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BUILDING. INSPECTOR RECORD
<br />DATE ID/SIG.SITE.WOBK OWN8 BUILDEN DELCATATTON
<br />I lEEtly.frrm unLr FMhy of Frrury rh.r I a .rmF rM rlE Codrd6' Lr.e Lq ror tu rolt xD8 E.s (S...mll.t
<br />BEE3! .,n Pmf6.h. CqL): Ar, Cd, or CNdy *hrh EquG! . Fr', lo rlnrtu1- .lrq. u4r.!. &mlsh q t!F! x,
<br />tutu,Fixk'dr Ufur,.!a ErtuiB Or.p?lid fd uhFd
<br />'o
<br />61.,{Erl!.m lhr lrm CE ! l.qsn Fttd
<br />ro tlE Frq\xm! ol rlr Co r-i( r LrnBl l,r (Ch.r'rq 9, ClllrftBdr *'rh Sdlln 7@ of D'vlDn .l or rlr Botan .al
<br />Prbfds,n' CuL),, rMr L ii r,E s.r.ng rlEt6@.,rr ft ht! fd rt .L8.rl.kn$6 A,,voL'-n6iSnri.7011.5br..,
<br />.pgli..nt for . Fml bx{l! llE .Ill r.tr] ro . .ivil FE,ly ol ml a)E rlE lit. hodFl dou.r lliD).
<br />L as owmr of rh. nmFn y, or 6y.npk]res v[h va!.s I rh.tr s,k onlEn\ Dn. wrll do rh. wcl.rd llEnBlm ! ft!
<br />t'ltcnl&l or.flcrcd f,tr qk (S( 104,4. lusms rnd Pmfc$k'nr C,{. fh. (inrrrEr,tr'! l.rcn$ !r* dEs .or rmly r(! rn o*rr df
<br />r}tlln)Fny vh, htrUr M 'nln,r\ rlENB,,nl str) &rs fl(h srl hm!.ll.r h.rcll Dr rhnNth hr d h., own.mpl,'y..\.
<br />F)vidcJ rhlr \u.h ml,l,wBnk e rtn mrcfticJ or ollcrcJ hr $L lt, ho*cvcr, rh. to lin8 .r iry,okm nn,ltlwirhmonc,ru
<br />ol cotr{'hrx[ rlf O*ri.r Burl&r wrll hlvc llE hontn ol ptuvin! rhnr lE r rtr drl nn hor! r inlmvc lhc Jn'trn, ntr rh. purlrM ol
<br />I. !s ueEr or rh. FsFny, .m .r(b{Ely conu&1oB unh llcn$d .onr(.^ n' oNrul rlr pn)Fr tsa. ?O1,1, Ilurms
<br />!n ffilrr Cd.: Trr Ci'nrr&ttr'. l.r.ne b* &$ Dl rtTl, n, u oeEr of nroFn, whl bui!: o, imtrctr rhs.on.
<br />rhJ wh, i'nrB..!r ld q..h ln,a...k *lth rcofrrdln li46l lo^unr h rh. cidturn's lr4€ Lp)
<br />llOBrEBs:sruflitisAllati
<br />Dlict-AiaTl(rN
<br />I h.rcby.llrh trh&r lEtulry ol Frllr,nto .f th.ldl('wnt (ALldrrirnl
<br />I hJv. r' *'lltrrtr , nr C.n,lird.o, Conxnrn, Scll I',{tr. r,tr workc^' 1unrFtr\lr tr}n, r\ nr,vdc! r, hy S..r0n lTUrdlrhc
<br />tL(
<br />l& "*r r,"
<br />1,r ,n.tulttrtrL n( !)11,r w,trk Ior wl,rh rhc llnn a Asr,l
<br />w' ll frrdih hrtch' comp.ns{n,n insurrnr., ar rcqumd hy Scdknr J?00 ol rhc L{l'{r C,nlc, Inr rh. lc.fnrun(c oi
<br />whrh lha I'.m 6 $(E1 My wortss- onlEns.l kr rsunR. crrEr .nl F)li.y numbet r:
<br />t)F taz
<br />cJc (\f t- l-L I
<br />_l .{nrry rhrr r rtr FrrDrmL. or rM eorl ro *irh rh! Fmn r B*J. I ndl d .rr{'b, rny F$n r .ny tME
<br />e B'o berm sbr{ b E qxt6t LnqEn{on l,s of Cd'rohr,.,rl.rN lh.l f I nrul! hqnd abFr k' tlr
<br />bn6 .nnrber,n tnrsxrB ors(sn 1700 of r,E t,rd Crr.. I arn, r!nh* h conply erh tls* F,anm
<br />WARNINC: Fatur n, EB s,rt 6 o.lEndrdn $@!. Lr unhwtul. ,rl rhrll subJel m cnploy.r to dtrEl FDlls.!rl
<br />0vn l,n.s qr t' oR hurrlr.J rl{,uunJ Joll*s rll0(,.01t
<br />SG.'rt,. l(,76 o, rhc llhtrC,rL, d.rcn lnd snomy'r t*i
<br />)), ,n r(t(] rnr r' rh. !o{ .l !
<br />,,^,",/o-(-70
<br />LICENSFD
<br />'(|NTNACTOIDS;IAAAIION
<br />I lErcby rlltm uEl.r pcn.lty .l F'wy lhri I am lltn*J u*l.r ,n*Bion .t Chq,rd e (n,lftEii8 r t S&rr,n 7u[) or lrvrnfl 1
<br />oI rlE Bu,ifts.nd thrtsrDr Ctil.. lrl ny ftcns !t h tull nrc nl.r.rr.
<br />,-.*,o-, 73 - C 1t)1O119crcl
<br />cox auqrraNEBlrllriltiE!.g
<br />I lrEhy lllrh unJcr F..lly .l Frury rh.t lhs. t r L$.slMrrr Lrnuf .I.B, tn rh. Ffotuft{ of rh. u n,*h.hthrFtu il
<br />rsud (s( :1097, crv c )
<br />tr crr Addrc\s
<br />AIIITSANI.PECIJEAIIA!
<br />I holtry rnim u.,lcr rn.lry or rEl,ury oE o,
<br />',F
<br />,n[,rins &.l.I.riin{:
<br />D(mlrro P.rn 'Alh.q Nobrrd(n Fd.ral R.3ul,rx)ns rT k 40, Pd6)
<br />Rc1]ural f.trcr ot l*rrl(d.n
<br />\ r-l.q!'ty lhd !h. rckrn riuLri,u rslt][r lf,r{o1lfr,vrl,. r, rll'{r$k ri, rhs FUF!
<br />U$rdr, 'hd
<br />I h.E Erl ,hu.Ir r.!nn ul er,c rh.r rh..h'E bn,mlr'n r (.,Gl I .Fr ro.!,rY'ry *lln r cn, r,Il coury
<br />niiuim.r rnJ Strr.L*i kbnn! hhr&1n3.s@dotr .rn h.r.by.dlrtrE nr.rrv.t ol rhi, C'rt .d Coury !o .n!( Fr rlE
<br />rhov. mnrkJruJ pn{Eny,r n{Errrr 10- t- Ze
<br />lpplicrnl or Arcnl Sistr{ium
<br />Z Ld,rr-t JuVc.
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathing
<br />Framinq
<br />lnsulation/Energy
<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 />Eloqd ZonerQerlifd('lv ffftahwwltt loU.?.t,bhob6 t&r
<br />FINAL lo-l1.Xo lJtalor ,V
<br />Certif icate of Occupancy
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />Subf loor/Vent/l nsulation
<br />Shear Wall
<br />_ld.i.r{ hLr sd'M_. B. & Pc nr lti! E(r
<br />-,., /0 - l' 7c-
<br />f-
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