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BUILDING- INSPECTOR RECORD
<br />COMM NTSSITE-WORK DATE ID/SIG.OWNER BUII.DIR DI:I,(ARATION
<br />I hsq.L!flim u ld F!lt) olFjuq
<br />'hn
<br />I d .roF toN rh. (-ontdo6' Lkru l,* fot lhc&ln'{iry r.en ls<rlrll !
<br />Bur'n6i od Piof<r6 Cod.) Ant Cr y or ( .ud, tr hrh r.qun6 . Fni to mdruc1. !116. 'iFo\ i .Lfrn6h or '.Fn et
<br />ertudde Fmrro i! is!k., .4. r.9ut6 thc +?licMt for eu.h Frrit lo 6r. a sisn.d slrdd rhtl h. o. shc ; licoEd 9u^u@
<br />ro rh. For s'oB or tlE ( . rtor! L(o*d li* (( t,r*6 9. CoMftins s nh S..lion 7000 or Dirrio I oa rhc llnrind 'ndftnLsio nr ( .&) dr rhat h. or rh. i! .Emr* lhdcnom $'l ih. bf,lis tu lh. rll.s.d clmfl n'n Any rinhri(,n.f sdmn 7011 5 hy.n,
<br />q,plrrnt f.r . p.m'r rubJcit rlr !r9li.!nr ro r .n 'l
<br />p.eh) ot mr frtr rhe fiv. huidal &lles (tlft)
<br />l, 6 o$F olrh. FoFd!, or mt.mphrc s'ilh r.a6 s llEir ark.ooFsrl6n, sill d' ih. $$l drj rlE rulr u mr
<br />iddrLd oior6cd lorsl.(Sa 7(x-r. Buv6r.nd Prf,r6sFm Co& lh.(.odrdm ! Lk.* L.n &Ed 4?ly ro tuo*E.f
<br />lh. FsFnv $tb tnil,:L oi i,np.orc llEon. drl trt dEtuchtr! him*ll or hssclt or ltuoush hi. or hd own drploy6.
<br />Fold.d rhd uLh itrqiordrE6cd ddtda! ofl.nd ftr oL ll hof,-s, rh. llildirts or iqrurtffi ir sll rih,. on. )@
<br />orcompLrpn. rh. ()sr6 Buildd *illh.!r rh. hido otFoun* rh!!lror rh. drl mr tutl or mfiort E p.lldy ft'r rrE Frlreof
<br />l. so*hd olrh. Fopqlr.. en.r.lu!n.lr.onkrdinx $nh li.d*J (onrr!.k)u ro connrud rh. p.,r<r ls* 7(}1,1, Bon.6
<br />.rn Frofc..n Cod. Th. (-odrrrorr I E.G I a\ d(6 mr qrl) t, u o$ n6 of FolEn' $ h. tDr lds or nrpo 6 !h(Fn.
<br />atul sho Nnk dslorru.hprolds" hr(o ndons) lic6s.d pu6&r kr th. (i,,nrddar Lxds Lrr)
<br />I dn.tnrfl u.d€ Sdn'n Il (tf C nYrh6r.N)n
<br />D.r. ()116
<br />\ronxEfls conlPFis^roN
<br />Dlg.aa4uQ!
<br />I hd.h! amm unds p.n6lrv o, psrur) oE of rhc fotl.u in! d<l6.1NB
<br />I h.r. Erj q ill ruinr!'n r Cdifrdc oa Conal kr s.lf-lBur. to srrld' codFM io.. s F.r id.d foi bl. Sdion 1700 ol ! h.
<br />trho. con.,6.rh. Ffomocc oIrh. *o.I tor *iich rn Fmil i!Nu.d
<br />I ha\ . ifrl Nll mli a'n s 0116 cdmF6t' ion isrr.ft.. s tqur.n br sdion 1700 ot rlE I ihor (odc. aor rh. Fn,m.k. of
<br />rh. *ork [r { hrh r hii p.mn B 'su.d My *orld' compalrdion rmurm. cMid &d rnlrcy rumb6 a.
<br />I rdrfr rhd 6 rh. Fform.e. ofrh.ro,L lor qh(h thi Fmil is isu.n. I drll B, ontl.! lnt Fd$n in iny nuK
<br />wr aro tE!ft q,irdr ro rh. $orld comp.Mion hsr of(.hlom'.. *l {.r thd if I3h.uld tEc.r rutt<r rorlE
<br />{orld .ontJorqrion pmdlnrE of Sdion :17(x) of rh. Ilt$ ( odc. I .h!ll. tonh*ilh comtly w hrh.sln)vision.
<br />$ iNlNC F.nur. ro s@ tr(,i6 mnFE i.n sr6{. ! u.b\ful. lxl rhrll suhr.d o nplo\s lo ainiEl Fuhir lnd
<br />cnrl fin6 up n, on€ hrndr.d lkJusaid doll6 ($l(xl,(x]o), F .dd nn ro ih..os oa.on .Brnn. d.maa6 6I'.\nl.d l rh.
<br />DIOJSAfI9!
<br />I My .rm undd D..!hy ot Fjurv lh, I u licdld ud.r Fnr iri.n oa ( h.prd s ( commmc inr u nh S.clion 7m0) of DNi3nn l
<br />of rh. BriilRr.rd ProfaioN Co&, !n my lk.N B m tull forc.,n c0cr
<br />o/t 6/tt &.b-
<br />(aljilallclllllt.laiDMi-acElic
<br />I hd.tit.mm undd F lht.f F jlry lhrl thd. is !..nrltu.1hn Lndins rydy tor lhc pafol]1@. oirh.*ork tor sni(hrhis Fmi E
<br />'a{.d ls( l0r'7, Cir ( )
<br />ATIII(ANLDESJI^IIO!
<br />I ha*y ilrm tr.d.r Fi.lD of I'sjury on. of !h. iollowiu dRl,ratn'ns:
<br />D.tulrrn. Pmtu A.tEror Norincdirn F.d.r.l R.suhrirnr(T l..r0, Pd6)
<br />R.quir.d tnrd of l*{ifknm
<br />I rdi6 rhd rh. Ld@lr.*oLlFB Essdlns <Estos rono\ale. nol icrliobr. ro rhs rojd
<br />I Gi,ft thd I h.r. r.!d rhi .ppli..l on drl star. rh.i rh. dhrv. rnldmrtn,n is (ond. I ltie lo comply * h tll (-n) .nd County
<br />ord'o..6 u<t Srd. Irn r dnn* ro h(ildi.E (nns.1N( drt hd.bl tuih.rn! rctrcln, tr 6 of lhrs Cil r &d ( ounrr" r. 6ra uIFn lh.
<br />atEvc Imlnn.d ropsiy tor NrEdon purlrB
<br />,\Dplk.nr orAadl Sitnrtrm K
<br />&,<n".6-
<br />fr2-.r_9/tt/t1
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drylvall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Irilason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL t -zt- /9 J/a S.tl ./g
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc.
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<br />II
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<br />:::;);ff::il,fuffiffi-e_
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