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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE tD/stG.COMMENTS
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loorA/enVlnsulation
<br />Roof Sheathing
<br />Shear Wall r({?-,[1( t 1 L.q1(a
<br />'7,!( )Framing t I dL tw fArrikLt-
<br />ln s ulation/E nerg y L
<br />Drywall -rDA(,lL -
<br />Ext./lnt. Lath t/ pPtr Puzl 4^)\zlt1l lq /,c 4/t5 (t"t)'srfhkn Un
<br />Brown Coat \
<br />Masonry ?r.rtrrm. ,ilFry- o")
<br />Pool Fence ?nr4*qt .-/Zf).-c4+-;\
<br />T-Bar
<br />Handicap Req 5 \ru\rg u lit)
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL {l'r\r1 p\Itqfq
<br />Certificate of Occupancy
<br />Nqtes,, Remgrks, Etq.
<br />t1 ,/.!r- -ao?
<br />oK \o b Q,t',
<br />Aa
<br />OWNER BUII-DER DElI'AR.ATION
<br />I hdct! .,Tm !n 6 F..lrt ol Fiury rhn t m add nsn rlE Co.'r.cr6' Lr.c l^ for 0r follo*irB lt&n {Sd 701 I J
<br />BulinBr !d Piofsioi Cortc) Any Cny or Counry which r.qulc ! tEin ro conntu( .Iq, inl,ovc ddnolirh or r+.r! uy
<br />nru.nrc. Fbr b nr isleq .!o 'quir6 0r +pli.ot lor sh Foil ro 6k . .i8rEd r.ffi rhr lE or iE ir litt d F iar
<br />lo rh. FrvisioN of ttE (onr,!crof! l,rccnEd t * lchlpld 9, Commdins wirh Sdrio. 7000 of Divilion 3 oflt Buin s ed
<br />PrefBioN Co<t) u rhd lEniE;dorpl rhd.tlh !d rh. bcit for rli.lksa,Batrptnn AI, violdion ol Sclio. 70! l.J bfuy
<br />.ppltan hr . pdni lubj<E rh. r{Dlhd.r h d .ivil p@ll, 6f ml lmrc lhs fiv. tundrcd douln (1500)
<br />-1.
<br />s .w ot th. FoFiy. or my dploy6 wnh w.s6 D lh.n allc .omF$a@n. wil & llt rort ,i tu rrurm i ml
<br />inqi.d ( of,6.d for $lc lsr ?o44. BBiB dd Pb,lsbB Co& Tn Codr.ctd'r LtG l& drd ior +tl, 'o
<br />D o*E of
<br />th. FlFry wr. hil(! ol inproE rhq@ .d wlh d6 Mh mrL hiB.lf or h*lf or rtNush hit dr hd o*{ mployd,
<br />Fuilal rhd {ct itrlFo\dlEBe
<br />'Dl
<br />iioi.d trofBld 6. rL ll hor6t E hildbg, it4.6qd i! sld *ilii w }d
<br />of.onpLrih. tlE otur au{di *iU h&. IE hrd, of p.ovins $d tE o, 3lE did mt hoild or i,'Fov. lh. FoFq fn tll plrlo& oa
<br />_1, 6orG otrn FoFrt. m d.l6ir.!r.otudin$ lhh lrsldl codrdoE ro $nrNd tlE Imj.tt (sd 7o{t, h5lr
<br />6d t\oto bn(ird. l h. conkr.roa! l,iccna L,* do6 el !r?ly 16 tu o*nd n f Fopd, who boildr or innmlB lhr@(
<br />ad eh. oddr fM *h Fojd snh.Coddonr)lkdE n p{jlid ro rlE cod,.dd'! t.a.& h*)
<br />-l
<br />6 ddF u.dd Salhn-. B & P C fo, lha ren
<br />Otr. Or.f,:
<br />.u0Bli[&rl;oua;!saua!
<br />DICTASAIjII!
<br />I hscby {ftinn ond6 o.nohyofrEurvoncofrh. nnb*1n{ dNlratrnr:
<br />-l
<br />hav€ dd eill milllin ! Cdrncllc olconsr ro Sclf.lBur. lor worldr conD.nErion, c provid.d fo, hy Srtio. r?m o f rh.
<br />L.bor Code fn rlE Dqfmc of tlE $dt tot *nkh $. pqn'l a isu.d
<br />_l h,!. rid *ill @inrd. N*m romFMbn iffiq s r.q!rcd tD Sdion l7(r0 of lh.lrDr ('od.. for rlE Fft''lrle. ol .
<br />ihc worl for $h,ch rh. Fflnii t i$u.d. My m*d snFNdion ruurxc€ cMnr ! polrcyoudbde:
<br />7Q av <r.c a ' l-.,
<br />V1.Zt) AL 6G4 \1 1"t' h
<br />l.diryfid in th. pafo!ruc. of rh. {ort tor {hi.n rhi Fnn i. !$u<{.1 sh.llmr anplor.ny F$n in D} MF
<br />s, 6 ro tdG lubidl lo 0E mrld @mFdir. h* of Ciifomljd lsc lhr if I n$uld taotu st*tt ro ilE
<br />*0116 .omFtsdionFovbioro otsdion 1700orrh. llhor code I shll fonheilh co,Dly wilh $or Fnliriod
<br />WARNINC: F ilw to d@ Frrd 6mF!rir6 co!-is. ii unl,qfrrl dd nrll 3ubd s dplors t.\ dqinrl FEIi6 !i
<br />.r1l 6n6 up ro onc ho&!d rhoqsd rLllm (tl0o.0&), in lddiion t. th. cor or comrmln'.. ddlsd 6 Prcvi,al for rlE
<br />S<riin 1076 ofrh. lrbor Code inrd !i.roB ! f€
<br />it
<br />IECTA8AIIO!
<br />I hd!5y .rm undd Fux, of Fiury rhd I m li(s.d ud.r Frr irion ol Ch.pr6 9 ($mnftos snh sdbn ?0o0) of Dirni.n l
<br />or rtE BNi6 &i Pmfsioa co&. nd m, liG i, nr tull for.. dn.,Ial
<br />Srrro-?
<br />,,"," r ,/r, itc.1 \U,-
<br />coNralt(IloxrEBu!{;lo!!(I
<br />I hq.ty .mrm unda Fn!h) of Fj(}- lhd lhdc B . @lntucl nn ldiine r3*y fttr rlE FfolM. of th. Nrt tu *tih rhi Fni it
<br />isu.d (sd. ltr97, ( i! C )
<br />alSu(a[Llrr:qdaalla!
<br />I hod'y .JIm und6 p6!hy ot Frury oB of dE followin! (k Lt.ri'B:
<br />Dmohion P6mns-Alb6rG Nolilicattun F.(k.l R.8ul.lrd (Inb 40. Pan6)
<br />-&.qun.d
<br />lnr6 of Nor'licdF.
<br />I cd rfy rhd fi. f.ddll quhlioB ,.sddins 6b6ld rfln d u. nol qrlt,bk lr' rha tmidr
<br />-l
<br />srify thar I Bqr rdd rhB qlplk.li,rn I tuldh{ $..h'v. i.aomdinn b.or.<t IalIElosnpl}wilhtllChy$dCounry
<br />oidileG !d Strrc l,u. Eldua ro b.ilding .odru.1b[ lrd hdor.!.urhorn rctre[n6 ofrni! Cilr_ dd Couur* lo 6rq qM ilE
<br />o.n1 tfo'ls*:*r^1"?\e ,tuutl
<br />-I
<br />Forms/Steel/Holdowns
<br />\4G
<br />'^rtEr:, cr> Yh{ofi- fi
<br />Flood Zone Certif.
<br />r,.*.cr"o ' 4 ( LrftcNumb(:
<br />C)7 L-,'-!]\-,--
<br />I
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