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COMMENTSSITE.WORK DATE ID/SIG. <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenUlnsulation <br />Roof Sheathinq <br />Shear Wall <br />Framinq <br />Pt-,faetr-llnsulation/Enerqy /4/J4? , <br />tDrywall, tt,'tl"lt ) <br />Ext./lnt. Lath I eL!?pLr <br />Brown Coal <br />Ivlasonry <br />Pool Fence <br />T-Bar <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL 3/4 /24 .*+?/.) <br />Certif icate of Occupa nc'y1 <br />Notes, Remarks, Etc <br />BUILDING. INSPECTOR RECORD <br />OWN!iR BUII,Df, R DEI-CARATION <br />I hBeb, oil-rm under p€nahy oa tejury thal I an cxdnpl ftom rh. Conlrtcros' Li.m. kN lor the folloNin! r@$n (sd 70r I 5 <br />Busins afri P(l6ri.n Codc) Any Cily o, Counly Nhrch rcquiG a ptf,nn lo coaslnrd, all(. nnpr.!c, ddnolish "r EIEn AnJ <br />nrrurc. pno! ro irs isuucc. atro r.qut6 ihc +pli.d fff strch psnit Io file a sisncd rarmar th.t hc or sh€ is lics.d pGuMr <br />kJ dr provisions oa lhe ConrAcloas l,iccnsql l-nv (charr.r 9. (omrncncins s'ilh Sdion 7000 of oivision I ol thc Busincss aid <br />Plolcssions Codc) orrhal hc or snc is.rc.rpl lhdciom md lhe b.sis lor lnc allqen ermplion. ny viol.rion ors..lion T0ll 5 bt..'t <br />opplicant for a p.nni subj€crsrhc applicrnl lo acivilpcnsllyofnor nor.rhd n!. hundr.d dolla6 (5500) <br />l.s o$nerollhcprolEny,or ry.ndort6 wilh war6 as lhcn sob compcnedion. s ill do th. Nott ud lhc $ndE i, nor <br />inrEdql or orr.n lor ele {s(.7044, Businss and Proi6sioE ( od. llE aontr.cto.s Licose lnv .i'G .or apply to an owns ol <br />rhc prupely who builds or i'nl'ovs lhdon, ed $ho dr6 nrch so'l nnnsclt or h@lf or fimu3n his or hd own chploy.6. <br />povid.drldsuch im!rcvorols @rcr inrdxlql orofid.d forsk I[ h\r66- rhe h,ildi.S or i'nlro\.mm i! $ld$irhin on. ]a <br />orcodpldion. rne o$ 6d auildG rvill halr thc bud6 or povinE rhd h. or she did nor hrild or imForc 6. ,opdy for thc purFs. ol <br />I. ns o\ n.r .l'lhe prop€1y. ar Bclusivcly conrradins \ irh li..nsd cofltr.clos lo con(rucl rh. pmid (s( 70,1t. u6'nd <br />and lhfssin ( od. rh.Contackx's l.ic.ns€ l,a\c do6 nol appl) ro a.orvnd olpopdywho buildso' i'npror.s rhcron. <br />I hove ud \ ill tuiarain a cedifi.ai. oacoNd ro Sclf'l6xrc to' so.k6 .omr)mrion. 6 ,,or idcd lor by Sdio. I700 olrhe <br />rllr)r ('ode. tor rhe pslomBnccoflhc *!tI for $hich lhc Fmir is Gsucd <br />lhar€andNrll'naimai.{.rhnt.onrN'solioninsrance.d'equtqlb!sdbnlT00ofth.liborCod€,aorrhct€foiinanceol <br />lhe \ror* ntr*lichthis pd n is istr€d. MyNorlm c.,.Fnraton iNure.c.,nid ddp.licynumb.r e <br />Ireniryrhat in rlrndldnl.n.eofthe*ork for shichrhisp.flnir is irsu.{. lsh.llnoi a.pkrt anypssor inaf,rmannq <br />s a ro b.$me srbjd ro rhr wor*6c.ompGrion la*soacaliaomia. a.d as'.r rhar ill should lE.n'c $rbjdl ro lh. <br />$orks'comrcnstiont(lisiotuoaseclionlT00ollhetlxrtCode.lshrll,ndhwnhco,npl!vithlioseprovisions. <br />WARNINC: F^ilurc ti sre $orke6' compcr n,hicd xn .l plutd t) dnniflal |amll6 and <br />h .n. htrnd'ed rhoNan.l d llrrs l$xlr. dr rxlcs rs plori(lc(t la' l1r <br />sdrnr' l016 ofrlte tabor (irde i.rE6r an a <br />r) r.( I \k \ I l(,\ <br />I lprcby.mnn utud pmahy of p.rjury lfrar I an licoed odo provisbn ol(-hipl6 9lcomnrcn.ing rvirh Sdion 7h$).rr)ivhion l <br />oI rhc &sin6s Md Phadiiod Cod.. md mv licos€ is in lulllorcedd cfldr <br />CONSTRUCTION LANDTNC ACENCY <br />I hd.by 0mrm und€r Fnalry olpsju.y thd rh@ G a codtudion Lndinr as€ncy forrlE pdfomr&cc olrhe$rk for rhich rhi! Frmn is <br />issu.n (sd 10e7, Civ. C.). <br />AEIIICAILUECIrItrdIO! <br />lhoett afln undd rtrihy olptrjury onc olth. follo\ins declMali.ns <br />Ddnolirrcn I'ermils-AsbsnxNoria.arbn l;€ddrl Rcctrlanons(lilled0, I'an6) <br />Reqtrtrtd I clrs.rN.tfi.irifn <br />ns eAddin! dlsros enrolnl ale n.l applic.blcrorh6 ptol.Ll <br />rhcaur\cinronnarnris.ordr l.Brerocomdysnhallciryand('ounry <br />n.a hs.hyaurhorta reprGonariv6 ollnis Cny dd Cormr ro.nl6 up.tr drc <br />rl <br />T 0/rD PaUlui <br />tL lt <br />,-: <br />:i$##:"NY':::. k*''im <br />t 7 \ lzf,grl3^rll <br />l hc'ch) rm"a un'jfl rd,i),,1 p6J,n oF olr\. |.-IlR rF,hldd.^ <br />i <br />Handicap Req.