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BUILDING- INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BT ILD[R DET-(-ARATION I h6.b rr,h urd6 p.mX) or Fj&). !h, I m .rmF fmn rlE (-onlractoE' I r(* rr* lor rh. tollouns r@n is< 70:\l t BE n6s dd Pmac$n n Cod.) Any ( ir y or Cou y which rcqutro a Fmn ro (onltruct. !llq. imltorq &inolbh or E!.n uv *tud6c pri{ kr irs islffi.. rLo r.qrr6 rh. 4'Dli.d n, ru(h rEinn to 6L . sisEd tldoal rhd lE or sn E ncdr.d putu.d ro rh. Flr6ioB of lE ( onrrtoir I icor.d l^ ((.rI ld 9. comnftr.3 *ih s(ror 7(lr] of Dni... :r .f 'h. Buln6 .nd Profdsions ftd.) or ln r lE or rh. 6 .rm$ 1nd.6on ed r hc b6ir lt r lhc llkr.d .r6npl io. An, violilion olsdbn 70:11 5 bv ant lrpl'clnt for. t@n.ubj.{r3 rh. rpplicDlto! rlF. ll! of ml mr.rha 6r. hun&cd&lld(t5ml l. s ornd ol th. F.rEny. or dy .mplorc *irh w46 6 th.it rn. conn@drn. Nill d. rlE *sk itrl rhc trud@ is .r' in6d<l dolld.n f.r s]. {Sd ro.l,i. B$ilK ,i errrrdsN Cod. lrkCoffioi! t.a@lin dEnn tPPle'oeorFol !h. FtyElt *ho lliki or inqrnr- rhmn, nn $llo rk6 s$ s{ h'msclf or lEelf or rhm4i ir o hd oun drhyc. proli'l.d rhd luch imFov@lr N d nnod.d r olldol Iitr sl. lf. ho{ 6 r, rh. buikli.s or in,Fovffir 6 vnd si'hin n. )4 of.on{'ktn( rlE os n6 Builds tr ill lE\. rtE hsb of F$n8 thd lr or .h. d,l ml hiu .r nnrmE 0E F\pd, tnt dr FtrIire or |, s otr F of th. F.Frr. u ltctuln.lv .odi.d in! t iih lic.r6.{ .orllrd(E ro codtud tlE FDr.d lS( 7(11'1. B6ind rrl Atrfssi Co& Ih.Cont&roisl 'ca* 1.tr d6mr 4lPL h m.$nd.lIt.Fryrto tu'ldr o mpd6 ihddr. rn'l who contEtu ttr such [oj.n! \ irh t (-odrido(3) lic6r{ t,!R@t kt rh. Cdniidor! l-i.tu. hq ) I rm AmF lnds s<ri,r D.r. ()rn.r $ oRxriR5'aotlFaisrr l lol\ DICIAAAIIA! I hecr,y am,r !.d6 rErflllv orrEju'r-on. ofrh. r(nk\r'n! ddlar.li{\r{ I h.\Gsn*ill roFldn s Ccn,f{tr. nrco'Mr r. s.lf-lcur. r( rort6 coEFeetr s rro\itaj for h s<l'on rTOrolrh. rlh)r ( od., for lhc psfof,nuc. ollhâ‚¬ r'orl ror which lhc Fnn it isu.d. I h.r. aid tr ' ll marnlih wodd comFsrion rMh.c., s i.qun.d h, sdion :r 7(x| oith. lrbor ('od.. lir rh. Ffomffi. of rhc $1trk ror shich rhii pnni! ir i*r.d Myworl6 comFrElioo insure...ni6 od policynun$s dc ! cdifythd in th. rqloruncc or lh. sorl fiy whichrhn Fnn r isstcd.l lhall nol dplola., Pdson in any mmnq F s r(, tEeoc tuti( n\ rh. {.*6 .on{tun,n h\ s ol( .lifomu, and .sc rhd il I 3hpuld komc tlhiE o rlr *!rld srFsDn rornilNoasdmn l?([)of rh.l..tnr Co&.I Cull fodhtrdh.onpl! rinrhosFori$nr \trARNINc. r_.ilur. k' KU. work6'comFu ion covflE. ts unl.wtul, md slull suhid u dpl,))i ro niminllFtrtE Mdl civil lind u0 ro oft hu.&.d lhorMd dolld (ll0o.0oo). i. &ldi$n to th..on olconFsrion. dlnuga a ro\ij.!j for !h. sdr p. 1076 nI rh. r,td Co<k. ors.n &d irorE) ! fc ucEll[D-cotrIaasaa DECIAEAUq! I hs.lry !m,i u.da p.n.ty o f rE jlry rhd I m lic.trEd und( Foyiri.n of ( hlpld 0 (rmtB(ins s'Ilh sd6n ?flxr) of DiYision I .f rh. AulB axl PNrBi.N Cod., rn m) kru k ,n tull fora rd.rd calnlallllafl.Llillll!]i-ac-El(r I h6rh! am, m unnd rEshy of Frjuo rhd lho. i . codtud i,n kndinr asacv lor rh. Ffoms.t .f rh. s.rt to. \ h(h lhn Fmi s aiucd ls( r(r7. (-n (' ) aff|.rslr-D!(lJaduo! I nEdr ,trh urd( Fn.hy of tE ury om ol lh. folhtr hB d.<h.noni t).lmlirion P6mirs-A3lEror Norili.rri.n F.it6.l R.guldion! (Iillc.l0- Pm6) R.rtuir{ ln6 olld{i6.iM I csr't\ thi rh. f.ndd r+uLti'6 r.!r{in8 .rbdos rmd ft mt (rlaibk b rhi p.ol.d I.o1ifythrl I haE @d thr .rpltartun ed rdr. rhd rh. .hov. inf.nnaltun i! cotr6l l .srd kJ co,nplr wnh all ( ilyrnd( ou.ry ..diBm6 a.d St.r.I.tr. clrdr 16 llildrs.odtudrd nn hd.tl' .lthrn rqrendtr6of rhir(-n' diCounlt_lo6rd uFn rrr .ho\. nmrrnd F.Fnr ,or id{E(ion ,nnFs Appli..ni or Aiml stn.lure Set Backs Ereclion Pads UFER Ground SLAB Floor Subf loor/VenUl nsulation Roof Sheathing Shear Wall Framing ln s u lation/Ene rgy Drywall Ext./lnt. Lath Brown Coat [,4asonry Pool Fence T-Bar Handrcap Req. Deputy Final Report Engineer Final Report Flood Zone Certif FINAL Certificate of Occupancy Notes, Remarks, Etc I Fo rm s/Stee l/H o ld own s L I I I I I I I I I --f-