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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE tD/srG.COMMENTS OWNER AUILDER DEI-C RATION
<br />I h*b rlrm ond6 FMlry of psjury lh,l I m.r.mr, 6on th. Co.'lr.cloE Lic@ L!* aorrh. follo$iry td)nlscrl)rlJ
<br />Busins ed lnl6inrr Cqi.) Ant Cny or ('oudy !'hi.h ,cqurE r Fnn ro odtud. rh6. impreve &roli* , rqun mj
<br />srruduc Fsr ro s isumc. tu .dtniB rlr 4pltd lor tuch Fmn ro 6k . s'sn.d saml lh, h. or 3h. k licdrn pt6@d
<br />ro lh. FtrvisEN or rh. ( a.rr&rori l-(dsd lr{ ((lurrd c, c.nnocinB snh Sdior ?m0 or DnBnn I ol rh. Bulln6s .rd
<br />Pmf*ioN cod., or rhrt lEor st s.!m[i rh-.tom.nd rh. bltts for llE.lks.d BdFion AnyliohrionofsdhiT0rl ih!.)
<br />ap?lrel for . p6nil 3ul,rdi lh. qDhc,tr! lo i ctr il pqully ot ml mor. !h! 6\. hun&cd dollG (15{Xrl
<br />L s o$F oarh. F.Fty. or my mph\c { nh tr ry6 6 thd $L mhF6rtut. uin do d. trnt id E rrErE. ml
<br />iddxLd m.E6.d fs rk (Sc 704.1. ttlliB ed Pml6nE Co<l TIE Colnn roc! Lire t^ rh6 d {pl} lo e osE or
<br />'iE FFD ulb hlld ( in+h\€ rlE& ni *ls d6qi r r h,m.lf or h*lf or lhmu*n tu m h6 om drh!6,
<br />pro\iLdlhn3EninrmtsEr!ed-nqnddotutnrl.ltlxs6Erlrhirli.sdinr.le.tidurldsahbwrq
<br />of.orFlriotr Eo*n auiBa $ill lE1. E hrd6olF$rB tL lE(lrEdilml hild or i'qFor! ttt FoF! 6r 'lr F,Feoa
<br />I. s o$ffi of rlE Fopd!. m.rclut^Glr co slos s{h hGsd (odracr6ro 6(3rtud rlr Foj.t ls< 7o4r, &!!B
<br />and Protsin ('o{t : T}. Conrkro.r l-(a* lr{ dG mr qrlt ro m o{E of Fopcly sno hril& o. Fprc\6 rna6..
<br />a.d rho .o d! fo! .uch FrFl! s'nh . (n r-rnl,lk6ed llrdEi lo ihcco.rdoa3 Li.e t u)
<br />I mcrmpl und.r Sdtion
<br />naalifEtl-(lJurlN^Ila!
<br />DEIIJIAIII)N
<br />I hd.by ailirm undd p.tr0lry oIp€juryoncorrhc ltlkr*,ry dNlarir'otri
<br />Ihav.urd*illDarnl!'n0(.n'llcal.of(inro k,sclllnrur.fir\vork6'.om ner6..6rro\id.tltrtrbys(rn.r700otrhr
<br />Inbor ('odc. for rh. pqlomucc ol th. f,ork ror \rhich lhc p6nil s ix\ucd
<br />Ihavcandtr,llmainrrintro,l6s'corl.nrrri,,n,nsurrnc..Nr.l]uknhlS(h.nlTlr0olthelah.r('odc.rordr!,t
<br />lh€ r.'l l.r \ti'(h rb{ rmtrr 't h$.j Itqr'ld\ d palicynumr. dc,^"{4lls cakc- I l_.
<br />^,..,*nful*oo b+oL- 06 ,,",;^ fl3of I A
<br />I.dirr rhar i.rh.Fr.rmnc.orrh.$oi\ ri! *hkhrhFF r u 't!'cd.I shallnnr opl!,\ rl' *.,,1,"""'.""""$ s ro bdoft sobrfr! ro rn. q ortdr' cohrns n,n li\ s of ( .r'n,mB. tud s3rt rhd ia l shuld h..om. sutial lo rh.
<br />s0116 conp.r$r ion Ir.\ 6nB .t Sd{n r7(Xrorrhr Iilrtr ({*- I {sll. f.nh\irh..nplys h rh.s Fo\ si,n!
<br />$ \k\t\r,dphrr !o mm'Ml FDiE ,nd
<br />.R h!fld,al rhus.d J.ll (tl
<br />!-,1r.r!!l!!-(.D
<br />I hd!6t rlIm u,id pauht 6l Frr, r.. ihr I m bdr!.d o,n r Fo! ilhn ol(1rF6 9 (c@nB *nn sdhn 7(I)0) ol Dn Lhn I
<br />of lh. ButrB dd PtufdbE ( o&. rn ny k* ! n tull foN rd.lEd. -,
<br />,,*,."48 e-ptt
<br />".,.qeb//Y
<br />LO/ L31 o o 4oz
<br />(adllilcljolLENDllcacENcY
<br />I hd.6y rmrm lndd F.rhyoftdjury thli !h6. Lr. codtudnrn hdins ssocy fd rhc pdfomMc. oflh.{od tor whichlh'r IEm( n
<br />iss!.d{sd 1097, ( 'v ( )
<br />dIIU(AtsI.DEO.4AAIIA!
<br />I ha*r nrm u.d6 parhy oapdjury om ofrh. frnb$r.B dale.tions
<br />D.,nolnio. PdnneAshato! Norilic io! l;ard rl R.,t ld o.r [nl. 40, Psl6l
<br />R.qut.d ln16olN.{ft{xn
<br />I cqli[ rhn rh. r6J.alrqulark 6t6ro! rdFr il !. mr qldE.bh ro rhis projd
<br />I calitrhd Iha.radrhs.t lE Fn n.orrccr I rsG r. conpl!rnh.ll (
<br />ordi.ffi6 a.d Srrrc tr$s Eldn{ ro rncrcF6dnrn6of rhB
<br />.hotc 6'F..{, Fopqiy for
<br />,\pplic.nr dr.lBmr Signr 7
<br />';/,;.
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathing /0/?. LLih t.t
<br />Shear Wall 7
<br />Framrng
<br />ln sulatio n/E ne rgy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL toln t1 /q./.{J b
<br />Certificate of Occu pancy
<br />Notes, Remarks, Etc
<br />Pmn6 n.m. (prlnl,: /
<br />I
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