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BUILDING- INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Roof Sheathinq tloiltaito ,)')t\,
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lalh
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Fleport
<br />Flood Zone Certif
<br />M\-v.,^az2lalral a2.t )
<br />Certilicate ot Occupancy r r rr
<br />Notes, Remarks, Elc
<br />I
<br />OWNER BUILD}:R DELCARATION
<br />I h.Eny amm ond.r p.n ry i)r lErru.) rhd I m.r.r{,t rmm rtE Co.rr16 l,Enc l,* for rlt rolb*'ng rc.$n 1S.{ tu:ll t
<br />aulinr* .il Pft,r.si(r c.d.)r An, Cily or County *nEh r.luncs a Fnnr ro cnn{rud, dlr.r, rml'rolc, dcmlnh nr ftlun My
<br />rlMU., pri{ ro n! n.um., .la r.quir ll! q'plter tu ut Fmir i(' nb r n8ftn sr.r.mnl rh.l lE or rlE ir lk$<d !ur{M'
<br />ro r,r rmlnion! oa rtr Contrxrdt Lk..*d l4 (Ctupr.r 9, comft'n8 *irh Sccrnn 7(m or Divtbn .l of llr Bu\iE( .Id
<br />Pmt (ii,nr(ixlc)orrhd h.d1rE is.x.npi llrrcltumr l rrE basi\ lor lhc allescd crctrprirn Anyvn,hlfnofsarbn?0.115hr.ny
<br />$dr. for . Fmil subFrr rlr .pplt.or to ..iril p.ony or rn mE ih irE hundErl d.llas (l5q))
<br />-1,
<br />rr owftr or rtE ln,Fdy. or my .nl0hF.t wilh wag.r .s tlFn sL s,trl'.ndaon, si! & Ew,t!nt letlNit@r
<br />ir.d6t d ofi.r.n fn .L ISE.r04:1. BuriEr .!n PlofBinB C.d.: TIE Cotudd'r tnn€ Lt* dB nll +ply ro u om ol
<br />$. FnFny elF hildr d i,prnB th.6tr .rd etb d6 sh rorr himr.lr or tE,(lr or rtrush hii d rEr ow..rplot..r.
<br />,'ovlbd lhrr rsh irrlm@.tt E mr i .nd.d orolH for {l lL lbM. tlE t!iBir\8.. irproErd n sb *tJ.u (* Fs
<br />ofonthrbtriEo,Eaui&.wi,lErllthr&nofFNiBdrlrmdEdildt ild-iqmEdrFlFrytrdEF II*ot
<br />-1,
<br />rt.wE or rlE m,|Eny, m crlulEly co rriins Birh lkn€d cod,rt6 ro d,nrMi rrE FnF (Sa 7lr,lj. Bh!r$
<br />trrd t\,tusir Cod.: Th. Cont&1or's t.(cnsc ljw dcr { 3!ply llr u ownF ol I'n,pcny *ho trildr o mPDv.s rlEron,
<br />rnd rho.ontBlllforructpn,Fk*nhaG,nrdonrli.en*dIlNunrk"h.ConrBcloisl-tcn*Ll*)
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<br />rmcrcnpl undcr S6lion-
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<br />1..
<br />.lt & P(' r,trihhr.tr\ l
<br />IIABf,IBS]g'IIIBTAIIII!
<br />TECIdEAIIII!
<br />I lEEb, rflirn u.d.r FMn! or Frirr .* of llr nnh*i.3 &(l,r0r ionr
<br />-l
<br />hlw ad *ill flinr.in r C.nifKsrc of Cnn*nr to S.ll lNuE ror *.rkd. onrlEn\.Iirn, .1 tmvid.d nr by Sdlr,n .l7m oi th.
<br />bh, C.n., ror rh. Frr{m orrh ri,rt td *hah rL Frhn ! nrun
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<br />hlw md will m.inllin hr[c6 cunlc.\Ii,n i.rn6(c. f,s BrtuiEd hy Sd ion .tr(l) ol rk L,tx, Gdq Lr lhc Ffomtc of
<br />rh qrt rd r hth rhir FDr n isd Mt $rtrksr drttnd.n inflnN .aii !n Frlty rurlE e
<br />.-*, AEf.\sre{.o F\ og+ c,As*J A\t\.-l
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<br />c.nify rh.i in rtF FrtornN of rh. rort fd whah rhr JEin( $ i{3url.l rhrll mr.qrh, r.y Fmn in.nyluE
<br />s ar io h.. B iubFr k' lrE wnrlfis o'mFn{ri'n ls*\ orcrliroEi!, ,*l +r rhd ir I sh.ut tE oE \ubFr b r&
<br />f,orlcr' snlFnqthn tNvilioni of Scdt'n l7i x) of rhc l,hn Arlc, I r]Erl. r('nh lh Nnnly wilh lh,e phvi.hn.
<br />wAlNlNC liilur t Em sdl6 R,n+.nqr5n dr.n8. tr lnh*tuL m'd {dt obFr 'n orllt'Fr ro FimiDl F ti\ rn
<br />ciyil fi..s ut ro o* huidEn rhnqnd dolls (ilfi).txtr). in ld'lnhn x, rt co{ ol.oqtn{tnrn. d!n3.t i! prorit.d rL rh.
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<br />.r"., urr.,.rrh, t.,h ' cl\t, hlNr $tj!{'i):L=r.-
<br />,., \)-\-'J -\t, .,0o,*,1 '1-
<br />ur!!$J)-laNr&tl]aBu[ga&lnor
<br />I rEEhy .rrm und.. FMlly or Fdjury lt l I m lilusd uds F.vition ar cn l,td 9 (omErina *irh S!.ri,n 7m I or Divnon l
<br />or !h. Burim.r dd Pn{sn,n. Cod.. un nry ltcn* is m tull tuN &d .fid
<br />"1:H-\?)"(:1q?\3
<br />. (<)-\b -tB
<br />coNsrRUC-rloN t tsNIltN(: A(:rN( v
<br />Ih.rcby rllrrhufr.Lr Fnulr, !llsjury rhur rhs. n ! condrudi'n I ing r8.r*y ntr rhc pclli uncc ol rhc * rk tu shi.h lhh Is mir i\
<br />xsu.rl rse_ l(P1, Cir (' I
<br />I cnJ.' . NJm
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<br />'""":ryuy2::--
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<br />.dify rh.l 0E rdj.nl E8lLrions r3rdina rlb.rroi EmRl !E m' q'0la.t'l. b rh! pnrFr
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<br />ccn if, (h!r I hrv. rcld lht up,'laslio. aln rllle rhll th. linvc nrlomr n,n G .omr I !8R lo cor{'ly wnh lll Cily lnd counr,
<br />ordiBrct 'id srrr. Lwr Glrina ro buildin8 codrudha.,n lErchy5urh,n tF(d.ris ol lhjr Cny itd Coonry k' . suF,ntlr
<br />t\c\sRY- 1 (A((t7-tD'l?
<br />SITE-WORK
<br />Shear Wall
<br />FINAL
<br />'i
<br />ATTLIIAILDECI.A8AIII]!
<br />I hd!t,.frmun&r FMny oflErrury or oflh lolbwin! ddlrft'm:
<br />tumrliril. P.rmirsAsh.$os Norificrrion t{dc.rl Rcrrllrr ion\ (Iirlc 4l). Pcn6)
<br />-llcr]ut
<br />d lr .r of |{ritrdiJr
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