL. sdirn . B .t P (' lor thB rceo
<br />l).r. Oinn
<br />uaaMtsfrqlrBr:rs llo!
<br />DISTIBALIA!
<br />I hrct r. rflnrn utrd6 pqulrr of rEruft o.c ol rh. nn6$ in* &rlmrnlB
<br />I hrr..d *ill min.i! r Cdirrdc of Col6r to S.lf-!,M. Lr slrla' omp.Mi,r 6 F jd.d tor b, sdion 1700 .f rlE
<br />libor Co&, for th. Ffolrte. olih. $!rt tu *hth ilE Fnir u isu.d
<br />I hav. nnd will mdinhin wortd comp.B.l ion insm.c.. a Equir.d b,, sdriin 17m of th. l,bor Cod., fd rh. IEfomB. of
<br />lh. s!* tor u htfi lhir Fmil a isrd My wortd' omFdrn iGuft. @i, rd poli, nuntE e
<br />I dirythd r !Flolla.offi.*orl lq$httfinFmi is sd.I nEIlmrdq,loyoypa$.inerlMF
<br />r 6 b b.roE et d ro E *. 6 6mFdi6n l,$! of ( rlhni& !i rBc thn if I llsulll b<o@ ebr6r to tlr
<br />so.Id'comFNrionFwithNoaSdi..i7mofllEt hr('.<kIddl fonh*1lh c.mply *ilh ttDs Fovii,oB
<br />WARNINC ljailut.lo su. w.l6'omp.NdiM cov6!s. i! ulawtul, Md lnall subjd an 6plo}f lo oihinal Fultis ed
<br />.i!il fDd up ro oc hu.dr.d tho@d dollE (3100.0001. in lddilion ro th. cort of coDFetior d!,usc! a prordcd fn lh.
<br />sdion 1076 .I rh. l$or ( ].,inr6dod
<br />D.," g3l(1
<br />I hd.5y,mm u,Ja pdslryolFjury rhd I @ licdE d rrnv6ion ot(turrrg 9 (com('n[ \ilh Sr:inn 7(trl) oilr\trnn l\
<br />or rh. &itB ed Prer*iE Co<L. rn nt ltG it h full nnc rn.fiBl
<br />,.*.a* PL
<br />-,. tlu,It.l
<br />qo43
<br />I hclby rltm ond6 D.nrlry o ( p6jury rhd rhd. ir ! rcn!rucrion lsdirg lgdcy for lh. pafolllec of lh. mrl tor xiich lhir Fdmn is
<br />drcd (sc :rm7. civ. c )
<br />l,(dq.l Ad&s:
<br />afrutANLDEcIJaduq!
<br />I todJy !ftm urdd Flhy of Fjury oE o, rlE lolbf,in8 .L<lei hN
<br />l).mlilion P.mieA3b6ro! Norili..rio. FeJ.rl R.suhn,.! ( I'lL.l0, Psr6)
<br />R.qund lnts of Noti6c.lirn
<br />I .diry rhd rh. l:dd.l ExuhrD6 '!*rd'.* rstErG ,mn !l dc mr 4rli.!nE to rha rroi.(
<br />dri narcrhar rhr ahrc,f,ftmartr,n B (nrBi taE,.!n,co mply trirh !ll (-ir) a.d (irnr,
<br />Cityed(irunltlo h(o uB,n thc.ond'rnion- and h.r.h! rurh.rT( 'qrr6cntarns fflhF
<br />Vl^^^-
<br />\eQ-r- VWIU(
<br />fllr
<br />Form s/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulalio n/E ne rgy
<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 />FINAL W li? t)6 VrrJ\X
<br />Certificate of O ancy
<br />Notes, Remarks , Etc.
<br />DATE iID/SIG. I COMMENTS
<br />Set Backs I
<br />I
<br />I
<br />I
<br />Flood Zone Certif.
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