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BUILDING. INSPECTOR RECORD <br />SITE-WOHK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erectron Pads <br />UFER Ground <br />SLAB Floor <br />Sublloor/VenVlnsulation <br />Rool Sheathing <br />Shear Wall <br />Framinq <br />lnsulation/Enerqy <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 />I I It .t / <br />'fl?7/?t ,tb <br />Certiticate ot Occupancy I' t <br />Notes, Remarks, Etc. <br />OWNER BUILDER DELCARATION <br />I h!r.b, ! nm ur,,cr,En.ll! ol !.4!ry rh.l I m ckml Eom lhc Conrrst^ I.il.n{ Ur nn rh. ldh,em! t.r{t (S.('iu}l 5 <br />tlurnc$ .Bl Prr.!\xnr CdcI Any C'1, or Co!d, whrh rcqurc{ r Fmt h &n3tu1, .1r.. ,.,'u'L. ,r"*'t"l, ", ,.p." .n, <br />nd(tur., l,xr h i. rsud.,lso r.qliEs rh. rr'tla.Dr for suhFrml l. irk r nsmd dd.Bnr rhir lror dt 6l{.i*d PUsd <br />!, llE Frvs!'nr .l rlE Cotrrr xtr r Lirnrl L,* (Ct:prc, 9. Conmtms r h s. on ruuJ dr Drvsrm J or lh. Bulmrr .&i <br />Ih,l.ar(rns C,xL) M rhrr tr or rh. a crcn1Fl rh.r.fiom rnl th. b.rr f,tr rhc r]kfcJ .r.nirir A.y ri.,llrk'n of S(rrt m] I t hy $y <br />rl4'ltrrnr f( r Fmr \ubFrt rh. lptlf,dr tJ I rivil p.MIy ol n, n!( rhrn av. hudral doll{r ( Sl(tl) <br />_1, I opE ol llE FoFny, or ny cnploF6 vilh trae .s llEn sb .!trIENrEn. w l & rlE *dk ,rr 'll r,EE a ni <br />ddrjal ,tr ofi.EJ tu el. ( Se.?oaa, ButiK .nl Pmf.$hN Ccj.: Th. Csrrr*r(\ Litu L, r,{xr tui {olt ro rn ow or <br />rh. Fld! ehl hr & { !qn6 rtEE4 .rn sh, &E uh uf,t h,relf d lrrc], o. rlnrth nrr r ,!' oq .lroltFt, <br />Ftrtrldl ri.r ruh hFtld!eddaildlddfiddn rb.ll tsw, tlE hlIlIE liFEld i! r:tl rahrc F, <br />.r$ryhn llr OrEr Buil,s viu llE dE hrilor of Favls lnr h. q !& .lil d hlllr n lttht t E F!Et! ld lh. FIFE ol <br />_I. (o*ffiolrlr Firdrr. a.ktusiElyofrro3 * h l.a€J Lurrdm b.rb{ur rh. <br />'n'Fr <br />(SR 70,L.86lls <br />lrl hllNr c({.: Th. G,nrBlm e L..ns Lr* d(B R{ .roly lo u o*E of ,ioltny tlb l'{rur M !ryntE. rh.Rr. <br />.d *no lr,nBir rd tuh FDj.<r *nh. codfurdl3) lrdE rl ro6d ro rlECo.rair'r lroE lle) <br />_l dcr.nli udt r Sd <br />roa$iallrautEtsArlo! <br />DECI.ITIAIIAN <br />I h.rchy tlftrm un.[r tEMIry of [t.!r] rE orrlr llnhwm8 ilelll.rt'.\] <br />-l <br />h.{ rdprll dm!.u . Ccdrrr.t of Colmt b Sclalnsurc n, s(t6 lrqEnrrii,n. tr F,vrlal for hy SR'xr JrItr of rrE <br />trhtr c.rlc. tur rlr rElntrle. or lh. qrl for whah lhc Fdt i tlkrj <br />I h!v. .ll *tll rornrfln *orkcri .omIrN.rion iniurah-c. ,i 'cqrEJ $y S\..r0n l7(, or rlE l2txtr C'r.L, ,,tr rh. !o lnrnl4c of <br />trhhl'lr,^I). m F '\url M' r,{ln.',nnF'n\,,r,n 'n.u'11.!"n'cr dnJF,1tr} nutr'l{' !u <br />/u/a/a-./ Znt <br />t"t,.\r.tuu,*, lJ k/CO/ ol7C9oi r,,t n,^to/ts,/zt <br />l.cnrlylhir rhc lxrli'rnunrc,,irhc sork lnr rhi.h rhF Frm'r isrru.J,I \hallnor tnfl!'yiny n Nrhd.yNdnncr <br />y) trs r, liloft suhF(r n, ih. wolk.A cdr{rnsdton lr*s ut Cdlitum'l, untl r3r rhor it I \hn' U t'c(oc suhFr b rh. - <br />w{k.i\ (mFnilrirn pnrvisoN .f sc.rbn l?0oofrhe Llhtr o'l..lsh.u. tunh*irhmmdy vihrh'* t'r'vinnnl <br />W,{l(NlNC I'arllrc r' scuc vtr[c^ $mpcnrati,tr (rvcratc ,s trnla*lul. atu] \hau nrltrd M mll')ycr b rnnnnrl FlrlrA dtrl <br />(vrl lirr\ trp n, onc ItrRlR.'l rh,usrtul Jollar\ ($l{D.t(Xl). m r'lJii(,, t,.o{ ol(.mF.s.xon, drd3.r r! F,vidcd fttr rh. <br />S..rknr ll)76!,r rh. Lhtr Cixir. tr tr.{rklrnonry <br />,,,,", 0q/0q/v/ <br />^ <br />LF^.ny drnm uBlr Fulr, ol Frrtry rhf,r I .h lrain{rl fnrlron dt Ch:prs I (olrmEn8 wnh S.crDn TXDlol U,rBnn.i <br />"t rh liu{L\\ rnl Pnn.str)nsC(i.. a ht lr.n{ N <br />'n <br />lull fi,r r l.ll&r <br />C-r o /O/70/ z <br />q u <br />CoNSTRTJCTIOII LENDINC AGENCV <br />I lEr.t', .rm td6 Fuh, of F,rty th.r ftr n r oEieiih Ld4 +q^.*y ror rlE Fft,r:I^! of lh. srl l', *tEh $n Fr', ! <br />lrBr (sc. lor?. crv c.) <br />AIILICAXI.DECTdSAIIA! <br />I tu$y nIm unLr FnrXy oI Flury oE ot r lolbwht Lk lldhni <br />D.mltron PcrmrlAsh. or Norf(rrs. FdLhl R.!ul:ro6iTnk ll{). Pd6l <br />_R.qumtl lJlld of llir titrh <br />lL.rnllh.l lh.lcdcrrlEEuLrr)n\ r-lding a\hcdor rcR,val rR R auflxrhk t, rhs I'n't rr <br />__l r.nni rhrr I h.v. r.d rhr ll)plf,rron.ni strlc th, t r anrvc intnml$n n.orc(.I rrr x'('i{)ly*nh.ll Cn, dc lnry <br />'itlr!i..rtr(lsrn. us'rcr,i r n) h0LUtr,r drlh.rchFnrh,trcrcnrcrnlrrrvc\rrrhrrC ylnlCi,utrryhcnicruB,nrrt <br />!h'u unrlnd pr)r^-dy tur ff <br />,llt,li(.nl nr A$nl sirn, <br />d/ <br />IIrIIIII <br />, <br />Flood Zone Certif . <br />FINAL <br />kar('s ,^(I,r.ss: <br />,^;21/d!/Zt