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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE rplslG.zh coMME ITS OWNER BUIlI)ER DETTARATION
<br />I h6cby fm undd pa.lry oi pojury rhlr I D B.mpr fiDn rh. codr*t6 Lt* t:r aor rh. tollowiry la$n (sd.70! I 5
<br />Esi,l* rn Prcasirr Co&) aDy Cny or Cout y whkh r.quiE . F6i lo elr.o.i .116 ioFoG d@,j.h or lE.n ey
<br />sB16q Fiorto.! islec..lo cquG rrE {pltlll for sh FDi b 6L.3i9El r.dEr rhrlEor,t a li!6.d Fr$d
<br />ro rhc Foftiod of tlE ConE!.roa3 Lta..d t * (O14(6 9, Comtuog *ith Serbn 70m ol Divirbn 3 of rh. B{siB od
<br />Pol6ion! Co&) or rhll h. or !h. ! d.nipl thq.from ed rhc b.!i! for lh. dl.8cd amplhn. Ary vi.lllnn of Sarion 701 I 5 by ey
<br />+pliol aor . pcmn rubjels rh. .tplicol ro r civil p..rly of nol mE lt6 fivc hut*H &lle! (1500)
<br />_ I,6o*GofrrEFoFry.(n,anplo,€*i$14€!rnnrE6npddio($ill&rtlEwI!dllEsr,ldEaml
<br />iddrd.d or ofis.d for sL (56.7041. BuilB Ed Pi!fdi,6 Cod. TIE Cotudoai Li.au l-* &6 ml aply lo & orE of
<br />rhcFmlqty eho hil& or ihpmE IIEEtr rd wh. &6 lucl Nlt tiG.lt o, h@lf or $DuEh hn or ha oM dployd,
<br />Fovd.<! thar Mh inFoE!. lGd inad.d dolH 6. sl I[how.t hrildi,a or itrF.DvsEl i sld wthio*)r
<br />olodplair th. Orc Buildc ei! hE tll h,rld! ofF !ttlilrdtlEdilolbriUordgoEdEF!F,btt FrF*ot
<br />l, e omd oarh. FoDdr. m .rcl$iv.l, .odrdinS wnh licm.d contBloE io mndru.r llE Fojccr (Sd. ?044. ttaus
<br />{rl PDto ir Co&: Tt. Contrrtor'! l,ic.u llw dE tut.pply to e o*n6 oaFoFty who huild! or inpro!6 thqoi.
<br />ed *ho @ffi fff ech FDt$ wn[ . CoMo(t) li.nr.d FE!,, to rh. Co'rr.{roir LiuE t *).
<br />I m.r.mF uoddSerion . B & PC l&rha 16.
<br />D.l. oro.t
<br />wonxrrs; coul,FrisATIoN
<br />Drcr af, Trolt
<br />I h6.t, rffrn undd porxy of Fj- r_ orc of rh. followins ddhraioB:
<br />Ih!!.adwillMi lin ! CdifE.L of Co@r ro S.lf-lNq. for wrta onFEdion. E poviLd for by Sdion 1700 of rh.
<br />lllor Codc tor rlE pcfolilec of tb. *oit ld *tttn tiE Fsn b is.4
<br />I h.r.,,i wrll Mi .in m 6 comFNrlbn ilsl)ffie B E{un.d by S6lon l70O ollh€ L{bor Codc. for tic Ffoll!,@ of
<br />rfi. mrk for *fiich lhis pdmn is i:trr.d M, wort6 @apgadion iEufuc. ..ffi &d pdl(y ,@bd ec, . ol+to geute('l, Y wssbz7? 141 3)11zz-
<br />I cdify d, r. rh. pdlornu.. of th. *orl for whkh lnir Fnl is ku.J, I shall ml mployuy pq$n m dy Uenqs s lo b.rotr ruticr ro rhc $!d6'omrE6r.io. LB of C.liaodi'. dd ryE $i if I rio!9 bdom rli,..l lo rh.
<br />$.116 co6F!.rio. Fova.a olscr.n !7m 6lrlE litor cod.. I tdl. fdh*tt onqit wht $ox p.ovirioB.
<br />$ARNINC: Illuc to su. $0116' compdE lon @v@*. E uh*tu!, rd snrll a dpk'rr ro oihnrl Frxi6 rd
<br />c'vil fin6 up to on. hun&cd lhousd dollm (t100.000), D
<br />,*-,-fltol4t-
<br />^
<br />I hd.6, .IIrm !hd6 p6alt, of Flu.y ihn I dn I ndd proYLion of (-h!plc I nnocins wilh Sstnn 7000){aDivision l
<br />6r rh. B6ilB.nrl ftofdbN Cod.. di m! lk@ i! in aull for dn dlcr
<br />c 2
<br />elt D
<br />I h6by aJIm u.d6 pcrulry of pqjury th.l rhd B . conn
<br />i$u.d (Sd.1007, Ciy. C ).
<br />L:rdinr asd.y aor th. FafomM.. olrhc wo for whi.h rhis pami' i!
<br />ATIIICANI.DECT4AAIIO!
<br />t hddt.&a urdq parly ot Fjury oe of $c bllovirS (bhria:
<br />Ddtulilbr Pmi!'^.&so! Notilicdion r.d6.l R.guhrbu Oilc ,10. P.16)
<br />Rcquircd tdt6 of Noti6.dir
<br />I cqria,y rhd rh. r.d6l r.suhrDE Gsdms a!4.. r.m\ !l e Nr @91.!bh ro rhu F.r.d
<br />l!d1'l\rli.r IlLr\c'trJrl'Arrrl'r,n(r,tr r, crhdrltn .or.d I lrrero conrply*irh lll Citylnd Counly
<br />n 6,d shr. t s Eldiry kl
<br />,!.r. mrion d pr6Fq lor
<br />Appli..nl or ,\8flr siBn.ru ,,.,. Sholz- r
<br />f-'iDr€,' '
<br />Set Backs 4//.t/,M ,Uu W Dla@)
<br />/t/a.db,L tet
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subfloor/VenUlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry dtz/ct kT,rbel z&
<br />Pool Fence L r'i4/2t UTDAT m,
<br />T-Bar '' 7'
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />-1, t^il t.,^fi
<br />FINAL rybl ol Ufd,0&va@
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />rcF6dd ir6 o rfiis Cny &d Coury ro 6rq upor lh.
<br />JL
<br />Forms/Steel/Holdowns
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