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BUILDING- INSPECTOR RECORD SITE.WORK COMMENTS O\A'ItER BUII,DER DI]ITARATIoN I fi(.hy rllirm undd p@lry ol pqur, 'hr' I d .r.dr,l t m rh. ('6nrado6 l.'ccc lls ftn rfi. fol6w'ns r@n (sr 7(rll 5 &!hs 3d Pr.r6i.n Cod.l An'('irtor(ou t$hkh r.qut6. Fmir ro codtud,.lrd. inF.r...lmtrn or Ep.r ey srtu.'m, Fkn ro ir! i!ium.., .ls equr6 rh. lpplicer lor ruch p6nn h [L i ]isn.d r ffil thll lE or sh. i li.dEd punudrr ro tlt Fnrirod of llE (i,ntklor's Li(.B.d lr$ ((1Bp{6 e, Comm*i.3 $nh s.cthn 7m0 ol Divrbn I of lh. Buind lnd Pmf6sion3 ( odc) or rh lE or 3h. I smpr lhg.from ud lh. txi! foi rlE rlks.d 6dpri.n. A.y \ iol,rron ot Sdr. 70 r t 5 b) lny aprli(Ml tor . Fmil suhjdB 'h. .p?lkd ro . .i!il r@lty of @t mr. $d nv. hun&.d &ll&r (1t00 ) t LBowndoflh.proltny,orftycdployGsnh*!s6slfi.n$Lco,npcr5.lion.qill&dE*ortsndllErIul@inol i.rdrd.d .r ofi6.n fs rk (Sa 70{4, BGiEs od Prnf<ioB Co&: nF Codrrlorr LaGE tlu'&d m' .rpl! ro a o{ffi.1 th. Fipary *lb hil& or mphr6 rhaFn. id sho &E scl NrL himiclf or hdklf or rhFuah hn or hq o*r mpLryâ‚¬. Fovid.d rhlr such inFordrErll E ml nc'&l or ofi.r.d tu *. lf. trq@, tE bitlirB or ihrmlliH ir Fld wirhin or y6 ot cotp|dm tll ()+G IliLld rill lb\! tlE hrdar of trerds thi tE tr lrr dri et hild o, urtrrow th. Fpdry ft, rlE FrF& of l. a os n6 orrh. prtrIEny. m .rctusn'.ly codrdinr *nh l'..G.n .ontrdoE ro codtud r,E rmr6t {sr 7ol r. &am6 .nj Eri6m Cod.: Th. (irntn(ttr s l-irdc hw d{d nor dptlyro do}nd of l()Ii6l}. trho bu'ldr or idpror6 rhsnrn. ed *h. conGr] lor .h Foi.(3 u nfi . ( offio(r) lioE dt'o,.drorlE(-odtudsLa.Mt w) I m.tmt, unds S(rFn rr.t. O*rd \[oRxrRar c-irPE 'rsa iiaii DEqIAAAUSN I hs.tD omrm und6 Flhr of Fjlrr.e oath. aollos i.g d<hntird Ihavearluillmrinr.ind a.n i6c.l. ol CoMt I. s.lf-lGui. for sl d .omp.nerion.6 rolid.d nrb,s<rion 1700.frhc t tty CdL. f.r rh. Ffollffi. ofrh. trdr fnr rnth lh. Fn't i, isud I hlvc ind srll dinlrin tr 0116 conFcsrio. iEu.mc a r.qun.n 6y sdrion :t 7m .f rh. ktr)r co&, aor rh. Fturlfu.. ol lh. r.d n, \h(h rhis p.rn s s{cd M} $o 6' omFM'o. ituurft..eir id p.l.} numb.r e. :lO r G\oht \ {r"rge".^c1 â‚¬=b3E\,G-Lzcr{'r'asc'l b ,t? I cdiry !h.' in th.Fto@nc. orlh. work tu which this Frmil i! su.d. I sh.ll nol drployany Fsn in lny mann.r $ at ro b.$d st a o rh. *cl6' onFM b. h*r or (-iliaomi( .nd +r lh, if I 3r.uld b.(om $hr..r ro rlE$!dd compcnsxon rrfisiod of S(1bn Uoooarh. trbor (.d., r sltrll,Ionhs hco.Dl) wnhrh.*FovilioB WARNIN(| l;a,lur. ro kurc rork6 .omFlsrion (.r is unhtrtuL ud shlu 3ubFl u oplo!6 to omiElFEhE and cnrl [n6 up ro ok huRt.d rli'usnd d{nlB ltl F iddnnn ro lh..o!l olconrE@rn,n. d. s6 * Fdid.{ ror rfi. Sdrkh 1076.frh.l.abor ( Gl. 'nrdarandart2/nltl- ^ 0t .t I hchy lmm un'ls pdnlty o f pgjury lhal I am rnd6 prN iron gf ch0tr6 9 l.om M. in! rdh ser iof, 7(r(D) of l)n Gion t of rhc Blri'B &d ProldbB (.dr, dnr l.6s s 'n 6rilrnK!i.fINr c 1t ,.",K2-looq 25) tfof rr f,oSe?o eocp llllirBucrar[Edltlc.6cEd(l I ncty amrm und( Fnlh v of Fjury rhd rh6. ir r o.ntudirn Lnddx asd.) for rh. Ffomm.c of 'h. *or{ li{ whi.h rhn F.mn i L$0el (56 :1097, ( n cr APPLI(]ANT D'CI IR,{ f I(IN I Eur*.6m undd p6.hy olpdrury on. of 'h. follo*in! ddlar nrns: D.mlition adnngAsbGtoJ Norar.dhn fd.idl R.suhrioE l'tnE,r0. Pan6l R.gun rj Llrd oaNouficalion I .61'ry rha' rh. r.J(ilrcsuldrnN qrdiry sh.srx rmo1.ls.60r arrFlicabl. k) rhis flojdt I cdiib 'nd I h.!. rdd rhi, .pplrdion dn nd. rhd rh. atnr. infoddion n .ond I .Sr( ro Nmrly *nh rll ( [, rnd (nd! ivd ofrhi! ciiy.d coonry to ols upon rh.odinnn.6 and starc l!$s Flllliry nl ldln* codstrudio.. 0.d hr.bt ,urhon,. rqi$rd vf nf tr Set Backs Forms/Steel/Holdowns UFER Ground SLAB Floor Subf loor/VenUlnsulation Roof Sheathing Shear Wall Frar!ing lnsulation/Ene Drywall Ext./lnt. Lath Brown Coat Pool Fence T-Bar Handicap Req Drputy Final Report En ineer Final Re rt Flood Zone Certif t. FINAL z?- Certificate of Occu pancy Notes, Remarks, Etc DATE ID/SIG. $o\c mrKn.J FrFn! r,n urrr6n nu.Fs :::::::::::::*";-e3):L"2'-P.rmrh n.m. , prino: -L VJJ6.ge Erection Pads l I Masonry I