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BUILDING- INSPECTOR RECORD SITE-WORK DATE ID/SIG.COMMENTS O$NTN bI]ILDER DEL('ARATION I hd.try lrrm undE pqBlry ot psjury thd I h dmF Fom th. Co r!.roB l-'..@ lr*' for rh. f.llo*ss r@. (sd 7011 5 Burnd drl ftoadrn Co&)r An) Cny or Couri) *hih EquG r Fni 'o .orutud, .hd. improG .lamlirh or rqrn Dt nru.r@. FFr to ir! 6uftq .to ..q!n fi. epli.ul for 3u.h Fni h 61. . ciln.d srrlaat lhd h. or rn. b [ctu.n plmd lo tn. ForisioN of tlE Conlr&clo.s l-icd3.d lrw ((fupi6 9. Conmdins snh s.don 7000 oa ON nie of lh. t dilr6 tnd PnfdoN Cod.) or rhd lEcrE B.Gipr ths.fton dt rh. b.!i for E.lle.d datr,rio. Anyvbldbnofs<irn70:ll5 brey $plicsi for r pqmh iubj6t! th. appliwl ro r riril r,6l! y o f not Borc lhtr 6t. h!n&.d doll6 (3500) l. a o\c of rh. FoFry. or ny dngh'6 u nh *.16 s rh.ir $h (ontEdion. will&r rh. "'o &ith.nd@bfrn iddial or off.rGl for s]. (sa 7044, BsilK &d ADaBoB ( od. Th. conrNo.! ti@ LE d6 mt +ply lo d orc of $.FlFry wh hiLl m nqD\E tlEEa !d s lE &6 sh ${lt hinElf o, hell or 0hush hit or h6 oM .npl.ya. providcl thar 3uch inFoy6mc ft mt idqxt d drolrqd tor $b. If, ho*!E rlE hrBrg or fiFivdrd it $ld wihb.m rd ofconplai.tr tIEO'rG Aollk siu lEr E hfbi ofF.rru thr lEd lrE dil br hxld or in4r.E th. FnFry tor $. giFr of L a o*E ofrh. trcpdn n q.l6ir.ly conrra.lios w'th lic.as.d comdclo6 ro .odtuci th. pmjd (sd. 704,1. tlBms !,rl PEk m C.&r Tt. Conidorr Lic.c ltw &E mr {?rr ro 6 of,ro oaFoFr! *lh bdilds or iftprcv6 rh6oa &d *tE o'rr.cr! fd ruct Foj6l] wirh s Contrrlo(s) lkascd pu6u.r b rnc ( odracrofs l.ndE tj*) I m.rmpi un& lidlbn D.r. Or.d }aBrit:all(alltr[ltrl9liAl(rr!&lll0l I hs.h) .mm unds lEalrt ofIEJUI)o.colrhc finl,Nrs d(|ffi..trs: I hac 4l *ill Mime ! CBlifrnc of Consi ro Sclf-ler. for w.rk6 $mFMtutr. s povid.d lor by Sdon lIN of rhr l,bd Cod( fo. lh. Ffomft. ofrh. wn tu *tth rh. IEmn . KU.n I havc and vill mlinllin uork6 compsEalhn iBur,ft., 6 ratun.d by S<rFn 1700 of rrE tlhor (td., lor rlE Ff(ffi. ol ltE Nrt tor *'hrh rhi Fsi a ilr,cd My $dt6 omFadion iMdr.6ir d Flky numlE e. I.drfyrbd 6th.Faollffi.of th. *orl lor shrhrhnFmd i! su.d.I ih.ll mr 6pLye) Fen in uy@F e d ro b6oB otirr ro rlE *o.ra' omFlrio, Lq! oacdilom! .d dsd lhd if I lrbuu b<om. luqd io 'lEwo 6' comrE!.rn'n pmviioB of Sdion l'7({) ot rh. hbo. Codc I Ju[ ronn*nn <'nlplt wnh rh.* prorilioB WARNTNG: F.il@ ro B@ wla smFutiin ova.*. i! u.h{tuI. di rh.ll sbj.( D anpbrq 'o EiniMl Fatis ud cnil ind up h on. h,.&.d rhoMd d.l Sdrbn 1076 of rlE ljbor ('.d.. in!6d 6d ronD(M'ion, tlamr6 6 Drovd.d ror rh. 3 I HD'attm und6 FEll) of Fjury lhd I d im\ .iotr orch.prd 9 (&mnins + nh s..rin 7000 ) ol Dn ision :l of rhc ltGiIB en PmfsioaCoJ.. od nrylic.N ir in fullfor.cmdâ‚¬fidr l- t-r 1l!L:)-- 1u-1-)q? I heby .rm un&r Flhy o t pqjury rld tha. t . odrudio. lsldh, .Bdy 6i lh. Ffffic of lh. N.l br $nth thb Fmn i is{.d llic 1097. Civ C , ATTLI(3IiITECIJSAIIA! I ha{'y rn'fu uMt6 psrlry of Fjury on. ol rhc follo* itrs dc ld.tiou: D.nDlilion Pmil!-kb6lor Nolifi..lion F.dml R.gul.hnr (Til.,l0, P&16) R.quir.d ltrt6 oa t{di6dion Ir wirfi all Cny !nd ( ounry ' sd Counry 'o 6ls r4.'n tlE DI V:t Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loor/VenUl nsulation Roof Sheathing Shear Wall Fram ing lnsulation/Ene rgy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif FINAL W t;a 5. M ',17- ila {l Certificate of Occupancy Notes, Remarks, Etc. I I I I I I I I I I I I I I I I I I I rcguhtrcN rqrdrng ilsh6t\ r.nFvilar. nol appl'crhlc(,rhir lrt)ql l\,t,lltv-