|
BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILD&R DELCARATION
<br />I ha*y .,Im u,r& Frh, of Fju.y lhr I 6 qsr6 noE E Cotr*ro6 rjcog t w for lh. 6,lowiry lq$n (Sc.7otl.J
<br />Bai,B &rj P$163b. Co<l.): t{., Ciry or Colnt wni.h Equn6 . p6 lo 6dtu r. dq. ilp.orq dr&lirh or rQ., &y
<br />nD.r@. Ffrr. iB i'!ll.@..to rcqui6llE +plirr for Mh Fnn lo 6L.3ign d lraMr th. lE or tE . lrcal!.d p@rr
<br />ro thc FovilioB of th. ContrErol! Lt.r!.d L.w (Ch,pt6 9. ComminS wnh Selion 7000 of Diviion I oflh. BBiod od
<br />Prof*iou Co&) or ln.t h. M it t Adpr rhddrcn Dd rlE tcit for d. ilhcd ddFion Ary virldioo of S<rb. 701 I i b, Dy
<br />ryplicer for !Fnn subratllE lpglid ro..ivlFdryofmt mErho nE hurr.d dolLB (iJoo)
<br />I, s oMq of lh€ FotEly, or ny cmplorE w h {.sB B lh.n $L @npaudiof,, will & tlE *ort EId rh. Jlnrlu. ir ml
<br />inr6d.d or olfd.d for d. (S< 7o4,{, BqtlB 6d PrDrdioB ('o& TlE aod,rroat U.oE kv &6 lor @lr ro & o*@ of
<br />dE FDFary *ho hikl c insDE tlEq !n *'ln r,csxi rst hitMlaor hdrlf or.hmuSn tn lEoE 4phyq
<br />Ford.d thr qh ii4.Dffi ft Dt dai.d d o,Erd 6r rL l[ hw. dE hrildig o itr+slGr ! $ld *ihh tr ]d
<br />otco,pLtD th.o*nd Buil& wi! hattu hrdn otFovitB thr h.q3h. dll ml t{ildor inFow thc FoFty tu EF F*ot
<br />l, d o*E of rlE F!Ft. d .kl6iEly codd&s {irh lkoE d rcdr-16 ro olln,Bt rtE F.iri (Sc ?ol,a. B.air
<br />!,'d Aof.im Co& Tn Conr,&loi! l-'ccc trw do6 rcr .ppl, to d ownd oaprcFry who blild! or itpmE lhdoc
<br />lnd who co.rdr for $.h Fojer! wnh r Codtr.ro(, ltcN.d puE@l to rh. Co,n rloa3 Lic.e t s).
<br />,,,,,;"W'k "(_
<br />I hs.!y rfm undq Fully olFru,, oN ot$. follo*ss
<br />I hav. .d *ill mtlli. ! Cdrifical. ol Conht lo S.lllerc ror {o @ onpa$liof,. a Flvidd lor by Sxtion l?m of lh.
<br />l.bor C.dq nn th. Ffolllre. of rlE *o forqhahlh.Fnn ! i!u.d
<br />I har. an! s,ll mai.rah tr ork6 .onpdrhon ireurdc., 6 rcqut.{ by Sdr io. 1700 ol rh. Iitrr Cod., for rhc FfolrM. ot
<br />rl! wort lor wh'ch rhi! pnnn L is.d Myvorlsi compasion iNurarcc coiq uul policy.uobd dc:
<br />PdlicyNumbdr Expn6:
<br />--
<br />I catit fi.I in tlt Ffolrllte olft. w* fd *tah fin Fmn i. is.d. I .&ll mt slPt y u, Fsn ir &y Ir.l:E
<br />i.rob4om$bjdro E*o 6 odpdrbr Lsofcdibmir.!d ir rhr if I ilbuld bcor Etlir:l ro0E
<br />wrl6'conFEllioDFlvniotuofsctio.3T0OolrhcL,!orCod..lCu[.fonhwiocooplrwirt$orFDvirio6.
<br />$ARNtN(;: Irailurc l,' q-urc *ork6 comFrsn)n .ovdd{c i!ful. sd shill rubttt e oploF lo 6inul F!]rE ud
<br />b rh. cor ot comrqsllion. d!D*6 6 prorii.d tor llEcnrl fB up ro oG husncd lhousrd &,lle! (lr
<br />SarFn 10?6 oflh. L$or Co&. ior6.n an nlorE,!
<br />-7
<br />I h6.b, rfirm und6 FEhy of FJut rhd I a ncdGl !r&9 (comi,s wah S.cio.70@) of DilnD.l
<br />ol rh. Busind dd Proasioa Codc. dld ny lk6r a! in tull forcc ed ciTal
<br />coririu(Iloll,l:tDllclcllct
<br />I hdby 6lfm undd d'r,lty o I Flu., rh.r rh@ ! . cooroobn lc.dbg lgcy for thc FfolM. of llt wrk lnr wnich lhi! Fhn n
<br />isu.d (Sa. 1097. Civ. C ).
<br />Lndd r N0.
<br />l6dd s Ad&6s:
<br />affiJcatrflEcts8alla!
<br />I h.rb, .ftn ui& F!t, of Fjury oR oallE follosin8 dclsdbN
<br />Dcnolilion P6niLlAsb6roi Notin..lion F.d6.l R.tulalioru (Tirl. 40, Ptn6)
<br />R.qui4d tnlr oaNdilidir
<br />I cdiry lh,r lh. falsnl rcsuh N Esudins NtBlos @dv.l E. not lpPli.tbl. ro $ii pmjd.
<br />I cdit rhn I hlv. r6d rhis nl sru. lhi $. !t !. nfonntio. 6 .ord I .gc to onpl, wnh .ll Ciy $d Coum,
<br />td'ffi6 6nd Sr!r. L!*! rcldt.s to 'klhs codrudrr sn ltrcb rlnhotu! rcF6ddi!6
<br />.h'v. mdtioEd pmFdy nn
<br />@o"t
<br />-::";[";E;-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing 'l .sl
<br />lns u la tio n/Energ y )od))L I
<br />Drywall I -t w -. lu -lr-.
<br />Ext./lnt. Lath 7N Y Prc,i l/Y
<br />Brown Coat r-
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL s- ts -L/J /a'9
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />.+-? &/
|