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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER'UILDER DELCARATION
<br />I ls.b.v.lrm und6 F l, ol pcjurt rlli I & aaipr tm [. cotusG l,j.aE L.E tor llE fold,i'A rs)n (S(?O]l.t 'au'.* .ll Profdion Co&) Any Chy or Cod, whah r.quG r Fni lo o lrtud. .ta, inq.ove d,slih or ,4.t xy
<br />structu.. Fior ro ilJ isuuc., dllo ,.quic fi. .ppla.er for sch Fmi' lo 6L , r!8n.d ]lrloot lhr h. or 3lE i licaa.d p@!
<br />ro rlE FovnpB ol rlE Codrloit Li.B!.d L.* (Ctrprd 9. Coh.rdrg wnh SErbn t00O ol Dirirba I ot lh. BuilB 6d
<br />ProfBi6G CdL) s thr lE m Jr ir daqr E.frotu !d iE bait lor lh. dlq.d ddiF.n A!) violrioa ofsarion 70ll t !yxy
<br />rt,lic&r for r Fnn subjrlr rh. lptlicul lo . ovil pcMlry of ml ooa rhd frv. hundr.d doll6 (S500)
<br />l. s ouG oldE Fodt: 6 ny .f,pbtG *nh w+6 s oEn $k ompoErsr *iI d) lh. wi .!d t i,En@ ir d
<br />idqi.d or olT6.d lor rL (Sd 70,1.{. B6i!B d ProrBio6 Co& n!. conmo t Lt@ ll* 66 Nr +dy ro e ow or
<br />rh. FoFry efio bil& or imFDE thsoq ud wlb dG nElt 6rI hrN.lf or n.*laor rhmu3h his .r nd oh dploy.6.
<br />proviL{ fid tuch i,lpo\@.d! c er ltdid 0lI@l tur sl.. lf, ls6q. llE hribnB m llqo6cn i sld wihb o@ td
<br />of orpbbc UE O*c Buil& wi[ lrw tlE tEd6 otFvl$ dn lE or !h. dd 'bl tuld d itqoE 0E FDFry &. tlE F !o!. or
<br />l. s oqE oallE D..rEty, m.tclBiv.ly codrrli4 ulh li..nsl.odrdon ro codtud tlE FojRl lsc 704,1, ttGG
<br />dd ADlstr ( o<t : Tt. C6nidor'3I-k.M lrw do6 mr lpply ro u ouna of Foldly *'ho brild! or ibFora rha6..
<br />ud who orf!.13 for ch Fq.cr! rnh i Conr-!o(r) li.su.d p@ud !o rlF Codrdoir Li.tr Lw).
<br />I m.rmrt unds SdlFn-
<br />Dil. Ornd
<br />woRr(xR3' coiyPEiSATloN
<br />IECIAAAIIA!
<br />I hd.h! llIm undd Fnrhy of Fjur orc ofrh. folhs'm* &clsdioB
<br />I h!v. .nd will rinrain , C.n'fi.d. oacon5r ro Sclf.lauc aor mrk6 !.mp.M ion. a pmvidcd tor by S<lio. 3700 of thc
<br />lrbor Codc. am lh. Ffotu otlh.so.t for *$d llE Fni a au.n.
<br />{, "'" r"0 *u, ."t,r* *..ltd conFB o. iEukq 6 r.qutrdl by sa1Ftr l70o orrh. bbor coiL. ror lh. Fr(nrl@. or
<br />$. ert lor whi.h rhn p6nn is isuqi My worl6 @mp.rodion iNuuc. ffi6 od policy nunbd d.
<br />..,i-,51o-k lp.l/\;|._ _
<br />PoricyNmb6. -!tr}-ar!^t" /r /tt
<br />I cdiry rhd iI th. Flolrw. of rlE rort lor f,htt lh! rEmn s e.{ I rlul @t arpb, ey F$n b uy m!ffi
<br />s & ro &on. 'uujar ro rhc *ort6'ompdadio. bwr ofclrifomi.. ud.sE ${ if I ihould heonc 'uqar to rrE
<br />Mrl6' compdBlrion provLiod ol Sdion l7UJ of l[. t bor Coda I Jdl fonh*ith 6mply wilh ll$* prDvilioB
<br />WARNING Flba ro s@ wla'onpddion otarg. i uLr'6)1 sn lhdl qbid & .iploF lo oinind Fr!i. !d
<br />.tri f!6 up t6 oE hund,.d tlbuldld .t lld (lrm.ooo), in lddnbn b th. cot ot coiFMio., do+6 r ForiLd fo. rh.
<br />ser ion 1076 or rk ltbor Code inr6.d ed lttorEy s f€.
<br />5 lt1 /21 Sl'<'<^ 6'|c^
<br />ucE$E-cadI8AgqE[lcll3auo!
<br />I hdrty .fim utdd Fd, of prrury th, I m lic@.d E& F.Eion of chrytE 9 (@!l:ffii!s *ilh sclbo 7000) of Divilbn l
<br />of rhc BuiB &d PEtueG co&. ed Ey lr€E ii i! tuU io@ rn dE.l.
<br />b ruoitY?
<br />,.,. "/tillr ."",*";i\<r !..(.U:lr(9"".61rIh
<br />cqlirBlcralJ.Edulq-6g[!.q
<br />I h6lry rlfm undr Fdy of Fjury rhn $c ir r odrudi,n lqdi.s .Bdy tu llE Fftu. of lhc e* t', *tth lhit Fli a
<br />iuud{SE. 109?, Civ C.).
<br />Laid'! Nm.
<br />ATTIICAILDECIJEAIIA!
<br />I idrty r&n uda pqrlh, of Fru.y oE of rlE fol,owt!8 d6Ld ioN
<br />Dqnolirioo PmieAlbdot Norilic.r io. Fe16.l ieubrioc (Till. 40. P.n6)
<br />R.quircd t-ard of tlotia'.ibn
<br />I .dify rhal fi. f.ddrl r.8uhn'B l+erlin* ab6lor roovd a. nol aprlNabl. ro lh6 ror<r
<br />-
<br />I (qiiry thd I he.,ad lh! rppl*lrDn dd nd. $i rh..t$!. infoMion B cotr*1 l.graro@mplyunh.ll C , &tl Coudy
<br />odiMe6 d sl!l. L!*t €hins lo buildine co.lrNdiotr drj lE by lu'horiz. EF.grrriv6 of rhis cny ed counry ro ars upo.llE
<br />dbo\. ngrionol proFly for idDdrion purDos.
<br />^*Ur-r- ^^rrr-r"* ?4p-r,.-,.rpa*t 9+",.r€^ O'4sa
<br />ilrc ltr
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<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
<br />Engineer Final Report
<br />Flood Zone Certif
<br />o
<br />FINAL -/l20 v 0/t!-6 I
<br />Certificate of Occupancy lt
<br />Notes, Remarks, Etc.
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