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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE rDisrG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Ereclion Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loorfu enVlnsulation
<br />Roof Sheathing t 3r\\9 ,4.4iilti )
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Mason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />t)IL
<br />FINAL 4?+ t ///
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />-)
<br />OWNER BUILDEi DSTTARATION
<br />I ha.lry lrm und6 Fi.lD of Fjury th.l I m q6R fioo fi. ConltuloE Li..e L.r tor lh. hlbwit l@n (Sd.70l I t
<br />Aci,B ,n Prot6irn Codc): Any Ciry or Counry *tth EuiG ! F,nn ro oGrrucl in6, mprotq &nolirh o. r.Fr u,
<br />lttuduc rn'lo irr i!lJ!N,.h. r.+i6trE Qplid lor Bi F$i b nb. riStr.n r.mr lhd lEor ir ! licqEd pred
<br />r. rhc provnioN ot tlE Conr..dn t Li..ncd t,w lch.Fq g, ( omftins *irh Sdbi 7000 of Dviriro ! of llt BuilB ad
<br />PrcadDs Co<t ) d rh, lE d i,r ir 6anpl rh6.n n ed rhc bGs lor tb. dkg.d qdFioi. Any vi.l.lior olsclio. 701 I t by oy
<br />.ppli.Dl lor r Fbi sbJdr tlE +pli.d ro . civil p. hy of mr mE lh& fir. hun<trd &1116 (tti)o)
<br />-t,ao*cofrh.FoFry,d6ymplotG*nhursduthcirskooF6aio.,silld,rhcm.dtlE*arEi!r'riddi.d .roUr.d tor eL (Sc 7044. BdilB md ProfsnE Cod.: Th.co ncrdtLa@t e do6 d +9lr ro x o*E ot
<br />th. F,pqry *lb hrilih or i,ryoE rh6otr od eho &16 scl' trlrt hirela or hs*llor lhtush ht o.lE om drployc
<br />F.lilal rh.l $.h ,nF!rsd! E d ndd.d ( otu 6r -L l[ h6*6!, thc t{ildin! n in4.orffir b {ld wih, on. }d
<br />olcorlplaio'l. tlE O*@ &illg wil lart dE h,\,a of FowE tr lE r lE dn d hild or itrp.oE dt FlPdy l,llE ti pcof
<br />_1. ar o*n6 6tih. Fopriy, db .r.lNiv.ly co rehS wnh li.aEai c.nrd6 ro @r\{lucr rt Fqixr (se 7or4. elIB
<br />!,n Elt in ( o&: rh. conrncior ! l-k.c t,.w &6 nor q,piy to o o*nd .f Fopdt who build. or imprcvd rhd6n,
<br />dd sho ..ddt a* sh Frj.<s rnfi . Coffi o(r) lt.rd FRu,n lo llE cd,rdd r l-it@ llw)
<br />I h!r...d q'ill m!'nlah wo @ .oDr..$lion 'Nu,M.. N .<urdl b, s(l io. l7t() of rh. l.$t Code for Ihc pqtolrMc. ol
<br />. q',!p.Gdr! 'nse. .-ir rn Fky .umb.r ,.
<br />D.re l).n.r
<br />l!lr85r:&r:(I,r!f}.lr,!rur
<br />I,IEClzlAAlIg!
<br />I hd.n\ rm,d trnJd lm.lr\ ol tEr,'l] rm ol rhc I(nI\r r! d(l.sar(!s
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<br />h,r. ai *,ll mid.i,t ! Cdifi.{. oaco.hr io S.lf-lB!rc aor wrkdi ompdaiio[ B FovA.d aor by Sfrlion ]700 of lh.
<br />t bd (o<te 4 lh.Faforltr! of rh. mrt fd e$kt rh. Fhn i! isEd
<br />!l( {,!l li{ \l'(l' lha x1tr'( '. Nnal \l\\,altr
<br />'Aq+*.?a^4
<br />t4 L14o|3vEq
<br />t 1Zet,
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<br />cenifr rhd if, rh. F6lmn..oarfi. work for whkh thi p.mil ir isu.d I Jrll nn an9hy m! F$. h uy lME
<br />F - r. tEoE $Bcr ro rn wrtd armFBnDn h*! otcrlrfons, d r!rcthd if I sfi.uld bccodc ubjdt b rlE
<br />worl6' sfttqE Iion Fnrnio6 ol S.(b. ll7{)0 ot rh. Lr}or ( qL. I r l. fnhwilh oi{'lr snh dFt Fn6ba
<br />wAR INC: Faitor.lo 3..c strl6' omFnsior covms. ir unlastuL ud ndl tubjd n at{,lo!€ lo aimin l FEl6 rd
<br />I m .rmF urd.r Sdiof,
<br />isu.d (Sd. 1097. Ci!. C.)
<br />l.n&r'! Nrm.
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<br />.i!,1 fi.6 up ro ok h!,& rhoE d dolL6 tllo0.00o). h ..ldilnn rh. cge of comr.Mtion, dmrSd a ,mrd.d for ltc
<br />sa{rh 1076.fih. rillr (ixl.
<br />I hdrby .lTrn lndd parly ot Fju,y fin I @ Ia{6.d ulrb Fo$o or Ch,Fc a (olllllEirs "nh S.ctb. 7000) of Davtio. t
<br />of lh. aBins ud Pmfdioro Code dd 6y liGN i! in tull lorft id.Ad
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<br />cosn'!irion P.mirs.tutBro! Nouficarioi l-.dd!l R.uu l,lioN Onl. 40. P.n6)
<br />-R€qun
<br />d l,lrdorNorifEdion
<br />I .diar th, rh. ao:!d.l ,lsuhtioB rqrdins st nB rffi\.|d. ml qrl..bk tr rhi! lnrFr
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<br />cdi6 rhd I fi6. rd lha rlpl(n6n drt rd.fotuion iscotr.n I nsrr I
<br />o.drn-'B ud Shr.lrN ElairB 16 tnrldifls.
<br />rnrr. mdridnd t oFny for isp..lion nrBG
<br />x,\pt,liux u' \(url sitnrrurt
<br />,,-u,r"" n-r.,u.Ur,, )(Uvaalat Cz*('s
<br />oco,nplv$ h rll( irynnd( ourry
<br />,h'\( tr\ $.! ruu/'D rL' m!d uF{,h.
<br />-" .r/r"lLt
<br />frf;
<br />Brown Coat
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