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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subfloor/VenUl nsulation
<br />Roof Sheathing s.i8,/?/Zz 7t)
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />'7, ILL I t0
<br />Certificate of Occupancy ,l
<br />Notes, Remarks, Etc
<br />OWNER BUTLDAR DETI'ARATION
<br />I hs*, .rrn urd6 p6!hy ol pdjur, lhlr I d .tdpr tom lhc ConhcroR Li.mE lrw aor lh. folb*;ir8 ;drii (5€.701 L5
<br />BGtrB d Prc6Bi,n Cod.): Art (nt or Cenr entn r.q!n6 . pcni lo @rBrud. .Ia, mFore (btulah or E9.it er
<br />rnhEe FDr to tu iMc. rto !.quiB llE +gltlt for sh Ftn lo nE.3ier.d ridld rhr lE or slE it lts!.d pu$!r
<br />ro rh. FovithN of tlE Conrralqt L@n*d L.w (CrrFa 9, CoMins wnh S<rhr 7000 ol Drnion I oa rh. BBilB ud
<br />Proa*ioB ('odc) or rh.l tr or sh. ir ddpl rhc.Ao6 dld th. L.!i! lo, lh. !ll.8.d qdFion Ary viohtionofsdlk. T0ll t b,&,
<br />.ppltdl h Fnn objd! tt .rplid b..ivil p.Ehy oamr mr. lha fi v. hu&.d doll&. (l5ol)
<br />-1.6
<br />owofln p.oraly, or mydplold qlh *.sd Blhd $LNntEdior triU &) E*!il3'd tlE strw I rcr
<br />i.r6d!d or ofir.d lor sL (S< 7044, 6ui,6 d PmfdioM Cod.: Tnc (tmr.crd t l,icce Liw &J6 mt apPly ro u oMd of
<br />rhc FDFry *ho hrilib o, irqlrqOEa( tn *n d.E Mh mrt hirelf or ls*llo. dEwi hi! !r ha omdploy.6.
<br />Fovid.d rhd !6h inFrrsEr! e r lrdd.d c otu ft,r rt l[ lb8d, tll hlitli,a o irrylrgEr 6 -ld v.hin G !a
<br />of @lPlri., ll!. o'rE a{i!s s'il lrw dE h,{h of Fort $i lI d iE dil bi Uild d osiort dE FDFI, 6r llE F po..of
<br />I. 6 orE ofrh. F.Fty. m adBiv.ty comr.lur u irh ltda.d conrr.roN ro ftdtud llr FoF (SE. 70r.1. lt6,6
<br />.,n Alho Corl.: TL Conlrel('r Lke t w do6 mr @ly ro o or E otF$Fr} r'ho b{itd! o. inFovB thg@n.
<br />ud *ho @rGxl' fs Mh Fqcr! *in r Comn ro($ !i!!.d Fl,lrd !o th. Co,rftrd'r Liw lsJ
<br />I M.\.npt uds Salion-
<br />-"'-//r/')'/,/q
<br />![c!.d8altad
<br />I hscby .nirm unds psBty or pqury orc ofrh. rdlosing dele ione- -
<br />-llrtrd*ilt
<br />dr.in. Cdlif.d.olcoEI ro s.lf-l.Jc ld wl6 ehFqri,\ a Fouii.d lor by Sdir l?m of th.
<br />Iitor Co<|c for & pqftu of ih. s,l fs *thh rhc Fnit i i.su.d
<br />I h.v. ,nd will uinl'in wortdr .omDd.lior i,Mm.. ! ..quiEd bv lial i.. 1700 of th. t bor ( od.. tor lh. FfolrM. or
<br />dr {ut lor r hih lhi! p6mn it iE).d My wnt(t oBFdbr iBuE. c!ro ed Islty .MtE r.:
<br />Polky Nmbr:-ErpiE
<br />-l
<br />cd'lyth.r i.rh.FfolrDc.ofrn mrt lor *hkh thi! Fmn i3 isu.4l rhlllml dplo) &y Fsn i.oyf,uE
<br />$ d ro bc{onE subjer to rhc wortd' compalll ion bB ol Cllilodi!, ud .se thd if I rhould h*onE Nt'ld to lh.
<br />{od6' .rmFrE lio. F.vti,B of Sclior l T00 ot lh. L.tq ( o<lc l dull. lonhwnh .omPly wnh $ox FovthB\r RItllNG, Fnlur to r@ *!rla 6np6abn @6.e. ir rL{ful. !d ndl sut €l a s.phr€ ro diminn FEr6 .nd
<br />cril fin6 !p ro oE hun<,r.d rhousi rtrll,a (tl00.o0o,. ir *ldnio, t. rfi. 6r ot conFEdt,i. dru86 6 Forilcj for rlE
<br />selion 1076 ofrh.I{htr Codc. imd.r sd.norE,i
<br />, /sa /., r
<br />DECIASADQ!
<br />, horby lmrm undd Fih, of Fjury lh, I ffi licdE d uid6 Folili6n ofcrrpra 9 (.omndci.g $nh sdlion ?000) of Divisio. l
<br />6a $c BNiIB and Prof6ioB cod., sn mr kw ir ir lull forc. !n dlal
<br />c0xlirau(.lla.tilf.lDjlli-aqllcl
<br />Ihs.br omnnundd p€.llry ofF.jury rhlr rhsc E a co.srtu.rkrn Lnding aldcy lorlh.Ffon,uce otrh.$o lorwhichlhhpdlnir b
<br />is!.d ls< 109?, Ci! ( )
<br />ATEUCASLII(IATAIIIIB
<br />I hd*t .JIm unda F.ly of Fjury o* of thc lollowins &rlr.lBc
<br />D.moh,on fd,nti-Alh6ros Notilic.tion F.dcrll Rcxulslionr { litl. 40. Pan6)
<br />-R.qur.d
<br />t!rd of rdtif!.rbn
<br />I c6! it thlr thc lcd6d r.8uLi ioB r.SrdinB sb.slos r6n.val ec rcl EDhcabL lo rh! pojd
<br />-l.dif,
<br />thd I lb\. rc.d thit.pplk.lnn &d q . thn dr.t-rqifonnibi. co.rEl ltlra lo omdy Nlh dl Ciry.,!d Couil
<br />odil[k6 rd sd. bs. EktrB ro trildi.s co'drudor E d lE.l'y rull$Dc r.!.*dd ir6 of rhi! Cny !d Cournt ro ors upon t r
<br />ft6\c IE'n^Gl FoFry r r.g9ion Fopooo
<br />n *, "-, - *-, ra***l/ $-o[{
<br />P.rolr( 60. (Ddat,:
<br />-,,,ttft/ty
<br />rYGltlFINAL
<br />Lic@. Numbo:
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<br />tl
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