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BUILDING. INSPECTOR RECORD
<br />SITE-WORK ID/SIG.COMMENTS OIYNf.R BUTLDER DELCARATION
<br />I hd.t y rmm undd p6dly of Fjury rtud I d erdfl lrco rh. Corfi.C1o6 l-t.e he for lh. following rrun (Sd 7(ll I 5
<br />Buind !d Prca@ion Co<L): Ary Cny or Coudt *hich r.qun6 a pqmn to connrud. .hE, improve ddrolilh or rE r ey
<br />rME Fi.. b ht iw.. &o Ei'riB rt +!li.d for sh Fni ro fiL . lisEJ rtfut rhr l* or ih. ir lrlB.d pulsd
<br />ro rh. Foirbc ol rE Colrdd t l-E6s.d t w (cluf,d 9. ( oMdi.e $ nh Sdiotr 70m of ttrirk'n I o!rh. B6ind ..d
<br />Prcadion! Cod.) or rh{ h. or ih. ir dmp( fi6.f,om &t rh. t .ir for th. .lkg.d .raPlrri. Any vbLlion ol Sctan 701 I 5 h, ut
<br />lppliclnl Ior ! Fmn llbjdls thc sprli.dl lo s civil pc.lhy ot nol moE lh& fivc hundr.{ dollG (St00)
<br />l. a orE of tlE FoFry,6 iy dplo)6 *nh r!s6 B llEr 5k onFlltion. "i0 d, tlE kit rld dr rrulE i mr
<br />iddd.d or offold ad st (Sd 7s4. AqiB md ftof<ioG cod.: Th. Cotudn r LtaB L.p &6 ml .prly lo D oqE of
<br />tLF Fty *'ho hrild d irryoG rlEoi. rn *ho &E sdr qrt hitu.lf or hd*lf or rh@qh hi. o.lE oM.rnph)6,
<br />Folidqj rhd luch imForsE s rc rcl hrad.d orofind 6r s.L ll ho*.E. $. tliLill3 q iqnwEn i! 5lll wnhin on. yu
<br />ofmnpkia tlE ()'*!6 Buil(b will hrw llE hrbl ol Fovir$ thr h. or !h. dn d hild n mFtrw 0! FoFly loi rlt FrF* of
<br />l. N ow of
<br />'h. rmFry. m 6(h!iv.ly.odrdm8 *nh lt.B.d conr*lw nr co'dNl rr! F',d 156 7or.l. &Bffi
<br />..d Ptsfrsin cod.: Th. co.rE ror'r l,ic.m. Llw .Ld .or apply b M owna of prcrEny who huildr or inp'ov6 rhF@n.
<br />md who onfld! ror 3u.h Frjdr uirh r comndo{i) li.6r.d pr6!!i ro rh. ( odr..roar l,k* lrs)
<br />I E.rmF !,is sarion
<br />l!04f,![st(0ut!!,tAra!
<br />DECIJAATIO!
<br />I lE.t y .md uod.r Fuh) ofp6jrr' o* otllc fou{s,* &(b.lirB
<br />I h.v. on will rornr.in . Cdif(.rc ol CoMl to s.ll-l6ur. fo, $.16 comFledrn, a Fovdol for by serbn l70o o f rh.
<br />L$or (.odc for th. Faoroc. o f lh. Nlt for *ti.h th. pdmir t is!.d
<br />_l h!1..n<l *ill tuinr.'n wort6 onFur{n |EU.E.. B .r'trwd br Serb, 1700 of rlE t bor (-.<l. for 'lr Ffolru.c ol
<br />rlE N.t lu *tth rha Fnn i! is.d My *std' otrrFEna. iBllJ,e .EE ri Flk, n.ntE R:
<br />I cdify rnd i, th. Ffo,Mc of lh. *ort for $hi.h lhir Fnn n ($al. I shlll ml cnploy oy lxmn in any meE
<br />s a ro b$rc subjcr ro rh. w 6 smpdadirn la*! ofcolifoD,a, uddscrhd rll lhould iEUm. lobjcl rotlE
<br />e*6 coiF&rb. pilyirioa oa Salio. lT00 of rhl lthor Codq l ihall, fonhwnh .omply wi h lhor prcvitioB
<br />$ALNlNc Failur. h) Er. $.rlm' comrc@tn,n rubr.!| d dplqn lo difiiMl F Ii6 .nd
<br />f codFirio,- &nas6 a ForA.d 6r rh.cnil fin6 up !o oE hu.&.ltbusd.hlLB (t
<br />SalFn 1076 olth.l-,&tr(irL, inrdd
<br />n
<br />Iha.ty lmm u ja p.uhy oflqrury
<br />'hd
<br />I e imvEior of Chrpig ,) Godn@iu * nh Sdrtrn 7ux))
<br />or rh. Bum6 Md Phf6loc C.&. nd ny licft; n in tuI nrcc sli.fid.
<br />C-n ?6;trac17
<br />D!,. al3l r--}rh-
<br />t hatbr.ltm uldn Frtyof Fju., lr lha. b. Ndidb! lad.B .ady for E FflM. of th.wl6r *ti.h lh! Foa a
<br />ie.d (Sc. !09?. Civ C ).
<br />L.n& r Nm.
<br />ATTII(ANLD};(IJAAIIO!
<br />I holby .rm lndd po.liy of pgjury orc of lhc tollowinS dccleal ionl
<br />Darclnion Pmi!-Aib6ro! Noliicrlio. Fcddrl R.Buhioa (Tnt 40, Pd6)
<br />Rcrlu,cd tt{ro olNo.ift.i..
<br />I cdily rhd th. Ld6!lrc3ulalNns rcsadin3 dh.sr.srmoraluc Nl appliclhlc lo rhs poJdl
<br />onanidcrh,rh.rt 1.ofotusn 6cmd I .!G ro complr s nh rU ( ny&dCounr!
<br />.dlbri2. r.s.driv6 of
<br />'hir
<br />Ci v !n Coull] lo ors urFn r,E
<br />I.d'r\ Iha' I hrLfoJ rhE topl'.tr
<br />ml'Mfr6 .Nh'o/'*\ (lr'q r ' h'
<br />.tr\c nB,r,mdlg! rtr,6e.qi{
<br />noorr-. *,rt', s"\,n*
<br />"*,**.,D(\<!1-?,MtLcr-
<br />,,r,, bl\1,)
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathin g
<br />Shear Wall
<br />Frami ng
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handica p Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL l7 /,t/r)(Da .U.nr S\
<br />Certificate of Occu pancy
<br />Notes, Remarks, Etc
<br />DATE
<br />Subf loor/VenVlnsulation
<br />I
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