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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNET BUILDER DEICAx fl ON
<br />I ffi), lrm ui&, Frltr of p6,'iry rhr I a crdpr fi!6 ilE Cofirrs Ltde L.s for E lolb*ins la)n (S6.7011.,
<br />BGIB ot Pro&3b. codc): Ary Cny o, coun, *trh Equic . Fo! ro @dF*t. rltq. inFovc ddlirh or q.n &y
<br />nMuq Ffr b nr isE( .Lo EqliE rlE +li,r ror sh FEn b 6L r 3r*rEd arEr rhr Ir d rlE i lilE d Frndr
<br />'o
<br />lh. FDrirb6 dl E Co.rrio! Lt.nr.d t * tct4ra 9, Comtrirg *irn Sdio. 7mO of Drirb. I of llE BrBiE rd
<br />PDldoN Co&) thn lt m nE L dmrr lhd!6oE !d rlE t6it for lh *g.d ad6io!. ny r.laion of Sdrb! 7031 5 by ey
<br />.$licut for.Fn sbjEls tlE .pplier lo lcivilpcdhyof mr mErhe fivc hu!!H &rlle {tr00).
<br />l, 6 omd of rh. FoFiy, d m, @plor6 wnh *.s6 o rhiir Dl. @npauioi. will &' E hrt lrl dr filElE b mt
<br />i drLd or ors.d for d. (Se.7044, Buind ud PiotdioN ( od.r TIE Coflr6.loir Lt.w ljv &6 rol lpply ro & om6 of
<br />lh. pmpaly wh) buil& or inlPreG th6n. !i *lk) &E ruch mlt hims.lf or h.elf or llmugt hn or hd oM dployd.
<br />prcvid<j rhd ruch inpro\q6a e 6l iId!.lii oro[acd tor sL ll howd. tlr hildiry or inqDEEn n $U wihi, on. ]d
<br />ofcompldba llE (nM Builda wil h!rc tlE h!da' ofFlvilu rll, lE or slE dA mr hiti or ityrcw dE FnFry tDr l.\. Frpo$ of
<br />L d 6rG orrhc FoFt. d .icla'y.lt codraros *nh ltqu.d cotudo^ ro 6tu rlE Flj.( lsd. 70+4. BGiE
<br />dn Plub.M ('o<L Ttc Codrrroar Li..e L.* &i6 6r roply ro 6 oqd otFoDdry *ho bo'l& or in9rcc rlE6aed *ho Nturt fs *h FF3 sth . (_offioni) livEd FJllld ro tlE Cotu(n i li@ Ll*)
<br />_l u.roF u.da S6tio.
<br />lLaSal:8ai:aMfEdsarlo!
<br />TEOJXAIIO!
<br />I hs.by lmrm un'js Fn.llyofpqlulyon.ofrh€ lollowtrg deh6lioN:
<br />I hr!. dd *ill mlinlain a C.dilicai. ofcoNoi ro sclr-lBur. for wort6 ompdslr ion, a In)lidd lor by SErion 1700 ol rh.
<br />tihlr ( orl., for lh. pdfol1,e. otrh. *or[ aor *hich lh. Fnr a isu.d
<br />I h.w and $ ill Mid.in f,ortG comp.cdion iBre., B r.qu!.d by Sarhn ITOO of rn |ib.r Co&. lor th. Ffru or
<br />! er.d My *0,16 ompquio! rN]4c ceE !n pol.y nunbs &.
<br />tlo,t-.ry* | G\Ce
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<br />"*.,',.r 57- ( r \,4,i-Q6oi 5 Ir-6t-2/
<br />l(6litlh.l n'h. Faollffi.ofllEworl aorwhf,hrhnFnn is Bucd.l3h!ll ml oploy uy F{n royd.Ie
<br />e d ro bdoN.uqd ro rh. wort6'cooFBarcn hwr of C.litomir. Ed rsE rh, it I ilDuld tEom ruqd to dE
<br />uorl6.onFurionrroviioNotsarionlTmolrh.lrbo.Cod..l{ull.fodn*ih.omplr$'ilhlbspmviioE.
<br />WARNINCT liillr. io sre mrt6' conFMlion cov6rt. n unh*tul, ed sh.ll subj*1 M 6ploF lo sini.d pqulb ed
<br />civil ,ine up k, on. huf,&d thousd dou6 (tlc$.Oo), in .dlilion to lhc con ol conp.Mlio.. dmas6 a providql lor th.
<br />Sdn)n 1076 olrhc libor Code intd.sl &d dlonEy s
<br />*"'a /"'/zt
<br />I h6cby dlm uftls FrXy oiFjury lht I u b.tu d u.<ld FrnDn o Cr.q6 9 (6lll,E.rt sdh s<r.. 7000) of Di\ 6D! 1
<br />of th. BuB arl PmfdrB Cod., ed m! lao* a n tull lore !d.rdl
<br />,.,. u{ /
<br />Oto
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<br />I h6cby arm undd FEhy ol pgjury lhd thd. i! . @nrrurrion lndins rs@y for lh. p6follM.. of rh. worr b.
<br />"hich
<br />lhir Fi"t a
<br />L!r.d (Sa.1097. Civ. C )
<br />afllllaNllfclJSalu!
<br />I hE*, lrm u*lc F.ll, oaFlury om ol
<br />'lE
<br />follo*'n! dEleaioB:
<br />Ddmk6n PmngArb6ror Notificdion F.d6n R.!!l{i.B lTnk.$, Pd6)
<br />R.qun.d l-dr6 oa Norifi.dion
<br />I cdily rh,r rhc lirldal Esul'lioa c!&di.r ahdb! rdnoval ar. nor rlplicrbl. ro ihir pruler
<br />I cdliir rhd I n vc rod lhir applicationed std.rh.r rhc.hor. infomaliofl ncor..l.l !3rd b mndy wnt lll Cily ed Coul,
<br />ordi,1e6 sd Sl.r.lr*s Elrins ro h{ildln3 codNclion. rlhs.bylullsrtercFe'ldrv6oflhi('}rndCoulylodl6uponth.
<br />rbor. indrnnal pmtd, for
<br />o
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<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 />Flood Zone Certif.
<br />FINAL (ll5l1r N 4--,ralA h-a I .flxvnr
<br />I ICertificate of Occupancy
<br />Notes, Remarks, Etc.
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<br />4 /zt/zt
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