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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUI I,I'ER DEL('A RATION
<br />I hc.bt rrm !nd.r p.n lty olFjurr lh.l I m qmF 6on lh. ConlrrloE LkN l,w for llk aollosin! ,!&n (Sd 70ll 5
<br />Buin6 rn hofdion (.d.) Ary ( ni. or Courrr. whkh r.l|una r Fnn ro oliru.r. .is. idFor.. (bmli.h or EF{ dy
<br />ntu(uc, FF roi!3 isuei rbo Equa6 $.491f,& for $cn Fnln lo 6l.r sig..d nr.,,rdl rhn h.o. tE ir li.dE d pNaI
<br />lo rh. Fsvnioro otlhc Co r*rois l.icd!.d liw {Chq,ts 9, Commac'trs sirh selio.7000 ofDivbion I ofrh. Burind Dd
<br />PorBioE Co&l d th, lE d ltE it .r6pl th€.nom .rd lh. bGi! nn rlE dlLr.d .r6nbn. Any virLr6. of S.(ion 701 I 5 by &y
<br />,rdarn tor, F6i obd! rh. rggli(nlt ro tcivil Ftulry of br ne rha lirc hu.drcd dollrs ($m)
<br />I. a osr6 oflh. Ftrp.n!. or my@ploy6 rirh sald &! lh.t an comFnsalion. *ill& ltE wc,t md Lh. rrulm il ml
<br />intdrLd or 0116.rl lm sl. (Sa 7044. Buh6 od ProfsioN ('od. TIE Codrrdors lj(* L,w dE ml prl] l. & osG ot
<br />rh. Frtdt $ tn t!il& o, nrwo\6 tlEa!( !d l l$ &E *h q$n hindf ., h.Ell or ilNugfi t6 q hc oqn orb)E.
<br />Fovxl.n rh, 3urh mFrffi @ m! -roi.d or oli,.d tr sk ll lbr6d, rh. trilra or in .6ffi is nld $ihh w
<br />'sol conpkion. rhl {nrM B{il.t r will halr rh. hdEt ot provins rhi fic or stu dii mr hlild or in{rotr rhc FoFty fd rh. F[poF ot
<br />l. a otr6 ot rh. Fopsry. m <clurn.lt onr.6
<br />'n3
<br />\ rrh hcda.d .onrn.1oB ro otlru.r th. Fj.t (Sft ?0.11. UG|K
<br />and ftrGsion ( irdc: Th. ( ontdoir l-i.6s. La$ dod.or rpplr ro.n o$nd otpretdy \ho build! o. improvB rhqan,
<br />rn'j *ho snrGdr tor !u(n Foj.cr! \ irt ! conrmi{(, ltd.d pu6@r x, rlr cornrdo.. l-icd* lr*)
<br />I rn.\ori rndd S(ton
<br />D.r. ortr.r:
<br />wonxFRs- ( ontPENsa'noi
<br />DECtllaIIAt
<br />I h6.t', .flim lndd Ftulrr" of Fjrry on. oath. aolhtr ing <k(rmr.6
<br />Ih.!.d willdi.r.hr(-.nifr.ofcoBarrosclarNur.for$nl6..omrddion.6Ellii.dforbrSftrbn1700.rrlt
<br />L.ttr Codc ftr
<br />'h. Ff()l:rl.N of rh. *{rt for riit
<br />'hc
<br />p6nn h isxn
<br />Ihtrrcand sill,nainlain uorkss co,np.Nrtion iNur c.. as r.qutcd ht S(r ion I 70() .t I hc lIhor $d.. lor lh. tsfoman.c ol
<br />tht trork ror s hich thir Fmrir ii isrxd M) uorkd comrEMion iNUr c. (atrir ard F,l(y numba a.
<br />G** _-sr+:re-gercO
<br />tr!,aon,.*, 4lV:/OiZ-"krfo..l .diay rhn
<br />'n
<br />thc Ftolrm. of ih. *nrl fff n hah rhi! Fn n $u.rr.I rh.lt e, atrploy3n! Fon ir intlMffi
<br />m aI0bc.!m. brcct to llE q$dd o'rrdEllhn l.$sof(nifomi!, ud r*E ltil ifI $ould t (oturubjEt lorlE
<br />\uI6' conr.Mrion p.ornh ots..rionlT00otrh. hlor Code l3lDll. fonhtrnho,nplt wirh rh6s lrcvbioN
<br />\lAtNlNc r.iluE lo sEr sdl6' comFMhn or6rs. ir lnhetul. r {rll iuhjd e dphld lo 6irin l Frli6 drl
<br />.i!il fin6 !p ro oG ho& tlbur-ld 6116 llll{l,(m}. in lddniod ro rlE d of cooFMion, &uc6 a rroridcd aor rh.
<br />t
<br />Sditrri 1(J76 of rh. Iibr(ddd mn.nom.\ s Ii6
<br />(,.,"t4_
<br />DESIAAIIO!
<br />I h@hy arro undd padlry o f pojury rhar I m licdB.d !nd6 ln v6io. or(tufls 9 (coh,6.ins wirh sdtion TLri)o) ofDivlrion l
<br />or ih. Bsi'6.ri P,DtdFd Cod.. tt<l ny li@ a in tuU fo(. tn.,Id
<br /><a9L T
<br />l-,,4^1+*L.rr-r:?c--,L-r" r=\rr<-
<br />qalllaltcl1o!1,llDtllilliEN(r
<br />IlEb) rm u[j.t Font of Fjurylhr ltd. i!. o'Erudio. Ldos.s*y torllE Ff(nl!m. otlh.sql6r *tahfin Fnn i!
<br />is!.d (sc :l0t)7. Ci!. C )
<br />ArtucSNr.[lc,a8aua!
<br />I hd'! aIEnn !i&r Fn.h, of pdjury on otfi. aolL*i.8 &(hr.lioB'
<br />Daarln6. P@n!-A.b.r6 Noria.dirn t.ddrl R.Auln ii6 ( I l..10. Pd6l
<br />i.qut rl l-dr6 of Ndin.din
<br />I cdii[ rhn rlf Gnsd r.suhrr6 Earduts ab6rd ramr !l e. mi ed{!r& lo rh. F.j.{
<br />Icdiryfia I h.v. r.ad rhl! lppli.dion.nd ar. rhd
<br />'h.
<br />ltotr infoma' ion ir cotu I .Urr ro comply rilh lll ( ity nd (.u y
<br />ordimoc6 dSr.r. ljNrcLrioa ro boildin*.hl aulbrn. rcriMldn6 oathn ( ilr and Counll k ol< uFmltE
<br />sbor nhthe! l'oFry f6 ,EFdion
<br />App[.rl o. ASot Shn.lur l,q
<br />\IernilF irr.Iprinr):-4 ur AQ,=pES
<br />.* ro/e r
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Shealhing /oat'7q K\ Zn
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report I
<br />Engineer Final Report
<br />Flood Zone Certif
<br />,,.\
<br />FINAL /6 -L1-n (.c,:;Pf/u)( gln )
<br />:Certificate of Occu pancy
<br />Notes, Remarks, Etc
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