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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Ereclion Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subfloor/VenUl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Fram ing
<br />lnsulatron/Energy
<br />Orywall
<br />OOr4tLE?.ttnt. Latn 417."il,4 0-Brown Coat ut
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />En gineer Final Report
<br />Flood Zone Certif
<br />t -.t
<br />FINAL Yqlt4 't d.+q)
<br />Certificate of Occu n
<br />Notes, Remarks , Etc
<br />OWNER BUII,DER DEL('AR TION .
<br />I hdcby .ltm u.d< F{ly ot Frrury lhr I m 6dF ft$s lh. ( odr.crrt Lic.@ L.v fo. th. tullowi'B la]. {5<.701 Lt
<br />B6in63 .rxl Pr6f*6n Cod.) Ant Ciry or (b!fl, *hich r.luic . tEmit ro 6rtrNd. rnc, imFoE &nolilh or EFn D,
<br />3luctuc Fi,r lo iti isue.. rLo rcqrn6 rtE +?lkur tu rkh F to fiL r riSsd 3rdaMr thd lE or tE B licqB.d itllrd r
<br />lo llE FolirioB of in Corrr&rqi LGnrd t w (Cher6 9, ComftinS ynn SGrion ?0m of Divi.bn ! oa $. a6i'B od
<br />Prcfd66 Cod.) or ln r lE or iE L .rd!d rhsl6.n .d tlE t6it for rh. .lLg.d ctdnFbtr Aly lbLrio. ofsdrbn 70ll t by &y
<br />.p4li.rn for ! Foir 3ubicr! rh. illili@r to . ovil p.tuty of tur mrc rh.n fivc nu(t d &'U6 (lro0)
<br />-1,
<br />a orra olth. FoFly, or my mplorc wnh $.g6 6 ihn $E onFsiotr will(ll tlE $nt -d tlE *ErE i ml
<br />iilorrni d oltdrd fd eL (Sc 70r]l, aaiB ed PNf*ioB Cod.: TIE co.r.ddt L..g kw 4B ml .pply ro a o$E of
<br />rl'. FtrFiy *tr hritl m ingDE rtE@ nd q tn {tE rd trqt hitulr or hd*lror rlhuAh hn d hd oE or9k'}q
<br />provid.d lhlr such inFlEr.nrr e rcl id6'.t d or ofi6.d for $L. l[ ho\vM, ltE hildDs or inProrlful ir $ld wilh oft )rofcotrpliotrrrr(xc &il& r hrE EhddofFotiry d[ lr6$.d! 'd hildor ins.ort 0E FoFV b.dEFrpoiof
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<br />I ztal, sornE ofrh. F.F!r. m.r(lEn.ly co 6dinr $ilh ltdlql.oiidon ro.odtud rlE F.jd (s*.10.14. t Bil6
<br />&d ProE in Co<L: Tt'r conrdd r Lk.@ L.w &€ mr @ly ro & o*E 6f Fop.ny lln b{ild! or idporB rhd@tr
<br />!d who mdd!f ruch FoFdr wth. Con66o(t) l(a$.d pu6ot r.dE Conlftlor'r Li.qu L!$)
<br />;,'"|:thy i-t Oo^
<br />ul!t_-$-!lt!\
<br />I h6.ty.mm und6 pallly of r,6j!ry om oflh. following daldr'ioNl
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<br />luv. rrl will roinr.in ! C6rificnc of CoMr to s.la-lBu. fot *orld,. 6npo$rbn, 6 Forid.d for b, S..rir. 1700 ofrh.
<br />l,!or Co& aor th. Fnllrtle ofth. m ft'rrntt'lEFmn it i$Ed
<br />IC
<br />Iy'l h.\.MdeillnMr.o *o dl (o,rFMo ier@a e r.qut.d by Sdion l7m of rh. Lalor Cod., lor lh. F6tuc of
<br />'h. wl nv *nth thi. FEn i ie.d My wtsr' s'rp@.ion iM ffir !d polkt nudbc G
<br />-Erpc
<br />:l.6rit rhrl iI tlr Ftollrre of rh. w,l rrr uhEh rhi, FEn n E{.d. I lrurl Ni dpLy dr F$. b o, m,lE
<br />s a lo bctom. Dbj6l ro ifi. "odrd comF!.lion IrN.acdiaomi!. md +E !t'd if I ihoold h6om shjEl l.llt
<br />"s 6' ompdE ion FovirioB of Scrh. I70.J oftn bbo. ( lde I CEll. fMh*nb complt $nh rt.r FovnioB
<br />WARNINGT F.ilur lo su. rod6' omFdio. 016.8. is unlNtul. !d tt6ll uhj.d s dploF lo oini,rl FEXB Dd
<br />civrl fin6 up lo oE hund.d llrcu$d dollc {1100,(Jo0). in.dlnior to rt. co{ ol cotrrFrslio( dan s6 a Foid.d for rh.
<br />sdn. 1076 ofrh. lihr Cod.. bl6.n Dd trEy ! fG
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<br />DTCIIXAIIO
<br />I h@by.mm undd pddlry o I Fjry lhrl I m liosat undr Frilion of(tupt6 9 (.omm6rins wilh Sccl6n TCOO) of Div'ron l
<br />ol ih auUB.d ltDf6r6 con . rn m! li.dg n d tull for( rd.firr
<br />Lictuc Clrs:_Lic.e Nuf,bd
<br />callrau(Itou.LllDllc.Ac!tr(1
<br />I hsrt! rmrn uJv.kr F,!h! ol prllry rh. rh6.6.6dtu rnn latli,a.s*! lor th. Ffoljffi. o,rlE *!* to' $hth lhL Fna i
<br />isrni (s< !097, Civ C )
<br />AIPIIIABI.DE(IJAAIIA!
<br />I hdd'y snm !nd6 p.n.hyoapsilr! on. oflh. follo$inr dd!m!6N:
<br />D.nFl ion P6nnr.A!t6r6 Ndific.rio. F.ddal R.eul{6N {Tnl. r0, Pd6)
<br />-R.q0n.d
<br />kG oa l.ldifi.dioD
<br />_l .or'ry ihi rrE t d.{rl Esulaioa Esdrtins aldk lm\d&c @l qDlirbL ro rht FF
<br />/41 cdiry fiir I iEE Ed rh! lpplicdio. {d rr.r. rhd dE ato\ . inaotuion t corr6r. I lsrr ro cohply q nh lll cny a.d counry
<br />ordin E6 dd Str'. t^. Ehiry io t{ildry.olgodio.. rt lF.b_l ru brt EF... n6 of rhn ( ny &d Codl} lo dr6 qnn rL
<br />;;-":Hil":'Jff^ffi4r ik tos,,d,b'.,Lu fi -p*.*n,,.,,a,,,,J&lN7ca ilL 9t fuod i*o
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