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BUILDING. INSPECTOH RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS oWNIJ* AUILDEII DELCARATIoN
<br />I lrrchy alln u cr p.nuh, ol Frrry rhur Lr cr.it,r ltutrr rlE Conrrdo^ Licms hw litr rhc aollo*ins Me'n rlic. ll 5
<br />Busircs fl] I'(ncsrion (irlc) Any Cily u (iu y $hnh rcqnirc\ a Fmr nr .a,nsrtur. rh.r, 'nnn,k. &nsl,ih r ,cFn un,
<br />{tutur.. pnr tr \ i\\mrkr, ,l\o nqu,E\ rh. ltdarnr i(, {uch Frmit lo fih . ri8Rl (.remnl th lE or nr i\ li.cn{d 't{sudrr
<br />ro rh. F)lxintr or rlt (tnk irtr \ l-Nnsdl ljs la,uplcr 9. ConnErciry $irh SR..rnn 7(r[, ot Dirnin .l ofuh. Bu$Es e,
<br />PoL$x,n((:o&ror rtnr E( o, \h. n.r.nDr rltato icl rh. hasir ln rhc alk8cJ cr.nqri,n ]\ny li)llrrr ol Seri,n 70.1La hy y
<br />xpdica fttr r Frn {hi{rh rh. ifi'li.d n, ..ieil n 'uh
<br />y or nor mr rh{n nvc hu,nrcd dollss I t5lx)r
<br />-1.
<br />8 ormr or rh F Fdt. o, dy c'rft,t$ $nh srs$ s rlEir $lc ompcndira *ill d, rL k,t .rl
<br />'lE
<br />slrE n n
<br />i,rdd.rl d or.Erl rd qL l Se 7Ol4. Burir*r ud Prof6h6 Cdc TIE Codraclm s Ltos Li* dxr n, lprly 16 e Ner dt
<br />rhc Fr{xny utn hi[.r! or iqd'Bridun !n who dixi hsnhirelf r h.BIf or rhmuai hird hcro$n.rnlorc6.
<br />Fovilcd rhlr *h i,Ile\ft|lls e hl in.nLd dolldrd tor FL li lNw. rh. boiUh8 d iqmwrd ir $la *anin m F,
<br />oforptrhn 0r O*mr Buitt *il! ht tlE h!&n of F)vins 0E,tdshdn d hirl d inlnE IE Fr,rdy aor tlE,trFrc of
<br />-1.
<br />!r owE of rlE Fot lly. !d cr.turikly.mrr..rhs snh ftcn*d.offi6 ro 6Ntud rh. F.,rr (s...,(x,r. BrnE.r
<br />,,n El,f6ls Cdlc fh. ConrErols Liccnsc liw d.Es mr qT'|, r{, u o*Er of prorEn, sho buiki .r inpDw{ rlrcmn.
<br />$d *no i'nudr(d sh tF,qls wifir Cdnhrqsr lat.sn nur{rd bilEC.dfflols ti.re bo,
<br />u ]r. ",,).----'
<br />I]ECI.ASAIION
<br />I herchy afitr undcr F illy ol lErr!ry otu o{ l hc followiu delTarn,n\:
<br />Ihurclnd*illiuiiruinu(cnifiu c ol Con* tu Scll lnrur tur w.rkcn sqx.uiotr. rs Fo!i.,.l ftr by Sccti'n :17()() of ltf,
<br />L,hor Cod., rd rlE ltrlunEncc ol rl! *rrt r'or which rh. p.rnlr i.r nsudd
<br />I hsk {nd wil, n$i rnir work.rl !onrEns!&'n iNuruE-^r. us r.!un.t by Sccr irn l70O of rhc ljbor Cud.. [r ltE lErrmroBc of
<br />rh. *drk for whi.h rh,s Fnnn a !sEl. My worlc^ ('mFncarion in\unm. cuir un lI)Ity nunhd d.:
<br />PolEv Numhcr:-Erpit.
<br />_l c.dityihxr in tl* |Erlo,@N. of llE vo,l for wnih lnir Frmil is iesu.d l shIll
<br />'Er
<br />cdploy.ny Fist in ey mnE
<br />$ !s ro tr$m $tfcr lo rh. qrlsl s'lEn$rion h*! of C.liromiL drd rsd rh3r ir I rhnuu h((m i,'irr lo rlE !*slsi mqrtr{thn pm{i\eN ot.(Brkr]rmofrlE trt i cd.. I dull f.'lhwirh 6nply rilh llrs Imtsi63
<br />WARNING: Failur. kt suE *rt r'o'rt .srhn.ot@s. k uda*tu|. rnd {h.ll obFr an atlroFr ro ffiMl FMii\ !'i
<br />.itil fifts up ro om hundn\l lhuwd.[ ls l3l(l,.lxD ry Dtr drmE.r {i F,vkL{ fin rlr
<br />sNrion :10'76 0l rlE ljb. (ixlc- inr.E{ d! dr6ry r
<br />u.,.,., L\l\4 l24z l
<br />I lrEty rrmr unlcr Fulrt ol F.iury rhd I rd liNEn und.r Fntisbn of clulrd 9 i6hdrin! anh Sdi,n ,frD) oi Driion l
<br />of rlr Bu\ims dd PrDf.si(ni Co&, d{ ny ltrm ir iI tull t m .d clIcl.
<br />C(TNSTRUCToN LI]\DING A(;!:NCI
<br />I hcnhyrlnnrrnlcr Fnrlrr., tErlur)lhd rh.ru i\r.on{ru.ii,, Lndi,rgDlctuy fttrrhcptrnnufrcoIrtt- sork l *hthrht|tr ir^
<br />^sur
<br />(S.. :rll)7. ( iv C.r
<br />L
<br />'.'1.'
<br />'' NJ i'
<br />IIII.IIANLDECIJAAII0N
<br />I hdr.t y r,imr omhr r.nalry ol ncnlry otu ol rh. folk,e r.E d.rld'r o.r
<br />thftnn{u P.rnn$ A{E(o\ Non,icor0n ltlcrul RcBtrhin,nr lTnk J0. Pd6)
<br />-Rcqumd
<br />txtrcr ol Ndilsuih
<br />I cdrly rful tlE lcdctul rc8uld nn\ rsud'n3 a{Est,s rcB'ql rr Rn +liiablc ro rhi\ pFirr
<br />/-l cdiry rh4 I har E.d rhi\ {rDklrion rnl {!t. lhd fi. !hot. itrtomEliotr is orc{ I .sr ro @rr?ly *nh .ll Cir, rrl Counry
<br />odiEresnnShrcL.w.Ehri'BrotuiHins.onnnEir^,nh.ftbyrdh,izrF.l.MiE(olrhnCn,rnCoudylodlslFn.
<br />h\c nurNkrl ln)tMy fttr
<br />.{pt i(,nl nr,\!dl SiaDlnn ul\41.21.1-l
<br />Slts lr z la. g
<br />Set Backs Ll Ir ^-oForms/Steel/Holdowns t lHta rr6ufr wN
<br />Erection Pads tl
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framino
<br />lnsulation/Energy
<br />Drywall
<br />Brown Coat
<br />ltrlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL
<br />Certif icate of Occupancy
<br />Notes, Bemarks, Etc
<br />Rev 08-07 2015
<br />I !m.r.,w tn&r Seril)n
<br />o.r., ' 9\t4 lZoZ \ ,
<br />Ext./lnt. Lath
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