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SITE-WORK DATE rD/slq.COMMENTS/ASet Backs
<br />Forms/Steel/Holdowns K-1-/ [It"wli)
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Rool Sheathinq
<br />Shear Wall //)
<br />Framinq Kl.ld D,V-L]U
<br />lnsu lation/Enerqy u \./)
<br />Drywall 7-z( -/g .lr)uSdfu &//
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\4aso n ry
<br />T-Bar
<br />Handicap Req.
<br />Depuly Final Report
<br />Engineer Final Report
<br />I
<br />FINAL 4)hlt{'(Y7r\Ue Vst)
<br />Certif icate of Occupancy ( l r U!
<br />Notes, Remarks, Etc.
<br />BUILDING- INSPECTOR RECORD
<br />li.rd hr r |trnir \uhjccr\ rhc af!lnrnrh u.iviltctrxlry.ln.r.xtrcrhrtr fiv. Iundrctldolh^ ls5(x))
<br />l..sowmroirhcporcny.ormy.mployccswilhwtScs$llEt\n.\nnPcnsrrion-willdolhework nd llL (n'durc is nor
<br />dcndcd or ollcrcd io' uE l Sd 7(N,l. Bu\irrcs tnd l'rolt\\ion\ C{xh Thc (bntrcr{r \ l-itci\c ti! dG! noi rPlyro osncrol
<br />or irrDrous rtcE,n. rd who des suh *nl* him\cllor krsclfor rhmuSh hi\ o. hcr.encmplotcc\.
<br />n['.vci]nsrrcNtrrcndcd.r{ntirslfttr\rLltho{cqr.rrf,ln,ildi',!o'inr|lortiE n{rldsirhi',on.}tn,
<br />ihc O{ncr AuiUcr srllh{rc rtL hu',lcn of lr,!i',! rh r lr.r Lh. did f,or tdild.r i'nF,c rhc fmrny
<br />is owncr ol rhc lropcdy. amcx.lusivclycontrlclin3 sirh licciccd.onrrrroslo.l,nndd tle lmr.rt (Scc 704'1. Busincs\
<br />t'i.fcssio.C.dc Thc (nnr6cior's t-ic.n\. Lrw docs n.r inPly ro an o*n$ o r rhrl. y sh. nuikl\or i'nfolcs thcrco.
<br />rn(l uho.ontxrr\ktrnrhtnoIr^*irhr(nntrxtrr\)lL.r'MdDU,{rrnlr)rlt{i)i'r((n'\1tr!'s.lx$]
<br />;:U[4,e-"'
<br />DEEIdBAIII]N
<br />I h.Lbv Jllin, Lndc' .cnakvo, ffiru^ onc ol rlre lcll, s tr's JftlJrJrFn.
<br />1K",,". *'".,":.:nincrcnrc'r( h scr;rNu. ror workcrr.o.,!cnsarion. N pmvidcd ro, hv ssrion.r?m or$c
<br />tryfr"o". r, rt. s rt.nrunc nr,h. q,1l r.' uh'.h rhc ncan i. i.suc'rf-#
<br />Ull-hlF,nd wrll rinratr' wnrlc.' c.mFnsahntr insursnce. as reqnhcrl hy Secrion .!?00 or rhc btnr Codc. fu rhe FYti'rmn'cor
<br />ih. work lor which rhk pdrnil is isssd Mysorkcn .dmFnqri{ insuruncc orict d B,li.y nun$cr sc
<br />Caricr.-
<br />nfr'r.colrtu$orktur$htlrrhrt1(rtrirn\!Lc.l\lllltrrr.DIn.)rni-Pcnfrrtrr'!n'xnN'
<br />!) 6r.h.cotrr{r6lc.rrnrhc\orkcr(.D rf.r\rii(,n htr\oIC lil(ntrir. rl rlrcc rhrr if I \k{ld h.onk n'hicr t, rlk
<br />q.rk.6 ..nrpcn\rri0n pn)vi\ii
<br />'q'.
<br />k,ycr h.rimi'[lIr ri$ rtrd
<br />nrg$ rs po('dcd lnr llr
<br />Ltcr\suD 11)N {,\c l()R
<br />l]}l(I BrlUali
<br />I hcrcby 0lljrnundcr penalryorpcrjurylhor I lnr lien\.d lnder pn vkiotr olChaPicr 9 (.onmncirs silh sc.rid: 1D0) oi Divi\ ion .r
<br />of rh. Bu\ikss atrd Prcic\sionr Codt, ,lrd m, llccnsc h in full tut& rd cllal
<br />I ic.tr\. Numh(r
<br />CI}IIIBIICIQNII,NI.UNG.EGEN.CI
<br />I hcrh, aflirm undcr lcMlryofpcrJuryrhar rhcrc G r coNruclion lcndnrt aScmy fu rhc p.rronMme ofrhc *ork lar $hrh lhi\ lcnir i\
<br />isucd (Scc :1097,Civ. C ).
<br />lxnd0'\ AJd,-.s
<br />-
<br />APPLICAN]' DF( II ARATION
<br />I ns$y anim u.dd pctrrlty oircrjrry.trc ofrhc folloqin8 dcchrlrions:
<br />Dcmlirion Pcrnih Astrslos Nolincari6. Fcd.irrl RcEulrlio"s ('l'irlc 40. Pd6)
<br />_Rcqutrd hn.rof Norif c.lior
<br />h)vc irfonnr(i0i i(.otrccl I
<br />rchyaurl(trtrc rcllc€nhr
<br />rholc trrnrioncd lrop.ny ior
<br />A0plionl dr A,rcnr sitnllur.
<br />-fF€
<br />rlutw ryUEry
<br />Pool Fence
<br />Flood Zone Certif .
<br />OWNER BUILDEI DELCARATION
<br />I h.tuby,rfirnr nndcr tcnrlry or p.rjury rhar I nm cxemPl frorn rhc ai,nta.ro^ Li.cnsc tj$ ru rhc rollowin8.ca$n (st.70:11.5
<br />Businc$ nnrl Prot$n,n Cdl.)r Atry ciry or Counly which rcquircs a !.mir ro conntucr' rlrcr. in{rovc. dcnoliril .r rcp.ir anv
<br />srrucrulc. prinb irs hsurncc..lso rcqunesrhc qrpli. r tnr su.h Pcflnilro lilc ! \isncd {.tcnf,nr rhal tEor shc ( li.cntd Nrur
<br />!, rh. Eovhio.s ofltr Conrla.rofr Liccnscd ti* (Chllnrcr 9, G'm!ftn.in8 wilh Scclion 7m0 or DivGion I or rh' BD{in's r'a
<br />Plofcsrion\ Code) or rhd 1.. or shc hcrcn, rhcreli. rndih.hrhlbrrhclllcgcdcrc'nprion AnyviolalionolSc.rion70.11.5hvan,
<br />I.cniryrhd t[.ltdcralrgulrri(,ns rcanlilr3 rstc{os rcnmvrlsc n, rDnli.]hlc ro rhir trojcr
<br />---I_
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