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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS O\I?JEI BUIIJ)ER DEI,CARATION
<br />I hcrty .rm u.& FEXy of FJur, tha I m .r6F ton rll Cod,e6 Uco, t w lbr ltt fouo*i.A lEr! {St 70ll ,
<br />Buin6 !d ProfdDn Co&) An, cny or cony rnrh raNE r Fni lo o.!rnrr. .!6. itr'r.lre ddlolli or nfu xv
<br />ffie Fi,r'o iB illdq.lb Equt6 r,E +9li.sr fot Mt Fbn lo 6]..ssrEd i.oEr ln lEor JE a li.q!.d Faud
<br />ro rh! Forili.B oa ,E Com.dd't LicnEd lre tctup{d 9. ftffii.s wnh Selhn ,000 ot Dillbn I ot tlE &auB dd
<br />PRradios Co&) or lh!| tt o itE i! .rmpi fi6cf,on ard l,E b..! aor th. .lLs.d qdFion A.y vioLlior ofsdtb. T0ll , br ov
<br />rpplicur aor a Fsil slbjE$ rh. rpplicur to tcivilPdhyolml not.lhd ir. nundr.d doll$ {tt00)
<br />L s otrc of rh. FlFry. or m, dplor6 with wtg6 s lh.t sl. mmpqs.laon. nill do dE w*t dd [r !d\rd@ k mr
<br />i,rdlcd or oflk d for nL (Sa.?Ol4. BdilB dd PbfdioN ('o&r Tt Conrftltr t Licde Llw rto6 nor etlv to 4 osd ol
<br />tlE D.opaty r hili d i.rEo€ tlEEa -d who dc rdl K hin*laor hd*lfor llEush hi. or ha om dlplov€.
<br />protiLd rhr 3Nt imFlEGrt G br itarl..t orofrcln 6r rL U.lB!E. tlE tlildi,B ot i'rFslGi a $ld vihnr @ )!
<br />ofclipribo ln. O.E eiEs wi[ llt llE hda olFuaB thr lE n tE dd d trild d itFoE ln. FoFiv 6r E FrDdor
<br />-1.
<br />B olE oalh. FoFly, e sclsi(I, cotnffing Mh lk.E{ colnrslo* io oidrud llE FoF (Sc 7014. 8l!!6
<br />.,n Fokir Co&: Th. conlsloi r Licar. L,w do6 mr .rrl, r. d owE olprcFly shd h! il.ls or inProvd $n@tr
<br />.nd sho ontds aor lEh D.!i{li ynh. CoMo(r lic.B.d ptE@t lo rlE (o, rcloa! tjc.M k*)
<br />B & P( forrhi!,(en
<br />lhl. Ot!61
<br />woRxERs coiiiis TloN
<br />ltlctdEarla!
<br />I hscby lrm u!&r Fdry of Frury oR ofrlE folh$ i'ts d(btlioB
<br />-l
<br />h.vc i'd vill did.i. . Cdifr.l. of Coell ro S.lf-lEG lor wt6i @Fstio., s FDliLd fd b, S<rio. l70O ordE
<br />t tor Co& ld rtE Ffo,l!ft. of rlE mrt 6r $icn lh. pddn ar aard.
<br />I hovc snd { ill nai.rain work.rr coarp.Barion i6urdc., ti Gqlnd b, Sat io! I700 oa rh. I dti'r (tdc. fot thc Faonne.. ol
<br />rh. wort lor which rhis lcflrn ir is.d My wortrt- codpdMri.n iNurecc csid err polic, nunrbd 8.:
<br />Policy Nub+ ErPt6
<br />-l
<br />(cliry dd ir th. Frollllu. of 0t *orl aor *hkh rhir Fmn s su.d, I strll mr drpb' .ny pd$. i. e, M
<br />$ s b bcoft eti6r ro rlE srrr6 corqGiion LB of ( .lifomn .rd +N lhd if Lbuld h4om st*tl lo tlt
<br />qs 6 omFB.iFiproltioNofsclbn 1700ordt bbot (ida I tldl, fonnwnh @mply wnn rll.- Fovirio6
<br />WARNING: F lllE ro sw wl6 conp6dion sEr.s. i! unlrytul. dd ih, suh]cl d 6pLF ro ciniMl FulB t d
<br />.nil 6n6 up ro on. hund..d thousd dolls (lloo.L{}0), in &Hilion lo lh. .or ol co!trp.8!tio.- .timi86 a proYid.d tu rh.
<br />sdion 1076 ofth. tnbor Cnd., inr.rd Md lnorn y. tc
<br />e //
<br />l)}l-LtBl.l&r
<br />I ha*t .ITm ur& Futy olFrury fir I e licd !.& Fovitbt of OrBq I (@.lri4,!a *nh Sarbtr 7000) oa Diaition l
<br />of fi. asi6 rd Pmloir6 Cod.. nd mt lia* it h 6rll tor -d.lE{
<br />".,.,r/tt/,e
<br />CONSTtrtI' ON I trNNING ACEN('Y
<br />I hqlt,y .lrm u.<rr FEhy of Fjury rhi lhd. is t odtud i'n Lt ins.sdy fo. rlE Ffolrll4c of lh. *ort 6r stth $n Fii i!
<br />sd(Sc 1097. Civ C )
<br />A.Elu(AtrLllticlJsarlo!
<br />I hody a6m undd pdalit ol pdjury ooc of th. rollowins d{lrd ion!:
<br />Daruliion Pm'rsArbdrN Nolifis.lion r.dtal R.suldion! (Iirl.40, Pdr6)
<br />-R.qurcd
<br />tdrq of r*lilf,dion
<br />-l
<br />.clify dlr rh. f.dd.l ,lruldiod Egrnug stdot rmr.l e d +P]k!bL lo lh6 FoF
<br />-l
<br />GriS rhr. I lbt Ed tli! Tplalliri .n sd. Uu d. ltow inhnDrbn ii .dnd I tgE ro onFlv *nh d Cilv !d Coult
<br />ordiee rd Slal. kw Er!{ lo hit tiis.odr.li,.. .n ha*,.lnlDriz n?.6.drit6 of lnn Cnv !d Coldv lo o s uFn tlt
<br />!bo!. mrion d propdry fd
<br />,tppric r orAgerrSignrrurc J ,,^," ry'e+/, g
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certif.
<br />)
<br />FINAL tl)llt4'tiunvupt,7rL/
<br />Certificate of Occu a
<br />Noles, Remarks, Etc.
<br />ou-
<br />(
<br />UFER Ground
<br />zJ---
<br />Larld'r .l&s:
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