|
BUILDING- INSPECTOR BECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />ln s u latio n/Enerqy
<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 />"At ,1 .o,
<br />FINAL htfirl D/Wt -/
<br />Certilicate of Occupancy tl I
<br />Notes, Remarks, Etc
<br />OWNER BUILD$R DI]L'NRATION
<br />I h.rchy riirn !nd.r rcnrkt r,r ncrjury rh! I M cx.n{,r rionr lh. Conlructo^ l.i.c.\c li, for rh.,ollowing fuy,n (lc.70.ll t
<br />Busirlcs\ flkl Pnncsiotr C(rt) Any Ciry or Clutrrr whicn ,cqurc\ ! Frnir k, .onnfld, ,lr.i i p()vc, demlnh o. rcplt lny
<br />(Dcrurc. !r lon! i\\Dunc., sl$ rqut.\rlc ll,Plf,anr lnr su.hrmir Io tilc! si8ncd ndcmnl lhll,ror dE n licrcd pursdl
<br />h rrqK'virnnB of r G'nl,slr, s Litnsn l i* (ClEptr. 9. (-lnnmE'ns B h Ss-'riiin IlJo or Divnion ] of rlr l]ulnEss .nd
<br />Pn{.\\i,6 Adcror rhrr E.. rlr is.r.mFr rhc.Lom url rh. tu\N rd rlt alh8.d.rc'qrion Any trldbn of SErbn 70.rl5ty,ny
<br />rtrtli.! (r r lxrnir subt ch ilr .lpl'canl lo 1ovil tEtr.ll, .f fr'l nnrc llEn ,lrr bundrcd dolbri r s5m,
<br />I. trr rwBr ol thc J'roFnt. or ry cmploF.s *irh w.8cs !s rhrn {'b comr.n\d t'n. will do
<br />'h.
<br />wltrk ,ftl rh. ntrlN i n,
<br />inlcnjqi or o,tlrcd r'or slc (S( 7o+{, Ausin.sr Md hrtcsnns Cirlc:]}c c.out.ttr r l-Ectrt trw.lE\ ml lpply to rtr ortt of
<br />rlE Fltdy $h, hlildl or intnN] dEm...'n whr tlc sEh Md hnnelror h.rslror lhou8h ht or h$ owncnrr,y..s.
<br />prlidrl rtu iod iqm\tmnk:m [{ hrdrkriffoilcdl tr €L ll h,aa.lh. l[lllnBr io{rrEmrr is dd *nlu (ft rrd
<br />olonpllio! llE O$E Buitlcr sillh.r! llE hr&n ol rDins lhr lro,didn hr tlildo, rtnrt E ln)tdy fr
<br />'lE rtrlF'E ol
<br />l-r\oshrofrheptufcny,,crrluriv.ly.unrirrin!wirhlrcn\dirffadq\x' {rud rhc !n+cl(Ss 7{N,r. Bdrt\\
<br />]d E!f$\r{ Cottc: Thc A,nk&tois Licc$c Lrw dcs nor.nplyt, owkr nl nmltnt wh. buildr .t imnnt!.s lhc!.oo.
<br />nnil *h, .onrndsfor ru.h lln,i.ds *nh r c.di&ron i lt.nrn puruanr b rrE (in 6roas L.r.e lj*)
<br />I ur.rcnfl u ].r s.crhn
<br />.ivil in.$ uI nr onc hundlc'l llrusand dollan lsrlxj.u)0). nr uddiln'n n,.un ol .omFtr\nrtr , !l rgr\ i\ !"o!(ld nr iltr
<br />s.crhn 10160r rhc I rhn(ixh tr .rc( mtl r drnv rrt.\
<br />troxf,!f,ll.cl]MPiNtA.rl0!
<br />DECIAAAIIOE
<br />t hcr.t y !finn lnihr pcexy ot Frrury om of tlE loltrwitrB dalsrlnnq
<br />I hav. sn sill mintlin r C.nifsrcolcons. ro S.lalnsuB for sorkF .nqtn$rion. is fiovidcd Lr bysdio. ]700of E
<br />lrh.r Cdc, fur thc F.fornec of rh. work lor whid rh. pdnir i\ krucn
<br />Yl turcridwill mi lin *o,lcr' oqEtrqrior inrurdc. {r rcqli rd by sdridn.1?00 olrlE L.ho. Crd.. for IIE tErfmdre of
<br />rh; uo ld *hrh rhn n mi ir L\ir.d M, k,l6 on'IEdrbn 'hurftc ffEr .,r, |blEy nutric. m
<br />""*,, CIB*'TI
<br />**,*'*"@r.r[",[zl
<br />l .cntly rh rn thc Fddnrum. of thc *ork nn *nrh rhn rrrntr t ii\ucd. l \h,ll cmploy lny FN !n iny nunm.
<br />$ r\ b lrronE rubFr io rh. ,inlc( $nlrnslDn lalr of c.inrnio. ril !3e rr tl I slDuld tEon rlhr<r ,o rh.
<br />*ortsi .ontF.vrion llola\ion\ of S(rn,n :l7(x, of r h. khr C,rlc. l \h.ll- Lnhu h cor9ly *irh rh,s pm$iJtu
<br />WALNING: Fnilurc ro s(urd work B comnctrsdrion covln8c ,r unlrwtul, d 1hrll slh].tr a chpk,ycr io dihindl ,EMlrics md
<br />lz l?oi z t
<br />ll(EIiIILlaNIXACIQf,
<br />DEtld.SIna!
<br />I hcrh,nllirNu c,r.!hyntncrJuryrhiIui!lrcn$lund&|jYni,,nolClq'rct9(.unnrn.it!*iihScctionTUrO)olDivisnnr:]
<br />ol lh( lauvf,s dkl l'mlcsi,nr\ Codc- $tl uy li.cn{ i\ in,ullnn.c urrffccr
<br />,-,...*c,,.. c-(9 C-L((P .-.,*n-,o, -15\te?
<br />*",61 ,3J|a! con,Ecror \4itz 'lJ--
<br />(allIBU(flaNuiIDttrG.AGEIcI
<br />I h.Ehy nln,n' ufrlcr FDll, or ltlory ln rhdc is r snsluli,tr Lndins !r.tu,ld rhc Frroffi. otllF srt for *'han
<br />'hn |Emi k
<br />n\uil lS.. rlrrT.Civ C )
<br />lxtr,l.a\ Ninr:
<br />lrn'l.r\,\dJr\\
<br />dXTLICINLI)I'g.A&IIIOX
<br />Ilarty lnNundurp.nrlr,olfl:rjurto'rultlrr,)lIrultr3,l.cl nii'i\
<br />D!m'Ir],trr l'crnril\ A\hino\ Nor'l'ctrri{,n 1..'Irl l{r!ulrhoi\ ( l 'rlc.lo. Prd6r
<br />-R!qurcn
<br />lrrrqolNoi,,nlrin,
<br />l..n'rrrhrribc frJ.rrl r.!uhri,n\ trllrdin8 rstrjo\r.nrrJlnrc notJpnlf,JbL r' thlprldr
<br />orJNn.o\,!il slrrc liw\ r.lrIlrg r,, huiktin! rotr!'x.rk
<br />rtxrc nrfi(nrd flrFny itr
<br />y{urhorizc rcfrr{rdn$ ofrhi\ C yn Counry h cnrs llx)n rtE
<br />6[ 3,' l" IApptiunl {r Asrnl SiAMloR
<br />,""-,- "...,rn*,, SCY$nt^ Oe'r65 6-
<br />I
<br />Flood Zone Certif.
|