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BUILDING. INSPECTOB RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation ,,
<br />Roof Sheathino Z///hojt)
<br />Shear Wall /-4P
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil
<br />,aFINAL7h/cn?0 W4r
<br />Certilicate of Occu nc
<br />Notes, Remarks, Etc
<br />OWNET BI'II-DET DT]L(ARATION
<br />I hcrchy erird undc, r.oDlry or l'crrfy rhar I M .r.n{! nom rh. (llntrodoN LE.nE ljw ror l h. tullowh8 rc!$i (s€c 70l l J
<br />aurnc\r u Pmfcsi,n Cnd.): Any Ciry or Cody *hth rcquirc! ! Fmir b $n{er, dr6, iri{irow. rLmrnh.r mFtr dy
<br />ndE- Fi, ro it sue., ds rq!i$ 'lr 9dr{, lor sh Frni h nb t rQrn lcnEl rhol L ( rri il lacMd Fnod
<br />ro !l.t F)vi\ionr ot 'lt C-Mrdd r l-a.n*d b* (Ch{r{ 9. C.nENin3 r'ih nnLlnn 70q) of Divirio. I o, i. AuriE$ ud .
<br />P6r.$a,nr Gd.) or rhsr tE or sl* is crc4r ttE ton .d ttr lEsn i(n l,E ulkscd crcqrbn Any vxrhrsn of sdr,n 701 I 5 by iy
<br />spnlicn tu a rErmir sul'ters rhc lpplicldr io , .ivil p.tuh, ol nor n,E rhm fiv. hu r.n dollus (lliro)
<br />L 8 ow of rlE FrFny. m mr.ir?loF. rnh *116 B rlEn !L oqiN.ri'n. *iU d, E wt !i 0E srErE ir ml
<br />iddrLd d ofi.nd td rb ISe 7044. Aow$.,!d PrDfB.bB Cod.' TL Cqlrrtlq ! Lir- L* ds Dr rpply i. s orr 6r
<br />rlE Fr,Fny who hlird or rtffi rlEE4 rd uh, dd! si w* n'lElf o. lErclf q rhNud hir r rEr own .nlpb)6.
<br />poviddt rhlr such imln)mds e mr irldd.d orof.El forel.l( k'Mw,ltE ttrildfu or trpmmt n$Esrninm)a.
<br />or@iil:lir! tlr Oed Build $I trw r hrL! otFnvi,A d{ rEornrdil mr boiB.r !t! oE lr. Ftrlry ford. FrtD€ of
<br />-1.
<br />GneEoIdE IFFny, ucrct^irclyent.1ins wnh h.n.n.onr mr..\,NM tlr F,F1 (Sd. 7014. BuqE$
<br />rnl Pnf6rin Cod.: Thc Conrr4loai Li.rntc Lls do.r n,r ryplyro 6 o*rd otIn,Fny who buirdr or impruEs lhs6n.
<br />rnd wh'.o.h*n,rEhFoj.drwilhsContubnr)lausnnununrrorlrCo,rr0c&r'3Lictr*tre)
<br />I .n .rqr un&r 5<1i,
<br />Da(. (rkn.r
<br />wonxr n-i, coirr lv,,is,t non
<br />UECLISIIIj]!
<br />I n*rcht rrlrm ukhr Fn.'lr) of Frtun ',m olrh nlll,f,trl,l JNbnrknn
<br />I h.k snl r ill tuirr.in r Cdifr.,. of Corc.t ro S.ll.lnsE lr vrt6r oqEr{ io.. ri Frvitdl td by Sdra,n i7m of rh.
<br />lihor Crxic, aor rtE r!.rfortuft. oa rh. sA lor ehkh llE lErmll is isru.d
<br />I haF.dl erllmd.m slk.s bn iBu.E.- .r EauiEd ty Str-n ]7OJ of dE Lb(f, Co*. for tJr Frfir'llnr of
<br />, **IU:)U'** ffi an Po|.Y mnts
<br />,(
<br />_l..nify!h.rintlEFfrmL!.rrh.srlfdshrhthirFminnu.4lrlpUr.,rik,rnyFsi.uylMF
<br />s s to tEa,nE otjd ro llE s s. orrEnelion ls* of c,lifohi!, Md lgE'h,
<br />'f
<br />I rtnuld rr.om subFl lotlE
<br />worlth co'qrtrurion lbvi.i.nr o{ S.cridn l1r0 ofrh. taho. C'od..I tulLlonhwirh onllly *nnlE,s nDvhi.nt
<br />W ll{tt{C] Filurc lo sE wt.n snrENbr s@r. ir uL*nJ[ id ,tll .ubitr e aryloFr lo sinnr] FEI|5.rn.iv nE. ulr ro oB hu,n !d rhoolzd &'lLE (tl00.m). in lddni,n b dr .d Dr.o,p.Erbtr d.,rg.! a F)viLd for llE
<br />S..rir 1076 of rlE t llo. C!d.. i dn id dbn y i rB
<br />D.t : Applor:- l rcrusin comrrc'rnT
<br />DICIJSAIIq!
<br />I hftt, .ilm ud.r Fulry 6f Fri,, 'hr I m li.dr'.d mrd Fovti,n or Chrr6 9 (offihr *irh Sarin TqDt ot Divi.irn l
<br />ol 0E Bui6s rn Pmr.shc Co&, !d hy lic.N n h tull foc ,n cffdt
<br />CO!IS:IBU{:IION!BDI!g.iGA'J
<br />I lErbyrrmuftlcr p.MxyofFi.ythd EE i! r o.drtrb. l.din!.!!E,lor tlt F&n,rc of rlE *f,I for *tah
<br />'hn Fd 6
<br />irxd (sd 1097, civ. c )
<br />AIfLII;AdI.IEIIIIAIIII!
<br />I lEd'y i lilrn, nd.r p..alr, of Frxry oft of rh. {.|t,*ine ll(ltrrrionl
<br />Oemliri,)n ltrnil!-A\hcdo\ Nolificulion ltdcral Rcaul tr,n! (Tirlc 4ll,l'M6)
<br />R.1lutr.l t lt.r of Ndifr.tnn
<br />-l
<br />cdlryrhs! thc r.n nlEslLrioN Essdirs a{Edos FnbvrlrE nn Erlt.bh !,'hhrsF
<br />I c.nify rhlr I hsv. rc&l rhn applittion dd sr.r. rhd lnc rt v. irtordrhn n co1Rl I tlE lo oiq,l, *nh aU Cny s
<br />odiMNt d'n Slalc t *! Eldus I hdrby .dlrro EF.d.trB of lhn Cny .id Colnr, k
<br />lhoh mnrrnrl FoFny ftt
<br />\plli.ur !tr ,1$ t tirMt,trr *rro?
<br />Rev 08-07.2015
<br />lrdc.'l A.&tsl
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