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. BUILDING- INSPECTOR RECORD
<br />COMMENTSID/SIG.SITE.WORK
<br />M,,Set Backs ..fi'/
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />\I<,1 1Rool Sheathinq
<br />Shear Wall
<br />\A>a:n.24Framinq
<br />5'l B )lnsu lalion/E ne roy
<br />s 5 t6 lPJf ',Dlywall
<br />DElnt. Lath
<br />€rown Coat IB
<br />lvlasonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />m^sr{\L lfi -/l0
<br />Certif icate ot Occupancy T
<br />Notes, Remari(s, Etc
<br />.sr.r^,ttJn tz q lb
<br />OWNER AUILDET DEI,CARATI(}N
<br />I hc,ch, trllonr rNtcr n n,liy or pctlury lhtr I rm .r.nrr rionr rhe Conr,.ttr' Ln.n€ lrs ror lhc IdkIrrF rrlen rS( 7l)ll 5
<br />Bu\m( tnd ft.acsrx,n Co.Lr Any Cny or Coudy rhih Fqlir.s , Irmit ro d{r{ur. 'h(. iir{rorc dcnrllsh ot rcIEtr oy
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<br />brh.F)viri.ntofrlr(onrelmtl-icn(ltrrlchlPr.r9.(itmnEftinS*nhS..lhn?(xI)olDtrnirnlnfrh'Brcitu\trid
<br />ft.tc$i,ns Ctxj.lur rhd h.o! rh. t.rcqrt rh.rclomaBl lht hrnr for th. alk3.d crcryrhn Anythlarin'rStrirnTlr'll5hylny
<br />rpflnunr t , r ,Ermil uhj.rt rh. dJfli..nr h ! ciril FMrry of otr m,R rh!. aiv. hufrled .lullaF (S:tm)
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<br />rh. F)pcdy *ho loikl\ or in{'n'v.\ ttER!.. drd sh( dms {f,h tru]l htn\.lf.r h.r*lIo' rhntu8h hn or hcr nwt 'r{'hv'ci
<br />I'dihl rh.l su.h itrt'ow.r E rn i dldl (r.flcGl ltr st lt h'tr.E. rtE t itltr3 or irlm\tr rsU*irhinuE)u
<br />;l $iI,lcrn[ rrr (r*K BoiLlci will hnE lh. br&n or FrinS lhd lI tr \h. drl nn tDiU d inltort E IDItnv n' 'lE I[{rR or
<br />l, rsosncrol rhct'n'|4ny. rtr'crrlu{vclyconirucriry $ h lictrscd crtrkrnn lo .d!{n'.r rlr ltr)l.cl(S.' 7(ll-{, aurn's
<br />aol hrlk.\m(ixk in Cont*,'. t.f,.trr t.rs d&\ trnlYk,,aorkr.lloFdj rhr huilJr o nllmr'l rtcro''
<br />a il sh cdntrkh |,tr \kh ImF1\ *irh tr c.nt .ro( n lken(t lunudnllorh.(i'ntracntr'! L8 { L:*,
<br />-.1, & P(' I'n rhtr rcr\n'
<br />-Jo h-.-.,-Ac- S> (- \e
<br />n oR(l Ls L'D[lP] Nsa rroN
<br />lrlllt&tfloN
<br />I rir(kanpr tr'khr Sc.rnrr
<br />lzt IrKI
<br />h'1rp".1"
<br />))E-1-1- t
<br />)c.'d
<br />'11z
<br />I hcr.by rmrn undd FMlly ol F,jnry oft ol lnc nnl'*in8 d..r,,irirtrr
<br />I h.t dn rill tu,nrlt.. (tnifxlr. ol( onc !, Scll lniorc ttr *tn k.n' ..nrF.srrn. ( Ftrvild iin hy ^*rion 17ln or rlE
<br />bhtrC,xt . for lhc pcrfnrror_c ollhc *o.l t" shichrhc l6nii i\ issucn
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<br />hlr Nnd will Mrnhitr worl.6 .tr.{Enlaiinn in\urrfr.- ir Erluiftrl by sRl hr lTlD ol rh. L,txt CuL for rhc Fturmtut ol
<br />rlF *uk ror *hih lhi ncfrir ir irexn. My *orlcr' rnmlEnsrhn iN$dm. &ris a,rl lblav nunh'r ec:
<br />P(nicy Numb.r:-ErPncrr
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<br />tr orts\, s,nlinqt nn nrovnr,n of Sdhn 17(Ir of rlF I ih, C,rL. I \hrn rdlh$t inrllll I ilh rlne ImrnFn\
<br />w,tnxtlt; l'"it,," t' *.,," "ork ri con,rcndi(,n (,vcmar n unhwful. xt shtrll rtrbr(l En cmpk''tr u mmirut FMh'i and
<br />.^,1 limr u, lo oE hmdFd rtrue d.rhr lillf,).lrx)r. itr rddii,n tn rlE .od ul conlEnqiion dsnB8$ r\ Pnrrti'J n' ih'
<br />Sdon:l(r?6ol ri.lrhrCnl.. inl.rsr and, ofty\ fe!
<br />-.., .ll f= \ r X ^rr"-,, Yo\:..'. q-\.-^ .D eA.-p< \ O\\ \\" uclarEugtNrtErrlrl -l
<br />llf:cll8 I10l
<br />I tcEhy rlftm undcr Fn.hyorfdrury lh.r I atn ltan{il nkl.r lrevhnrn ufchnFls 9l.omnErcir8 *irh Sdrn ,(xr)) ol Divni'n l
<br />nr lhc lturixs rnd PNfcrcin( C.xic. int s! lacnr ir fullntre rl.ftcr
<br />llDiUTIl{:rclJ.EBIUItG.AIit,lilI
<br />I h.Rhy dlfirnr under Fmlryol Friuryrhor rh.E ii,.onsrdclion LndinS as.ncv ror rt* r.rfomm. 'frh' qolt
<br />'or
<br />whth rhh Fmn i
<br />nrud rsN In7.cn c r
<br />l.ftLi. Nrft
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<br />ar&ll rirll[gJlfl]al
<br />I EE{,y tmurl.r Jl.ulry oaFUury om.lrhc trrll,*in3 rlqbrrii.n!
<br />D.nxn nr Prrf, rA(Eno! Norili.nrirn l{lerolRc8uhrn,ni (lnlc'lr.I\d6)
<br />_R.qund Llur ol tLriar.lir
<br />I drfy rhd llE fol.nl E8lLli'nr E3drlina r\h.q.r Em\ i r. ft{ rmla$lc h rhir n('Fr
<br />cdifyrh l h.rr Erd rht rnpli.rhn ini (.rc rhar !h. rtr)w infotmrbn n.oBr I.arero(
<br />.nnnrm.\ ind sritc trsi rlat 'i3 t, tt rki trrS .oo<r.r nn. a'xi ht!
<br />.h'r nr i,imilt'ordy ntr n'\FCri{nr nutx'{'\
<br />Apprro,r orAE.nr shniru* Y- Le.-.-ClC-"r.\,P.milts..nr rpnnl r: Y t> * 11 .L-.
<br />-
<br />.?-
<br />DATE
<br />r\$ /Forms/Steel/Holdowns
<br />/\r\nll ,/
<br />ArlIra
<br />&1261drrtrg
<br />'\.-PaJ
<br />g1?de,
<br />rXSl
<br />T-Bar
<br />Flood Zone Certif .
<br />FINAL
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