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BUILDING. INSPECTOR RECORD SITE-WORK DATE ID/SIG.COMMENTS OWN[R AUILDEI' DEI,I('ARATION I lE.b ,nm unLr FMlr) o{ Fjlo lhd I m .rmFl nlh rlE Conrtrod Lte tl* Lr rh. fulhuin8 r6n l9r 7011 5 BBinBB and Prua6ion ( G.i.) Any Cily or ( o!ry shrch r.qun6 . Fni ro coNdd. .1r.. mtrov.. &nolirh or qFn any Jlruc1u.. rhr ro its isudE. ah. 'qqund rh. atplicol fo.u.h Fmi kr 6k a s(n d 3ldool rh,l l8 or sic n li6rn ra,Ml ro rh. rh\6ioB of rlE (-onrerorr t.'c6*d l,q,(Ch. ( 9. (onmftrs *hh sdio. ?{xro of D.rrF.r dtrh. Bdrnd t.d Prcfsnlns Cod. ) or rhar n or sh. B .r@rr rh6.non &d rh. h^!ir for rh. dll.8.d .rnplFn Any vFhl 'on of Sd hn ?0 r l 5 b any qrl'.ur for a Fnn subj<r! lh. aplli.er lo . rilil p.nrl y of nol mor. I hs fi\. hunLtr.d dollar I1500) I,6 0*16 of rh. protEty. or my mplolB n fi u!s6 s lhctr vnc.omFdion. \ill & th.$o* ttd rh. ndm k n{ inrsridt or oFr.d for srl. (Sd 7014, llusrGi Md Prcf<ioB (-.d. Th. (ilnlrackr! I-ad3c I r* d.6 nor tpply i(' M o\ !d ol rh. Ftrrd, * ho hoil& or ulrrc\ElrEoc ,n rrr &E sh nn* fiim*ll or h&lf or rhmwh hB d hd our 6110! c, Forid.n rhar such mF.rt1ds r. nn idarld-1.. oitdrd tu sk Ii lssad.llE t! l tg or mtnr.:rd n $ld tr ihr oN )d ofsmpl.lion. lhc ( xud Burrld will hrv. rh. htrd.n ofln)lins rh, h. or sh. dil rcl huild or nnFovc rhc F)rdy tu rh. t{!B)s or L 8.$nrofrh. Fordy, m dcltrrir.lyconrrcliry snh [cdrd coilriclo^ ro cddtud !h. rmj.d tsc. 7O1.r, Dumer !d FstsihC.d.:1h. Conlrrlor t l-icd. lrs d66 nor.ptlr lo M ou.6 ofp.olEly sh. b!il& ot imprord rhdmi. rnd who oddr lor $ch pmJ.dr lnt ! ('onrdo(r ltds.d p[6u.n lo rh. ( odrdoar l-i.(c l!*) I an.\.'npl trndd Sdn,n li & P{ l!tr rhii Y.n lr.t.: ornd woRl(Fiis- ('(rNiiiiNsA noN lrlclaf,Allo! I hd.5y rmm u..Lr p.nah) of FJur_ oE ofr h. follotr in3 .k(l{.rioB I h,E drl tr ill hai.rain r Cdiliclr. oaconst lo s.lf.lBurc aor \!rt6 con!4r!lio.. d Fo\id.d lor by 56lnrn l7{xr oalhc lltor Co<le fn lh. psfolrl@c orrh. *tn afr rtth rh. pdmn a &ru.d Ihr\..nd\!illnrim.in\frtss (o'npâ‚¬nsark,n insurrtr.c. ns 'qur.J byS(r r rrrnolrh.libor{i\lc. forrl'r |rrfN rtrrcof :T-il"'il;,?- :1' "7: ;; I "a*,""^*.AL,L 8?1 2 8A csir orl Flt) .umhq uc '1f4"1;a :f,zfrs I cqri0rhat in rh. pslirm.c. drlh. *ork for whkh lhB pdmir r is!.rj, I sll.ll mt 6do, lny pq$n in tny mena $ c 'o tE<om sutid h rh. $0*6 NmFEin. h*r of Crl'aomiL dd {6 lhr lf I 3lblli baom rubd h rlt u'od6.omr.nelionon'vliocors..lirnllT00otlh.tlborCod.,Isltrll,fodh$irhcompLuntlho.rnvaioa NARNINC: Fa'ltrr. ro Rurc *0r[6 connef,s.rion (o\d.3â‚¬ t 0nhBf!l. d shnll rubjdr tu ro h (rtrftri,llan.'lr'6 anll .ni! nn6 up ro.n. ho n.d rhoend {hlhB Itl(x).O(x)), iI idlibn ro rh. co{ ol &m!36 c I'rorid.d f{tr rh. (-oda inrdd ard atrorE!t 1 Ihd.5yanimundoFn,ofFjuryrhdI$licaldlond6prnvisionof(hsplq9lcomdcin3snhsfttion70m)ofl)ivhionI of rh. Bc!6 !d Prcfeird Cd.. -d m! kru i h tul nn. di.lTRt 7 ct1 -2 l],4n CA.NSIAI(]]ANIT;NDIdG.6CI!(I I hcby ,mrm unld F,sll, o I p6jury thal lhdc n ! Nnllruclion lgxlrng asd.y for rh. pdfomsc. of lhc work [t uhth rhK lrsil ii is.d{s( 10{7, cir c } AXTLI(ATLDIi(].AAAIIOT I hdrhr .rm rnd6 F,h) .f Fjor' oE of r lE rolb$ inr dclu' ions D.Dol'ri'n Ptuirr-Asb6ror N.ri6.dio. F.ld.l R.guLn'o.s (Tirl. {0. Pan6r lcrun.d ltrrq of |{rilrdio. I cdifyIhd lhcfâ‚¬d<alr.rulll('n! EsEd'nB &jbeiroi rc'no\ rl . nor drdicabL b rhis pt.td I.d'tu rh, I h'\. r..d rha.ppli.dirn drj ri'. rhd E.t \.'n k'n 6 cor..r I ts6 ro odpl! i nh all (-tj tnd ( r'unrt ordin.k6..d Sr.r. lr{. mLnlE ro G?rMrrltrd ol rhit Cny .nd ('ounr) lo arq upon lh. !hov. m6lnn.J pmtEny in tf>/rr rld dE Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loor/VenVlnsulation Roof Sheathing Shear Wall Framinq lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Enqineer Final Report Flood Zone Certif . I FINAL -Yfr/t.r .bret) Certificate of Occu nc Notes, Remarks, Etc I I I I I I I I I I I I 5c