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BUILDING- INSPECTOR RECORD
<br />SITE-WORK ID/SIG.COMMENTS OWNtrN AUILDER DEL(ANATII'N
<br />I krchy .mrn unlcr FMh, or rErnry rhal I u.r.nrx lmn llI Codr&1o. l.i.nc llr ror rh. rolloeDr r y,n lsR Toll t
<br />Bu\iE{s tr.d t'ror6lfn CirL)r Any Cny or (itur , rhih r.rutrr. Fm, n, i,nntud..116, rnpror.. iLm rh o. rcrttr lny
<br />{MUE. Frtr k, i'r siuffic. .rt r.q!r( rh. llldrmr lltr rkh rmr k, fik. nsrn {!'.mnr $d lE or ilE r liancd pursur
<br />h rlf, I'rrln[nr of rh. (-(rkrttr r l.i$nrd ld l(i!pi.,9- Comrm'ry Birh SNr[n ?(XX) of Divrion ] of rh. auwr(.nd
<br />Pmfc$tu.\ C&l.r.r rhlrlr.r shc ir cr.mnt lh.Efi.mlBt rh. h.v. for !h. rlkedl cr..prrrtr AnyvhhlhnofSernn?o.ll I by lny
<br />lnplirad nn ! pnir ohFh rhc applicanr n' ! civil pcnrlry or ml mrc rh8n fivc hudrcti dollfi (!5iI))
<br />I. r\ usn r uf rh. ln'Fn y, or my .mpk,r..r uirh wlgs r\ r h.ir {'L ()nrFn\rr iir, *ill do rh. wolt dn ltr {ule is nol
<br />dcftL\l o. orTcr.d tu {lc ( S( ?o+r- Butirc$ onn ft rc\(rN colc Th. cohh.r tr \ l-i.cn{ I iw dms ml orply h 'n ownd ol
<br />rh. nnr*ny wh' huikt! or intftlcr rtrR)n. all *hr .kr5 uh *! him*lforh.rslro h('u8hhis..hc.n*n.nI[)ycc\.
<br />pn,viicil rhnt ru.h ml,drmnc m mr n .d.rl or olIcRl r(tr s! ,l lx,srrr, rh. t('Urnr or uqnrftd ( s,kl *irhn oB d
<br />ofonf,Lit'n. rlr()*trr lruiur *illlEE rlE hrLn or rovl,l3 rhd lI q nf, dn rn hial n, nirn,k rh I'nFny an rti forF{ nr
<br />l. a!.*Ero, rhc F neny. mcrlusnTlyc.dr r
<br />'nB
<br />tr trt li.cn$d cndr&1o^ t' .on{er rtE F)Fr rSN 7{X.1, B!{rs
<br />Pirf.\\r{ (irk l h. C..rmror'r t-i.nr. L* d(rr fr{ rptly ro rn otr tur ., lln'Fa y u h ' buildr .r nrymr cl rn r.on.
<br />*ho (o md r ntr such rmFr snh ! Contdi r li..€'l pursua n'rhc(nnkKnn{Iicncb*l
<br />I nmcrcnU trnJ!, S!.ri,nr_
<br />Dole: {r'mr
<br />]Irxlil:8l](autl;rrtllr]!u[g.a&rr!,rr
<br />I hrct l rllnnrr.(lcr trnrlry oin{rNrl oru 'n rlt r"llii*tr,p lnalJrJrhn\
<br />-lhrE.drrll
<br />i.ron . Cdifr.!. or co.{ r's.ll ln.ur. for Nlt6i drnurndr)n. a( ro .n(ortlySarrnl?(x)olrlx
<br />blrtr (iiL. f.r rlr FrfirllEn! of rh. $olt fr rhrh !h. Fmr is $krl
<br />-lh!\ca'
<br />nrlrnrainrarnworlc^coUrni.tknrn\urfte,Nrcquncdh!ssrr.lrlx|olrlElilinCodc.lorrlIFnnnum.or
<br />rhc so ( ntr trhEhrni\ Frirni' is is\lcd My rorksi' onnl'lnsllifl in\urunc.rtrnr u Fnnynunts m:
<br />_l.rnily rhnr rn rh. FriormNof rh. rork n, *hkh rhs l(rmir r *{kd,l rhlllR, oirJ'hy rny F e. in ary mrBr
<br />$ r r, tr.oc rubj..r b
<br />'lF
<br />rrrt6( $rFnd rrn Lls ol c.lrfomin. rnd r8N lh.r il I lhould tEcoE $t .r' t, rrr
<br />q,*d{ drqx.sr.,n 0f,,vision\ .f S.nion !7(I) ol r rE llhtr C.dc. I tulr. lonh*'nh irl y r irh rh,E r,trr i\im\
<br />WARNIN(; trlrlur n) sr. *rl.F $qxn$r[n $rirn*. i\ trnl,*ful, lni rhrll iuhFt !. co{'kFr k! 6mrMl FBIB md
<br />.iyil fimr up 1,, oE hundrcd r,nuend dour Itlix).(xr,). m ddiriotr k, rtt.on ol.u'qxnsnon. d.m8.r r. |r.rit.d ntr rlE
<br />Sarion:10?6ollt lirrn Codc- i"rmr rnd lnorEy\ re\
<br />D.le: Appllonl:
<br />I tcDNSEt' (:(rvflr,{(.(tR
<br />l,rrg.dtalta!
<br />I h.rh, finnrrl( Fmlry o f Frjury thnr I r I'Gn{,lundcr liornnr olChrphr) r(.nnrrEint *iihSR..rbn?(xrrror l}i!^itn,.1
<br />ot rlE &rrN* !n(l ltnf.$i.n\ Co,L- rln,yli..h.nhtu||turcrndcfli(r
<br />s1ltral]r;.IlllNrENllNtillillr}
<br />I h.hhydfln un,ld Ftulry of trrjury rhrr rh.rc is ! ronqfl.rrn L.din8 lBcR y lir rhc p. nrnurcc oa rb. *ork f(tr q hi.h rhi\ Frfrir is
<br />issucd rscc 11097 ( iv C )
<br />AtSur;ANfDEl;UAArlt!
<br />I hod, .trm un L, Fnlll y of Frriry ox nf rli n'll'rin! &.bdion\
<br />D.ml ion lcrmnrAllrtor No{iar.riotr [d.r.l R.iuhrion\ (Tirk.r0. Pfi6,
<br />-R.auird
<br />tdis or Mnirrllion
<br />_l ccnily rhur rh.lidcd egtlrioni Eafdiry Nh.{os r.nbvDldc nor imli.sblc t' lhs pn'rccl
<br />-l
<br />lcnrfy lhlr I h!v. r.!d rhir lDrltarirn uxl (!rc rh.r r,E rtFv. infomri,n i\cnrc(r I {ard kr o,rply wirh {ll Ciry.Bl c.unry
<br />ordimNcrr sr!'.Iis{ahir3I u.\(nrjtrr\rrrhnCi\r C.
<br />!tl,r. nrnr(rk, t'n,|rnt tur )-3s-19
<br />I Iac
<br />,
<br />i? ,-\olc^
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lns u lation/E nerg y
<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 />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL (-t.{ - /a J)c-Sr 4e)
<br />Certif icate ot Occupancy
<br />Notes, Remarks, Elc
<br />DATE
<br />Erection Pads
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