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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS O\{NI]R IItIILt'ER DELCARA'I]oN
<br />I hcrcby dfllnn undcr Fnalry ot rcrjury rhar I an cx.mpr lion rhc Conk(tn l-iccisc Lrw f(tr rhc rolk,winS m\rn (SN7o]l5
<br />Uusincs ARI Pnrasion codc) Atry Ciry or coutrry which rcqun.\ r rrnnir lo cotrrru.r. drc', i.rrov.. dcnnnish or tr'I'in rny
<br />(dcrurc. nrirlo ils ksu rc. nl{i rcqutcs rhc lPfli.nd 6r \u.h Fnnn () fitra li8trcd {{cmtrr th.t h.or shc k lienscd puru.nl
<br />ro lhc pmvisn rs ol lhc c( n.rd s l-iccn\cd I-sw lchtrnicr 9- Conrnrkin! wirh Sc.ri,'n TOOO of Divisii l ol rhc Busirc$ rnrl
<br />Iror'csi{,fls Codc) or rhal hcnr\hc h cxc$pt rhcrcho andrhc br!s rar lh. rllcEcd crcn0rion Anyviol,rionotssrbnTl).ll 5b}trny
<br />rmli..nr rd a|.nnir srhjfrr\ rhc aprl'crnrn, acivilprnalryofnor,norcrhrn fivc hund,.ddoll,^($too)
<br />_l-aso*rcrolrhcpmtEny.ormycmphyccs*ith},iac\nsrhcnsk(n|tnstrli()n.*illdolhcsorkirnrh.(uiEisnor
<br />irtrcnd.d or.f...d tor salc (S& ?014. Bu\i'rcs aBl Ptrrc\lions Cqlc 'l'hc Conkrckn \ l-i.rn$ l-aw dks ior trrdy r. r owtrcr of
<br />rhcpmpcny *ho Suilds .r inpmrs rh.ron. and wio ilm\ o.h wort h iDsc lf or h.^clf or rhmuAh hir or h.r ntrn. ri,y.c5.
<br />pnvAcd r hrr such inll,ntroEnh uc rFr ir cd.{ .t ofrLrd tu {b Ii th*cvcr. rlE hurli.e or inDn,vcmnr il sU *irhin om )er
<br />ofcoi1lLri{nrrh.Owncr Boi[hr willhnh rhcl{dcnofpmvingrhar hr.rshc ilnrrhuiu o' nnpn,K rhc tnitrny loir)rN$'rol
<br />LN.qNr.rrh.liopcny.rrcklusiv.ly.oitx.ri'rA*irhlicrisdd.ohrnn\r,..rnru.rrhctroicclrscc.7041.l}lNncs
<br />r l PDlt\\iinCodc lhcConrracttr s Liccnr Lrs (locs n.r upplrr(i oslcrolproFny*hohuild\ori piovc\rh.rcon.
<br />nkl !vh. cortr.r\r(, \uch t()j(c wirh ! coftn(,(\ I liccnsc pur\ur rt)rhccin r!.ttr s Lic.n\c L.$)
<br />,Lt t _1L+,ltLl /
<br />I hrr.l)\ xrri'nr r n(L( Nnxlr! or trrrltrton. orlhc
<br />lhrvc ind will'tuinrrinr C.nifirdcofCoiscnrn, Sclf lf\urc l(r *ork.rr conlP.d\rri,nr. r\ pn,vid.d f(rhyScd otr:17{x),'l rh.
<br />htrr C{xlc. trrhcpcrlbnr(r.oirhc w.rk lb.*hichrhc Fnnir i tsucd
<br />rhc aork lnr whrh rhis ltflnir i\ n\ucd I{y workcr\'..n'Jr \rri{,, i'r\ufutr(.micr akl [)li.t trumbcr ff.
<br />-lccnilylhari.lhrpcriornun.coirhcsorkio,whEhrhislxn(nrsuc(|.I$rl1NlenDloy3nypcBoninrnymnin'v, n\k,hc.oft sobjLcr t,rh. so*r*.o ,,f,n\ari(,, h*s of C,lilnrnir, a rgrc rhrrifl sl!)rld h..otrr \ubicr rorhc
<br />sork$\..ilt{tr\{i.rtn,ri\iosolSL\rn :lT00olrhc trhrCodc.l \hrll, n)nhsirhL\rnnlt wrrhrhJ\. provhion\.
<br />rvARNlN(l: lilurc ro scure rorkcn conDcnsr'ion corch8c i\ unlllrul. and \hall suhjccr z. $Dloycr ro dimiful FM\is Jtrd
<br />civil fir\ trp h on. hufdrcJ ihousrfd tlollrF ll1lx).(xxr. in addir(,n b r oi c.nl|)c'sri,]tr. drn B.\ rs t,'r!i,l.,l l(r rlr.
<br />:::Ej#r}{_tUry^.) Ll
<br />t)L( t, \R \ t l()l
<br />I lkrcb, l,tm undc! ncntrllyofpcrjury rltu Ianr lislqluNlcr provhion olCnnprcr'r lco'n'Rncin! *ith sKrtr 7fiD)ofDivision l
<br />ol Ihc tlurirE$ind Pdlsnns Codc. a'kl nryli.cnsc n ir tullnr.c inl clrirr
<br />I-(ctr\c( ln\s l-i.ctr\. Nu *rr
<br />Ddt. Contrr.lor
<br />CQNSIBIJCIIONIINDMirIIiUNII
<br />I hr.by rfhi,n u rrFnrlryolp.rjur!rhrrrhc..i\aconsrDcri'nkndingalcn(vf(trrhrp$fonnntu..frhcE.rkIorshichrhnp.irnin
<br />is\rd rs.c :llxr? aiv a I
<br />ITIUIjANfIE!:IA&IIIQN
<br />I tf,Ettrlnmundcr p.n!lry olFrjurl onc ofthc aoll,,wins ncchrrlt'nv
<br />Ocnrniotr PcrnirsAshcsrosNorilicaliotr l,cdcDl Rquhridrs(Tirlc40. Pnr)
<br />-Rcrlutcd
<br />hrcr of Norifi cari.n
<br />lcrnil.yrhrrrh.lc,l.rrl'rgul ri,)ns rBrriliry r\tu{o\rcnrvrlx'. nor,,ftnicrhld t) rhn fmJc.r
<br />rgrcc ro.onlnly sirh rllCiry xtrd Counry
<br />iv$.lrIi\( ilyitrd C.uniy
<br />, lcn \ rh.n l h.r. '.ri rrri\ i|l, (.'t {i rl{. r rl' rh
<br />.nr r..tr. c. r,u s, r.. r Jtr\, 1,r, L. y,rJ r..ritu.,. {. ql,.-}). rh,/,,... sa,.r
<br />Jh,..,n\1.,,.{.'ltr1! LL, 1' l. r"r",.r-___) / / I r
<br />,tppri.nr",rsnts,n"r.t / z/l''/ t t't t /l)L I
<br />n.^rrn, ,n,nn^u, /
<br />t3
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />f,oof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Cenif
<br />FINAL I'4,7zllIr .C{,711{1t W /tr)--'
<br />Certificate of Occu pancy v{'-/ lr u Ez _-t r-\
<br />Noles, Remarks , Etc.
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<br />T-Bar
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