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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.OWNEf, EUILDEN DELC RAION
<br />I tEd,y lffsm utxh. p.n ny of Frrr.y rhd I m .x.n+ 6Dh llr Co'$ri6 t.ilB L* tor tlE folt *irE lE$r (Sd.7011 J
<br />auriEs ird Profsbn Cod.,: Any Cily or Cony,hth cqut6 r FM to odoci. .lq, infrDw. &mlih or lrn ry
<br />ffie Fiorto irs itffi. rlo EqliB tlr.Dglt{r for *h Fril lo fll.r.itd tLtfrfl lld lEot rli ii li!'a.d FlwJr
<br />ro rlE Fovieb8 or dE Confulq r Lir.r.d t w IOEFg q Conrran! *in Sclbn ?0m of Divirion 3 of E Buirii .nrl
<br />Pmr.$irtu Co&) or llEl hc q rlt 6 .!c,9r lidln.d.rd rh b.G fo, rlE rll.t d cEtrFi,i An, vbbrit. ofsdinr ?0-l I t bro,
<br />.ppli. ror o Fdn qbFrt rh .pplk.nt ro r .ivil FEn, or ml mE lh.n nv. lbdcd &,1L,. (luo).
<br />-t.
<br />as o*mrolrll In,Fnr, d ny.npld}l.r wnh vos.s !i th.ir s,k con{tnsihi, wrll tlo th. wrl !d rlE rur k tur
<br />ini.ndcr or oniEd lu sL (SE.?()41. Bu\imr! ed Prsr.sions cd. TIE Co k-l,tr \ Ltctre L,w des d +ply b a owEr ol
<br />rhc F,rEnt wh. trith or inn()Er rlEmtr.d wL &s \Eh *r hinN.lf ur h.rilf or lhmqh hi. or tc. o*n .q,by(i,
<br />nrovAcd rhal ruch im,ln)w@nh ft n inr.tolal...fcEd lor eh.lt hrsB, rrE trilli.! or iq'rcEmnr issldwnhinDft ttr
<br />of.nqrlctiJtr ttrown.r Buittl ri0 hlvc lhc h)rdq oflrling thd rE m shc tlid n tuild or i,qnlw lh. PsFiy for t r purF)E ol
<br />l. r( o*ncrolrh. Pl)r.ny. r u.lu{rcly .ofiad
<br />'ng
<br />r).on(ru.r rlr |m,l.d rscc 7o4,r, Bu{rB$
<br />In ho(a{s CdL Thr (i,nrrt \ l-icnr. L.w dcs mt ncr o! lln)F!rylho huikl\.r inrn,ft\ rhrto^
<br />rnJ *ho onhr ror sch I'lFrt siur . C.drrlon,
<br />^:;"'ryf;i
<br />DECIIAAIIIN
<br />I lEEby .mrm undlt p.rhy or Fr,llry dr .r rh. lolhwing &rla6thn'
<br />-l
<br />h!rc $d *ill minrsin r C.d irr.r. ot G,n€nt ro s.la-ln$E for hrtcc coi{Ens.'io..rr pmvitn for by S€di,n ]700 or rlE
<br />Iih.r Cclc. lbr ttc rErlo,nrtrc oa llE *o.k tu *lkh
<br />'lE Fmj' ii irsu.n
<br />I lrv. itrd slllnuinl(ir workrr\'(onrFigri{nr i'rsuisncc. rs rcqunud hySu.rnr.lT(Xrolrh lib rCodc.lorth. plrtu urf.l
<br />rhc *ork fnr whi.hrhislx nril i\ i$Kl My workc^ ..nltnsarion insur!'r'..rrf,r rllt,li, trun1tn m
<br />folicrNutr$.r:
<br />-l
<br />edi,, thrr in rlE |ErlormE ol rlE pod fc vhth rhi.! F mr ir 6cd, I th.ll ml .npt', ry Fe. i. Dl lmmt
<br />s a b t roE $bFcr lo llE hrl6' orlF ndi,n L*i orc.lifomr..!n .rE ln,r il I dbuld b..or sbFr lo llt
<br />mrt6' otr{EMrion InDvtio r oa Ssrion 17@ of 'k rior Co&, I h o'rrly rrh !tr- povirix
<br />.irrhFr ro siminn Irdi6 8l
<br />.N,l fircl up to otu hu'dEd rtnlend dolls (llft).(Il)). rn ion. d.mgc! a pbtid.n for rtE
<br />Sarhn 11076 ot th tib.r Cod.
<br />,",,, t //Y l't'\
<br />OECI.AXAIION
<br />I hcEby dr6rm undcr pcullyolp.rjury ltul I !n lie.s.d und.r Folnion orCtuPls 9 (.odfttui.g with Setion ?0m) of Divi{irn I
<br />of rlf Bustus ald Pn'lc$i,ns Co!c. Dd ny ltcnlc ir in tull rot€ .rn cfiar
<br />Lirtrc CLs:
<br />qqlEIAU OdlJdDllIiJ;I!'J
<br />LEEb, rfm u.&r Frhy ol Fp.y lhrl ltE! i r odrucri,. bnirs {sy for E Ffm of rlE }dt lot lnth rht Ftu i!
<br />iirun 156. 1097, Civ. C.).
<br />APPI ICANT NF('I IIATI(}N
<br />I hmhry otrmund$ Irc.lliy orFrju,y oN orrh. rollowin8 dccluations:
<br />Dcmlirion P.rmik.Asbcsl.s Noli,icdirn !.n El Rcgol,iiiJns (_Tnb 40, Prn6)
<br />-R.quncd
<br />LJrrd 6f fioria.dr
<br />I.diry rhd rh. Li.rrl rcsuLr nN Ea oi rcmrrl e &r lrplt.hL to rhN rtutsd
<br />I (dity ihtr t IEE Eal
<br />'hit
<br />.pplt.ti,n 0E .lbE i.fodi,n it cqt6i I .!E td ontply wnh dl Cny rn Counr,
<br />urlnri,. rqrcs'nrritd or ihir C y !n Coully to..r6r,Fn rrt
<br />P.mitEuh€lpa{9:
<br />-,,){ lv f Ll
<br />Set Backs
<br />Formsi Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />Subf loor/VenVl nsulation
<br />Rool Sheathinq
<br />Shear Wall
<br />Framino
<br />lnsulationi Eneroy
<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 />Enqineer Final Reoort
<br />Flood Zone Certif
<br />FINAL ,A l-<?NF
<br />Certif icate ol Occu nc
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />SLAB Floor
<br />ordturct.d Sb'c tnu. Ehli,{
<br />-T
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