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BUILDING. INSPECTOR RECORD SITE.WORK ID/SIG.COMMENTS OWN':R BUIIIf,R DT:I,('ARATION I hs.h amm u 16 Fuhy of Flnrt thd I m crcqi ftum 'h. (-odrd.6' Lk.e ts for rh. f.llosE8 r.en (s< 70ll J Inrin6r md Pnf6sion ('od.). Aiy cily or counry *hich r.qut6 . p6ni! to coNlrud. allq. iq!rov.. &mdlBh or qBr any drucru., Fd ro irr isud.. rL. i.qund rh. rprl'cd for rxh Fni r. 6k. !r8Rl nd.rMr rha lE or slE t l(mEd puNd ro rh. treKFN ot rh. Conkrctoit l-icaEd tr* ((r[pr( 9. Commtrins *Ih seinn 70t[ of otrii.n ] ol rh. Bsr.N .nd Pn' lasiotrs codc) or rhd h.o.shc n.r.nDt lh6.liom ud inc bnsis for th. lllcs.dcrcmpl(n. Anyliolari.nols.1tr'n 70ll 5 by tnt radrul fu' a Fm ebd3 lh. q,plicul t, i .ir rl r@h) ol d frtE lh!, n\ c hu.ddl Lhllds (1500) I.so\v.6olrh.FolEnt,ormr.n:Plorcwirh$686arh.nskcomF.srion.rilldolhcso*snrh.3rtur4nn"r [naxLd orofls.J atrel(Sa 7Or4, BNiB ed FrnfdnE ( od. llECodr-roi! Lrek$ &\6 d +pl!n'..o\n6ol rh. FnFd' *t &il6or ',{ror6rlEa( i *n d6shs t him..ll or lErklt or llmu8h hE or lE o"n opt,yd, arovi& thsr su.h imFoEFtu r. nol idqLd orofis.d for sL lt bNBE. tlE hilding or inlmrclMr B 5H qirhi. on. \6 ormtrpLra tu ( )$E tl,lb *nl h.r! tlr hrdo of Foliry rhr lE r{ +E dd mr tdLl o nF\. Jr FJrdy ao. rlr FrrF* ol L ao\â‚¬olrh. FF f, m.!clLrir.l! codrd'n8 snh li..&d $lfuoB kt.odtud ilE lrnr.d lS( 7O{.06'Er .rl lt!tosfrCorL Ih.(tntdor,t Lic6r t& {h6 mr !pr\ lo & oun( o, proDd} rho brildr 6r ihDo\6rh6on. .nd *ho .onr6dr lor luch Fni.nr snh , co.rido(s) l'cdrdr puRu.nr r. rh. (-o rrdors l,i.ms taq) I m.\mpi !tukr Sdr$n llaa5fis-(aufllsAlali DECIASAIIAI I h.rq,mdu.dc.FrhlofFJun omorrh.folh*ins&.lrdiod I h.r. ,nd s,ll nu'nl.m . Cdrii.rr. of ( onsr t\ s.ll ln.urc fn. \rork6t &!npasi'i('.. 6 r,o\ id.d ny b] Scnon 1701) or lhc I lhor Co{.- lor rh. FlollMcc o t rh. rorl fiy trtth lh. p6n'l i i*!.d I hav. rnd willn,idri. Rorkd' .onp.B.! io. iBu4ft., s r.qun.n hy56lio.lT0Oof th.liktrGrd!. ror lh. Faoffi.of th. *orl ntr$hRhlhiFnil i! is.l My sort6'snFNdio. iNlre.ceid ddFlicy nrmbs 6. l..nirylhat inlhcp<rforM.of lh.\ork lorwhichlhi! p.rmn i! !!u.d.l rhlll el dq,lo} r.} F$i in tny men6 $ 6!d b.$ft st d ro ih. trst6 omFdFn |,tr! olcrl'ramn.,i r*E rhi if I nFuld tcnm rbci l. rrE $ ortd .oflpasr io6 FN 6ioc or sdi.. t70o . f rh. t bor (bd.. I sh.ll. fonhtr cdnlt)l) \rh rbs pn]vlvons $ARNINC: f'oilu. ro su. so.li6'co'rposalion co\'fl*. is unhrtul- bd ! subjd mpL\6 fu â‚¬ihinllFnrti! md cnil n.6 up 'o oE hufttd lhoNnd &116 (t100.1r00,. in .dd'lirn lo of .omFMri.n. d,mr6 a rnora.d anr 'h.sfrlio. :1076 orth.ljbor (i!j., mr6.r sd drom._t ! tG I h.drr tflid un&r Fuhr ol Fiu' t- lhd I m li.dEd und.r tsvirirn of(tuFc e (o.nffiiry r nh S.clrn 7(xx)) ot Dn airn .r of lh. ttuin* Md Pmt6rioE Codc. !d my la@ ! h tull forc.,n.fi.d ,.....,.. (' I ha.h) rlfmund< Ddrhr of Frrr- rhd rlE. i! ! ('dMhi knlu.8*) f tn Flffi. of thc rlrk 6r "irh rhi Fmi it irrucd (S( 109?. Civ. C ) AIIIICAtrLDESJSTUAX I hod!.rm u.d6 r'a.hy.rpdilry onc oflhc lollo*in8 d(la.lhB' l)amliir. Pm(3 tub.ror tldifEdrn F..Lr.l R.ruhri.a I ri! k .r0. Pd6) R.qut.d t u6of NorifKnirn I cd 'ly rld rh. fcdd.l r.sul.toE E8rd'na .sb.rlos rd.\ .l s. nol appl'..61. b rhr rmF(1 I.drf\ ihd I h.\. ied !h6.Dol(arFn an i6r.rhd rh..h.\. i Fn scotr.n I !ar( b comdr rih.ll(-'[ and (!u t rot r.Fcgn n6.frh8 cnyed ( ounryro dra uB)ntnonlm.nc6 !.d Stor.lj\rEldin3 h hlikjn3.odrudk,n. nd ,rr,\.mo rmcJIr,ld\ itr n\Pii, rnplic.nr or 116l \irnrtur. \ Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loor/VenUl nsulation Roof Sheathinq lol rlo 9D/?-t;dlt xt Shear Wall Frami ng lnsulation/Energy Drywali Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif FINAL t0lo lttc,'*q'lt etuk pancyCertificate of Occu IDATE / rhr. /ok-<Z-L I I I I I I I I I Notes, Remarks, Etc.