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BUILDING- INSPECTOR RECORD
<br />SITE.WORK ID/SIG.COMMENTS OlrNER BUIll)ER DEL< ARATION
<br />I h6.ty .rIm unda Frly .r pGjury rhi I d dat$ 6!n th. Colid* Ltffi Le for lhc tolh*iB t@t (Sd 701L5
<br />ItBir* .d Profelir Co&) Any Cii, or Cooiy rttn rcqun6 . patnh to @n3to.1 .116, idForq da@li.rt or lF.r ey
<br />ntucl@, FFr ro nr bu!re. .lo r.a{ic llE +pltsl for Mh Fni lo f l.. q,Ed sdrd rllr It or tE it licq!.d F,i,.n
<br />ro rlE Flvsh6 ot0E ('o.Esrot L.o!.d Lrw tchrFd 9. CoMrns vnh Sclion ?000 of Diltkn I of lh. Baina d
<br />Profdioro Cod.) thd lE or dE L ddpr rhstfrom.!d rh. bGs tu rh. dk8.d aaEion. Ary rnhnn of S.dbn 7011 5 b, D,
<br />.pDlt&r for . pdni 3ub(a $. rrpli@t lo r civil p.rhy ol nol mrc tt& fivc lund..d dollt! ($00).
<br />l. s ow ofllE E$Fry. or hy on9lor6 wilh *.s6 s rh.tr nk conPsB.Iior. Mll do thc *dr dd tu nn(lG ! @t
<br />lnorLd d oitoq, lo. sb (s6 7044, BdiIS ed PrDfdbE Cod. TIE Conr-ld s LiEE t v &€ d @ly lo a ow of
<br />rtE FlFty who bil& or mFG U6otr !d vtrJ do6 ilch m ninslr or h6*lf or lhDu8h ha 6 tE om 4plor6,
<br />ForiLlthash,nFrtqEi!cmndiqlsotuqlftint lr. lngtE. rtE hildiiV or ingffid i 5ld vinb oE tu
<br />ofco.pkrb[ th. O*nE &!ta win hrE UE h(k of Fsils 0i lE or Jt dd 6l trdd or if,proE dE FFy 6r tlE Flpo*of
<br />l, ! ouc olrh. r.oFry, e a.lBivcly corrrdins $'lh li.dE d or *1oB rn odrud ttt Fotll (Se ,044, Buud
<br />drd P,liidCod.: Th.Co r{oat Lic@ tre 1106 Dt pt,ly !o m0*16of p.orGly*ho b{,|d. or inp61€ lhaoc
<br />od e.no on.Il! 6r $.t p.ojalt wnh r Co rxro(r) li.a!.d D6@ rc (h. codE lolr l-icoe ljw).
<br />I m .rdpt ud6 Sdion
<br />lloSsE8li:calu[dsArlQl
<br />DECIJf,AIAX
<br />u ftq.by r,rm urds Frly of F)ury on. otde folb$inB <kLrilioN
<br />'
<br />I et tr* - -, * . cdtrfrdr orco6dt to sdfiNc.o, uMl6 o',F!rlh$ & FoviLd tor by s6rion !7oo olthc
<br />. Ll,W r'.de r.. rtr Ff.* ortlr w* 6r *nEn th. p6br s dr.d
<br />I h!v. &d will tui .h wort6 conpqlaion an3lJruc 6 E{ui(d b, Sc1i,n l7oooflL tr!.,
<br />rh. wrl lor wh{h lh! Fm ir srd_y, *o,La' omFdiodj!;rtmc. ffi !d polry nunbq
<br />ttt arnV t/a,r/"4,-1 tt4tp-r
<br />,,,"^**:- EEsari *-..,*.- '-lt-
<br />co<lr fo, rhc Ffonrec of
<br />I z) LO
<br />l.dify rhli in th. Faolruc. of thcwort tm qhrch lh6 Fo 6 s.( I ih.l mr dplot ey F$n inry.uE
<br />$ s ro bdom -tixr ro rL wrt6' @nrpoisdion Ls ofc.lilohL {rl tAR thd ir I rbuld b<oru !ut!d lo lhc
<br />wrt6'ompdnrion!rcvnoBofsdio.lT0Oofth.IltdCodelCdLfonh$nhco'lplywnhOo*,frv!6c
<br />WARNII(; FrluE k\ cw sorl6 c. rtErs.lion ovsla.sJ lhall lubja1 M 6ploF !o diElnol r@hi6 d.l
<br />h. . r of (omo.dioa d.!Es6 a Fntirjcd f,r rh..ill n.6 op ro orc hlndr.d thou$d &lla (tl@.(m
<br />oarh. Lrbor Code inr6d M.lzltl'ouo a \bCD ftoT.
<br />I h6.ht rrm oRls FEIy of FJury thll I d hc!$.d Flviiio. of ClDprd 9 {m"r!ecir* wilh S.dion 7000)otDivilioi I
<br />of the Auin6 ed P6fa'oG Cod.. d{ m, lcN n in tull lo(. ad.,T.n
<br />c-?17qqetg
<br />o.t I Z 7 lzoC,Q u, uxrY-
<br />I ha.by lmm u.dr lBaliy o f Flury Od rhs. t ! cordN.lln lddes ,sdy for thc Ffoffi. of rlE *ort ,or rnrh $! Frr a
<br />isu.d {Sa 1097. Cn C.)
<br />l-ddi Ad&d: -
<br />AITIJCANIDICIJAAITA!
<br />I hdrbr rlr{6 uala Fu}r of FJ- r. oE of fi. folLEi,B dqLnl iod:
<br />D.molirion P6ntu-Albclor Nonfi.dion F.dad R.gtlarion! Ont 40, P.n6)
<br />R.qutcd l6rE of Norilicdion
<br />I .strt rhd rlE fcdol rcslldbB rq{d'ns 6b6ros llmrrl r. &{ edrrbL ro thi! Forn
<br />'hd
<br />I hrt.ad ihB ap?lmlFn.rl rbov. nfotuior t corar. I isrc ro ohdy *nn ,ll Ciy .d coury
<br />Md Srorcli$sEldlll3ro buldin8 hd.t't auhotu. t.ri6drdiv6 olth! Cir) dd ( ou.!yro dr6 urD. ttr
<br />mrio*d FF!! fm rE <rion
<br />,\rpll r or ,rtdr Sl*n.tum orr" 'L
<br />rmlcmnctpanrt, K G@\A0r
<br />(rto*
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subfloor/VenUl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL U,t h"fu; I ?3)
<br />Certificate of Occupancy I /
<br />Notes, Remarks, Etc.
<br />(
<br />DATE
<br />Flood Zone Certif.
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