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SITE-WORK DATE ID/SIG.COMMENTS O\i NER EUII.DER DELCARATION
<br />I h<.t, ,lIrD u.&r Fut) .t F)uD thd I n .\6ti n m rlE ('olird6 l-ic.K lrn for rh. folbsDl r*r lS( 70!l 5
<br />IlGr,ld ad ftofB5n Cd.) Ant Cd) or Coud\ uhKt r.qu(6 ! Fn( ro omrucr. ins. inl,otr, &mlirh nr qJr r
<br />rrudue Fnl ro iri isue.. .L r.!uir6 ih. rptlier lor iuch Fnn b 6k 3 !C..n srmr !h, & or rh. ir licded pollld
<br />ro rhc Fo\ishB of rlE ( ontEro.! Lrdr.d lrs (( h.tn6 e. Comddcin8 trnh Sdrn 7(XrO .a Dnissn I .f rh. Runn6 rnd
<br />Potsrcns Cod.) or thlt lE or .n. is ampl lh(cnom Md rh. tEir for lh. allq.d cropi ion An) violalion.ls.(lha 70r15 h\ rny
<br />dpplicant forapdnn luhjdr.rh. rrplica to !c'vilpd.lrrolnor nor.rhd firc hundr.d dollm(1500)
<br />l. B o$ra of th. Flrnr, o. m, mplo)6 $.ih *.86 a lh.ir $L mnFMi(rf,, will& tlE $orl ad tlE irurE i! mr
<br />id.,r&l or of.r.d io. sE (S( 7(x.1, Bsird ed PrcfdirN Cod.: 11'. Cot r*lor't L(at llq {t'6 lol Spry ro u os6 oa
<br />rlE FFtr who h!il6 Ltr n{rr6 rlE@ .d s rb dq *h F.t hiElf or lEElf n ltmush hit or h6 osn nplot6.
<br />p.oriLd rh.i rucn iormlsEn! G d ndrd.do,ofidd 6r xL l[ hqcq. r,E tlild,t3 or !!r6sEr i Fld uitin m )d
<br />of o,IPlaio( E (xn &!ld. *i[ h.\r tlE hnb orF$B rh. rE ft .rr dd m' r!,ld d i,!. ! rt< FbF, tu rlE FlFr or
<br />l. 6 o\rn6 ol rh. FoFdy, m cr.lusi!.1, .onh&r 'n! s ir h li.ar.d .ofu&1o6 k, .oNtud rlE Fo]d {Sc 7or{. I}Bin6
<br />!d EakFn C.&r I h. (tntrelors L,ic6sc Lr$ do6 nor.F lt!o m o$n6 ofFruFc1! $ho huil& o mptov6lhdAln.
<br />ind *ho.onimdrror$.hInids*nhaConlncxlnr)lic.N.dru6u r ro rh. ('onrr.llois l-(d3. t5v)
<br />q,^ n- La.ul)ariff,sloutEl6Arr0f,
<br />DECIAEAIIAI!,lim u.&r Fulll otFjury oE of trE fdlosll!. Lk Lnrh6:
<br />I h,\.a.dsillroitrlon! (.n'frcllcof Co,sol ro S.lf.lNur. f.r s Ml6 mqrdion. d rr!\ ii.d for b) Sdion r',lx,ofrh.
<br />he,r Co&. lor lh. Ffo,rrle. ollh. *nt loi *hrh lh. nannn i! issu.d
<br />I hav. a.d will niinr.in ro*6i' .ornFfrrmn insurDnc.. tr\ Ertun.d by Sdr nn r 700 ol rhc ldo' (ndq nr r h. p6lo',nrnc. oa
<br />rh. *orl for which tht pdmir i3 isu.d. Mts..ldi comlbq!'on,Bu,M...m( dd tslrt numtE d.
<br />I cdlit lhll h lh. Ffornl&c of rh. \ort for trhxh rhir F n i isu.d.I sh6ll mr 6010) lny Fqen in!.! nuF
<br />$ 6r. banN $t <r r. rh.q.n* conFadFn hrrof( llitomr ud asd rhi fI rrruld ti..m. $qft! ro !h.
<br />r o*c' onpa$'ion ,nrn EioN of sdrion .17m ofih. l rh6r ( od.. I datl. lodhs irh 6md, tr nh rhos proviriotu
<br />\\
<br />^RNIN(:
<br />L lL r r! !a r (!'l{\comFnsi.n (o\6ry. n lnhstul. dd shtrll strbjd1 M orployd to ominal Fuh'6 atu
<br />rho6and dolla6 (t1(x).(xrlr). u, trltLliln,n lo lhc.o( ol (.tr,tEn\irn,n. dana!$ 6s furkd ntr rh.
<br />(L7
<br />OE(|IAAIIqB
<br />I Wt.rm"frj.r Frh, df Flurr !h, , 6licn d un& Frlbi of Ch.lrq Iloh,lsds *hh scdnn 7fin) olDn,.hn l
<br />of th. AGitB !d PNfdirB Co<b. sd my lrN ! i. tull aorc. s'd.Itd
<br />g4*,.",,7.13- (.\
<br />caliltrlr(IlatrflDtrc_acEl(}
<br />I h6clD .,Im undd Fuh, of Fjt.y rh, rhd. i! . .onrtudir. lnlms a€ft! lor rh. Ffomm. orrn *.rl for (hi(h rhir Fni i!
<br />isu.d (sc 1097, cN ('l
<br />AIIU(AN[II:CIAEAIIA!
<br />I hqdy !trm utul6 Fndlrt of Fj!r} on. ofrh. follotrins d<lddnJn3
<br />Dsmhi.n Psnil!.AslBk'r Norifi.liion r..da.lR.!uldirm ( r(k.10, Pd6,
<br />R.qun d Ldld orf(!ili(dF.
<br />I cdii rh, rh. f.dd.l r+uhid6 Esdd'ns stBto!rmrd&. m' qrlrlbLrothE FoF
<br />I c6l,tlhd I h3!. rdd rhlt !r'9hc rcn ad slarc ltd rh. ftr\. inlomdion is cond I !*r€roconpN\nhrll( ntrnd ( ounN
<br />.dmft6 rnd sl.t.litr! Ekr[ls lo hildins conirrrnrn, drl h6.ny.uthorie r.rrMrdn6 orrhn ( ny ud Courr kr -ts !B'n rlr
<br />ah,v. mmnoncn proFnr fitr NIEtion purlDs
<br />,rppli.inr or,\gent si!trr(nr(
<br />gr.rmilm n*me(prinl):
<br />?-t7- L7 ,
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Ereclion Pads
<br />U FER Ground
<br />SLAB Floor
<br />Subf loor/VenUl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framin s
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />tl
<br />FINAL filr ltl rialff{
<br />Certificate of Occu 1Tpancy
<br />Notes, Remarks Etc
<br />BUILDING- INSPECTOR RECORD
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