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SITE-WORK DATE tD/srG.COMMENTS OWNER BUILDER DEI]CARATION
<br />I hq.ty .rm ur& Fulry ol Frury thn I m a.npt 6oh tlE ( ontr..16 l-ic.e L.q fo, fi. tollowitS ren (Sd 701 I 5
<br />B$in63 .rid Proldion co&): Any Cily o, Coilry *nah 6quiG . Fnil lo m'Elu.i. rla itpmE d.Dlilh or Ep.i ev
<br />n^.r4 Fi.r lo il! i!!ll!e .ho Equns tlt lgpltDl lor ru.h Fnil lo 6b a !i8..d srdml th, & or dr it lica!.d F8rrn
<br />to r,r FovnFo of $. Co.Erld't Li.nr.n L.* (Cn.pld 9. Comirs snh Serb. 7O0o of Di\ibn I of $. BBiB xd
<br />Pof*io6 Cod.) or thrl lE or 3lE i! dmpr fic.fron ud ih. b.st tor th. !tlc!.d .rorlion an, vioLtion of Sdbtr ?011 J bev
<br />epliod f.r . Fnil subcls rr epli..,n ro. ciril FMt) of mr mrc lne fi\c h!.(H &llrs {1500)
<br />-1.
<br />s orc ot0E FDpqrn or my alplo)d vnh s!s6 6 llEir $l. 6nFEdiD. will & lh. *oI &d th. rtudm i hl
<br />illadrd or ord.d for sl. (SE 7O,l l. &Bi!B Dd PtDtB66 ( od. IE Conndd ! ti.e t^ dd ml +Pry ro, ow of
<br />rh. FoFty who hil& or unFDG lhaol! ,i wbo &6 sh mtt h'mElf or h$lr or lnmugh hir or hi om dPlot6.
<br />F.viLd rh,r 3Et 6F.rglt6 Gd nad.d dotu tusE l[ lb*6q.IIE h,ildi,a G hsDffi irnuwihjI*yt
<br />oaco'nOLtiotr thc(xnd Builda will'aw lL b'mtorofF!! grhirEorJFdildhnBqtrnFov.dEFtrFtyftrrlEF Feor
<br />L s osM ofrtc prcFly. u ci.l6i!.lt contr.dirs vilt lic.nscd conrt(o6 ro codrud llE Fojc.t (sd 7044, BBK
<br />!t Prot&.i Cod.: Tn Co ddd . L(.e lr* d€ @l @ly r. 6 o$E of FoFry *ho blil4t ot inprotd rhq@..
<br />sd who col{dds fo, ,uch Frjdr wnh r Codtuo(J) li.dE d puau&, b th. Conrrrcldl Li.@ lrr)
<br />I m.rmf, uidd sdd .B & P.C. for lha@n
<br />oir.: Or.c
<br />\IO{XE.-(' CONiPf,NSATION
<br />DECIASAIIA!
<br />I hs.by lnirm uidcr Fun, oa FJu r.. om ot lh. folh$ nu &tledioc:
<br />-lh,t
<br />!n*illmi.inrCdltta.ofco@rtos.lf-lMt.fotuql6.6mp.Mln,\6Fo\iLdaorbysdrion1?00ofthc
<br />)ffi;
<br />for th. paformoc. ol lh. ert f.r *hth rh. pdnn is isu.d
<br />wo .r' onltsBdren nsurm.. a r.qu,.n b,v sd nn 1700 of rh. ttbor (bd., for tlE Flolrift. ol
<br />Dn i$ro& cMia dd Flicy ounba r.:
<br />l.cni&lh.l u lht Ffo,llrs. of tlE {ott for rhi.h lh! ponn n iq.d.l nr[ mi qnploy 6y 94)n in .nv nu6
<br />e s ro ba!m. $tijei io ri. *ort6' onFE ion bs oa(_tliaomi{ &d teE lnt irl {buld bcoft tutiet L tlt
<br />wr*d smpadion privitioB olsdion l7m of rhc blnr
<br />@pl'rF ro simin l Fdi, !i
<br />ion, dmrq6 s Fovil.d lor th.
<br />\iARN|NC FrluE lo su. *nrra omD.Mio. o\6.3. it
<br />civil abd up to orc hun&cd rho@d dolld ($l
<br />Sario. t076 oflhc lill.r Cod..
<br />I hftb) !,Im uds Funy olFjuy thd I m FDr nion oa(1E is g (oMdi.s *nh S.dion ?000) ol Divirion l
<br />ol rh.llusind ed Prcl*i.BCod., dt my licN is h fullfo,ccerl.fifl
<br />C4
<br />".,,,JIo - ?t -J6,"",
<br />I bc.by .rm u!'& Fdy orFjury th, lhq. i! r otdNclbn ladiis ,so.y aor lhc FfotrMcc of th. mrl tot rhkh tht Fmil i!
<br />$ucd (s< l()97. ci! C).
<br />l..nJ.r ! N.m.
<br />-
<br />AIE TCAtrLIICIJEAITO!
<br />I ha6,' .rftn u(b Frh, of Fjur, oE of llE lollou ins delfd ioB
<br />Dsmlnion PdirsAlhdro! Norificltion F.d@l R.sul.lio6 flnk 40, Pd6)
<br />-R.qunoJ
<br />laro of N.i6.rih
<br />I ..lrt rhr 0E t darl Esuhti.6 ESilns Btd6 rcm\ il e tun +plk.bL to lhi prcrd
<br />-lcqiitrhd
<br />I h{* Bl rhi!.lplkrion i(,n is .ord I .att k' .dmrly wnh lll Cny ind (butrr,
<br />ordrnffiG !fljst'r.l^. Ekr{ t rdhiz rcF@dn6 .f lhis Chy !d Coutl) ro ala $on rlr
<br />lhrvc malk'nd p.oFny aor
<br />ADDli.!nl or ,\E0l Sknir I
<br />-^,,, /o' e'/'E
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathing loho/[4r/hfi-/aL,'
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drylva ll
<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 />FINAL t// f//*B44rrr,/r?,'
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc.
<br />BUILDING- INSPECTOR RECORD
<br />/a a_6
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