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<br />SITE-RK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subfloor/VenUl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />ln s u lation/Energ y
<br />Drywall
<br />Ext./lnt. Lath
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />i,vtuNaFINALIDI t7y
<br />Certificate of Occupancy U
<br />Notes, Remarks, Etc.
<br />OWNER BUII-DEX DEITCAXATION
<br />t hdlhy .rm lndd FMliy or pa,t.y thi I m amF noE rl* cotu.ddt l-K.u t s ir fi. follof,Es .6'ri d< ,011'J
<br />tt6in* .,n Profttlon Co&) A., ctry or Couity *hi.h r.quiE . paEi ro Nnnrud. 3116. idFov., damlilh or lq.n ay
<br />.truclu., Fior ro it! i*uucc. als! eqtn6 thc rpgliqr for such FEt lo fiL . 3isn.d $d.,6t rhd h. or 3h. i! licdB.d p@&t
<br />h rh. Fori3ioB of rtE aonreroar Li.. ed Ltw (Orpr6 9, Com@cin8 with Salion ?000 of Divilion t ol U. Buins ud
<br />PmfsioN Co&) o. thrl lE o, J'. n .rdF lhccfrom md rh. b.ir for dE nkscd sdFin Any vi6l{ion of Sdio! 7011 5 h, ey
<br />i@li.d for. Fnh sbrd tlE .pplt.d lo . ciril p6rly of mt mG $a li!. hu,t&.d &rltrs (lJoO)
<br />l. 6 ow olrhc p.oFry. or ny.inphr6 vih *le6 6 rhci. $k rcnFBibr mll& $. *sr in tu rturE i5 lDl
<br />inrotLd or of6.d fd ul.lse.?041, BEi!E &d ProfdioN co&r Tlt co n.ld t tj.ce ttw &B mt.t?ly to & o$c of
<br />th. rmFry wll' hrildt or ir.prc!61td6l! nn who doc ru.h slr him.tf ot h6.lf or lhrcush his o' ha om dpl46.
<br />pruvid.d rhlt $ch nnDmvaEll E d i qd.d orotrscd for !L ll h.wd. LIE hildfu or improffil i 5ld sithiEe )a
<br />ofNnpt{iotr tlE ownc 8!il& will hlE 0E hldar otFo$ns ln lEorllEdn mt tl!i! m in4.ott lh. FoFy ttr llE F,F.. of
<br />sll.
<br />-1.
<br />s ow orih. FFry, e aclcrv.lt cotu-ire $nn lkdE d codratoB lo onrtud rlE Ftrj.s (Sd ,Olr. BEi6
<br />.nd t\Dftst Co&: Tn. Contncid . Lr.e L!* &,6 Nr .pply ro & o$ad orForEry *ho t{ild! or inprct6 rhao..
<br />6d *'ho co 6d! tor iu.h Foid! wnh ! coltdo(r) liccB.d puEu!, to lh. Conlr.ciolr Li* L.w).
<br />-l
<br />u cxmpl undq Sdl
<br />l&a8riE8s:lalEErsArrql
<br />llECIAEAIlqB
<br />I hd.by lmm unda p.n.hy of psjury on. ofrh. foltosiry &dr!l oN
<br />-l
<br />hiv. &'d *ill oir!.in ! CqtifEr. oacolMt lo S.lf-lNurc tor ertas' enrpdrtiDn, B Fivid.d lor by Sdtion 1700 of th.
<br />l.kr Codc lo. rh. Ffo'lj8. of rn ftrt fo triih th. Fnil ir is.d.
<br />I h^..,rd *ill mht.6 N*d comF6.rpn !@.. B ,atu,td b-! Sdbn !70o of lh. lllor CdL. fitr
<br />'lE Ffollm. or
<br />rlE snt for Ehkhfii p.m i! is.d My* td' .@posi6n iNur.E ffir.!d F lry !@bd r.
<br />,*- - q-otntr hfuraML.-
<br />0-Z7
<br />I cdiry fi{ i. th. pqfoffi of th. so,t tor snth lhi. Fnn L is!.d. I3ll.ll ml dph} e, Fst 'n
<br />o, nffi
<br />$ ErohaorstiirtotL*o 6 o6Fdio. hB olcdilomi sd 4ft thn rf I lrbuB t cor $B.cl lollt
<br />sond' comFslrnrn p.ovnio6 of sdiiotr 1700 ol rlE L,bor ( alq I JllL fonh*nh .onpl, *ht ltoE FlvirioB
<br />WARNINC Fa'lurc h Jr.' w. sork€6'ir urhwtul. md shrll !!bid u oplolq kr aininl] pduki: ud
<br />(ivrl fin4 ut ro onc hundr.d lnousd tun $ rhc cN of(onn Mlion, ddlBd a protid.d tu rh€
<br />s<iron .1076 o I rh. I rhr ( odc. inl6.d
<br />D&CIISAIIO!
<br />I h6.hy .JIm !nd,r FEhy of p6iu,y rha I m lic.rc.d mda F.vitio. of CIEprq 9 (comMus *ith selhn 7000) ol Drilion l
<br />ol rh. Buind Md ProfdioN Cod., rxl By licG G in tull lo(r od.ral.
<br />('ONS'TRUCTION Lf NNING ^(:EN('VI hd.by .mm undd F.rh, of ldjlry I h.l lh6. ir . consrudhr L.di0s .stu, for lh. FfollMcc orlh. *!rk for *hich thls Fni it
<br />s!cdls6.lo9?. (iv ( )
<br />ATTIICANfPIUISAIIO!
<br />I ho* ofin un& porhy ot prjury on. of rh. followin3 d.clfrioB
<br />t>mnrion PornlAthdc Notiicnb. Far6i R.euhio6(InE40. Pd6l
<br />-R.qurcd
<br />tdrsof Nor'ftnir
<br />I .dit rhd rh. f.d6.l r.Sul.tios r.sedrns 6b6tG r*nsl rc nor .Pplk.bL h tht pFj.cl
<br />-
<br />I cqrily thal I hav. r.!d thN rt lkdio.{'l.rhat 1n.rh'\r infomdioo is cordr I !*ra ro .omply with ill Cily.!d ( oor,
<br />ordiMnc6 d Sl .l$!Eltinsro tudiotr ri hd.t'r .ulhr r.F&id'r6 of rhn Cny ed Couly ro 6rd ulrn tlE
<br />rb\. morirn j pilF y ntr
<br />appli(.nr or.\gdtSign.lurc ro I urld
<br />a
<br />I
<br />g,IqIE-
<br />BUILDING. INSPECTOR RECORD
<br />Brown Coat
<br />Flood Zone Certif.
<br />^", tol2qltS
<br />,.*.* 4{rA l***"-6 ,o3024q
<br />,,,. rclJ4/ tl *.^51'-H<, t) crrtsfu.ca'n-,
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