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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNB AUILI'ER DII,CANATtr')N
<br />I t reby aafrm ud.r p.Nlry of rrriry rhd I m .r.ng tr,m llE C.ntr&lon Ltcns l,* nrr lli follnwh8 ,!&. (sN.7o.ll5
<br />Bulin.s rn Pmf.$i,n Cod.): Any Cily or Counry uhth Erlutcr r tEEn to cotr(tr, alln, !q"ov., thmlnh ur EF sy
<br />nBfurq rix to ih nsumc. sls rqriB rh. rplli.$r fttr o.h F mr lo liL ! sg..n nd.Enl lhrl h. or {E ir lk.trrd ponu.!{
<br />io rtE FDvirhN of rh Conhcrolt Lhn-d Lrw (Cbpr.r 9. ConftminS wi'h Sdiio. ?Le of Diviion :! of rlt BuliE$ od
<br />Poferlirn! cl{b) or rh.r lt or ilr L .roq'r rlErrlum .rn rlE hsi for rlE nlL8.d .rc4'lio,. 4., vi,Ll i.i or sdirn 701 I 5 hy e,
<br />sppli.lnr for ! ocmr shjarr ttE qflic.nr ro r civil p.M!, of mr n'E rho fiv. hudr.J &llsi I tJ(,).
<br />-1.
<br />s owr of lhc FlFny. or n, .rlI,hyr! rilh *{6 8llEi v,b orlFnEri,n. sll d, dE w I!ndEltBlEirml
<br />imdrddl doff.ral ror sL (se.7u4. AuliEs r Prof*rbN Cod. TIE Cdllrrq\ Lj.6i Lrw dEr d {'ply b.n o*Er of
<br />rrEpibFny qlDt il&o. nvr.6 E6^ lrl uho AB trh qr* hrm.lrq,EElrc irEuah ht d ld owr.n 10r.6.
<br />pmviLd rhd Mh infhwe m d iro.Ld oltu ltr sL. l( hes. tlr hlildiis or inFffid it t ld *thin m Je
<br />oforpkrir^ fi. o\,E auiE vil, hE tlt h!d.n orFovinS iEdnEdnril!i!6ilv.oEllrFlpclyfo, E Flporof
<br />-L
<br />as ouE oatlE FlFny, u.rllirly codrErir! wirh lirtrd s.(rrm &, drdM rlE F F rS< ?044, SurE(
<br />{rl ffiin Co&i TIE Co rrol3 Liens Lrv do$ mr .!rly ro D o*F nr rroFny *ho hlilt or inlpowr 'lt ron.
<br />.nd wrE 6fufs rd sh Fj.!r! rhh . C.dr(ons) lirn*n pulurr ro r,E Conrt \ t!.m L*r
<br />_I.n.rng uftl., S(r
<br />ulBlil:&t-.Lauu $rra!
<br />Dl:g.AM.Urr!
<br />I lrEby rrm uda Fuhy ol Firr, oE ol ll.t tolb*uls &(l(rriok
<br />-t
<br />t E {d rill6tth r Cdiftn. of CoNd h S.r-ltlre ra xrt6 oq.B.m D FdiLrl 16 brseri,.lTO of dE
<br />t ao. C.&. fti tlE Ffdllrc of tu rqt fd whan ft F d ir B$.n.
<br />NQt*.-*r,-** sr'o'q.dio. irffi, s rquiEd b,s..ris IIDorrh. LrD.. c.<t rdut Ffm or
<br />2',lvtCVt ion nr(!E (rrr rd p.li, NmlE e
<br />fr YY\CAC^^tr lzo6Dq@o17o9_ErI,iEr \l
<br />Nql.drifyth.t ii tL Frf(,lijrN olrlE m* to stah rhi! Fmt i.8.8d,I crlr ml.npk,r&y Fs 6 uy MG
<br />s ri ro tr.m $bFr b OE wt6 otrFBdion Lu ol C.lifomir ]d t r rhr if t rh{ld tEor obiil b tlE
<br />krl6 onp.eriin prevbild of Sdlrs l?u)6trrE lrh, Cid.. l fi[ frnhrit oq r rin fE Foviiia
<br />WAnNiNG: FrituE b s@ *vt6 of,p.nrrih sYat! n ld.rnrl .rn nrl ob..r & dpbF lo qi n l FrrB.rn
<br />cnil fiE. ur lo oE hudEn llru$d drll$ (tl(|.(ll)). u dilbn ro 0. (d or o,p.ndiotr d.milr rs Fovik for llE
<br />Serion 1076 6f rlE trb.r Codc. dtrd lrt dnmv r tc
<br />o",,1 ll-t lzo n**,,
<br />lEclttlr0!
<br />I hmby nrm und€r F hyof Friury lhd I n liur.d udd Fnvnis of Chlprd9(d)nme,tg fihS.dnn,000)of Diethn l
<br />of rh. Burifts r.d ProtKirnr Cod., rrt my lic.^€ s in tull fotr! rd clf6rc to q)Ll5(o
<br />LO V'\ vlvlt 5;O \qr
<br />ralrEugur.rN"LtilDtllj-a.tillrr
<br />I l*rcby amnn utucr rEnolry of pciury rhd rhcr n ! coo{rucrl,n Lndi4,8.t, rd rh.,xrriii,rok! ofth. mrl n, *hi.hrti Is'ni n
<br />hs.d (se l0i)7. ci! c.)
<br />AITIISNADTCIAEAIIO!
<br />,6y1frmun&r lsrllyof pcrjury onc.f th. lolhwins d.chruin,ns:
<br />Dcmlirion P.rmirlAsh.sros Ndific.rhn F.ns0l Rqulorioni {Tirlc.s). Pd6)
<br />Rcquird b($ orNdif.{ion
<br />I cdiry th, $. lcdcEl ESularn,B rgrdin8 o*Eror rcnnvrl uc mr rp',ltlnb lo rhir pr,jd
<br />_l lcniay rhsr I h.r rc.d lhir rrDli(tibn drl \r.k rhd rtE itDv. i.litrm'tn i( conel | .8N t0 orr,l, *irh .ll Cny ril Cosry
<br />onlioct .rld Sr.r. L2$ elnnB ro h{
<br />at v. n.nriomC pxrFnyi(tr in
<br />D
<br />ADou.dl or At6l SirDlum
<br />"-u-*,rnr,,N e DATD
<br />.9*JnEs'diEr or'hs c yr*lcT )bT'dueo.,'r
<br />lG.--.-- *,. -l llllzO
<br />Set Backs
<br />Formsi Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Rool Sheathino
<br />Shear Wall
<br />Framino
<br />lnsulation/Enerqy
<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 />FINAL
<br />Certiticate ot Occupancy
<br />Notes, Remarks, Elc.
<br />Rev 08-07-2015
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