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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.,COMMENTS OTVN ER BUILDET DET-CARATION I h6cby alfqh uad6 FDn, of Fiuy rht I6q6F to6 rh Coltrm Ltaslry for th. ro owi'ra l@r (Sa701I J Brins {d Prolsion C!&) A,y Citv o! Co!,ry whi.h rcquid . p6n to otrrNcl. drd. iopiovc. dqnolish or rc.n ay ntudue Fi, ro ir! 6l4c. irto GquG lh. +diel for sh FEn lo 6k r si8!.d ni.,r!d rbd L or tlf, ir liâ‚¬!.n FElr b rh. prDvirioB of ttE Conl,erois t-t..!.d lrw (Ci.I'd 9. Comtri.s vith Saion 7000 of Divitbr I ol 0E auilB Ed Pol*b6 Co&) d rt b. or rh. i! d.ofl thq.fioo .!d rh. b.ii! for lh. .lk8.d d6 io.. Ant violliotr olsrlbD 701 I 5 by ey pdtd for.FDh $brâ‚¬a lh. +?lkDllo.civilF htofml mr.th& fivc hudrcd &Us!{ltoo). L a om6 oarh. FFly, or ny dplorE *ilh s.g6 6 lh.n iE cohFsdion. eill & llE f,dt !d $. rMrE i ml idcd.d m o,Iqd for iL (Sa.?0.1,1. Buind od Prof4oB Co& TIE Cont-16 r Liu* try dG Nr eply lo & o*G ol $. Fopary wtb hril& or inF.â‚¬ tlEbtr .n vth rb6 Bi N* hielf or hdxlf or thmuBh lrie q h6 om @pk'y6. provd rhn $ch ioFsvo6u e d i.nddqj oroFgld ftr sL.lt,lFws. dE hrildiry or uq!6rd i! $B wnhinoE ylqr of.otrpldbtr tlr Ow Builda *i[ llE dE hrddr ofF!\iry di h. or tE dit ml hlE d itrp.or! ln. FlFry 6r tlE Frpo!. ol l, G ouE of rlE FoFty, m .r.tcn.l, cotud$g r'nh li..Eal .odr(m to olfud llE Foj.rl (S<. ,04.1, Eaind lrl Aorso Co& Th. Conrr&lor. l-'c@ trw doG @r iprlr ro u o$n6 oaFoFry who boil& or ioprov6 rho6i. and who (nlr..l! fu su.h Fol.r! wnh a CodE lo(3) licm.d r EBr lo ihc ConrE loir l.ic@ Lrw). _l m.roF oda Serhn_.B & PC fo'lh6 rd,. D.I. O*m: woRl(fqs.coMpE s TroN DECIdSAIIO! I hftby rinm und6 Fi.lry of Flury oG oath. follo*ing d..LrdhN I hdv. Erl *nl mllnrdin . ( diff,d. ofco,wr to S.lt- lBur. fd eorl6 comp.Mrion, d Fovid.d for by sdion 1700 of tlE Irbor Co&, for rh. pdfolM. of rhâ‚¬ *o* for whi(h rb. Fmn t isu.d I h.tc and *rll drrnr,in workd compdsarion Blreq 6 raluEd by S<rFn l?00 of UE Llbor Co&. ao. r& Ffolll1le of lh. *orl tor u,hich thn Fnit ir i$.d. My wortd comFsd6n idumc. ceia d pohcy nuabd ,.: I cdit thll in 6e pqtolfucc of rh.vo for *hich thir p6ni ! illurl I 3hdl .or @ploy ay Fsn ir ry m@q $ B to h@m $bj.'al JDuti h6or abj.rl lo llE sort6' omFsrnFrviri,Bof Sd6nlrmoffi.t bor Co& l ildL ftldfi*nn ohply qnh lhoE FovibN. WARNINC Fiil@ ro s@ @rtd' @mpqerion @valgc ! ubvtul. ed sh.ll lubjd D @ploF lo cirnid pquli. and .iYil lm6 up ro oE huo&cd rhoMld doll6 (1100.000), ii *ldnio. 'o th.6r of .ooFMioD, dr!36 a FlriLd for t sdirn 1076 oarlE Lrhor Cod., ot.d !d tunEy r f6r Lt.Gcr8:a-_Lt@.Nu6b<: calliralJcuqNrEdDldclcEd.q I hq.5y .l[m urls F[liy or Fjq- 'hi tlsc ir . @dru.lio! ld'd{s tscy lor l,t Ff(fuG of $. rqt t{ *tth lha FEi ir is!.d (SE. 1097. Civ. C ). L.alq s Nm. atructNfDEcldSalrox I ho+ .n'rn unds p6!hy of Fjuy onc of th. tollowins {k Lt.lFe: D.mohion Pmi&Atb6r Norincaion r'.d6.1 R.SulrioN (Thl. 40, P.n6) R.quir.d l.116 ofl'knin airn I cEtO lnd th. t d.El cgulalioB Esrdi!3 aldor rom\ rl r. nor rgpldb|. ro rh! FoF _l cdiry thll I lw. rqj tbir .pplidion lrd i.l. rhd rh. rh.t. infortrrlion n cMCl. I .grE to coopl, viLh .ll Cny 8d Coury ddi.a6.rd sl'r. t s,.tni!g ro hrildiq.olu^(io'l. rn bdtty lltor4 r.Fslrivd of thir cny ed coud! ro d. l4on t r .tov. h6tt n d pDpdy rs iBpclion FrF6. lppric.nt or ,rsmt sisn.tum !' Pâ‚¬rnrilN nir((Ddn'):* Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loor/VenUlnsulation Roof Sheathino Shear Wall Framinq lnsulation/Enerqy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif FINAL z/>ch.J^l Z^> Certificate of Occu nc Notes, Remarks, Etc I - UCEISELCqXIf,ACIOA DICIAEAIIOA I hs.b, lrfm ud6 Fdly of Fjuy rhr I m licas.d u,'da FDviion of clrdq 9 {on1ll6ur8 *nh S{rD. 7000) ol Dn aio! I ol rh. asind.rd Pmf6ioB CorL, !i ny lE* ir m full for rd.ffd