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SITE.WORK DATE ID/SIG.COMMENTS oWNER AUILDEII DEI-('ARAIION
<br />I hd.ty aflim uids p.rnlly ot pqury thd I m.r.,nFr 6oi rh. (rntddon Li.dr. tjs for lh.follo*in8 r.e)tr isr70:]I5
<br />aurinGs ! Protsion (id.l ny Cilr or (i,ur y trhich rqrt6. iEri b conrrud, ilt6, imFor.. &molih,{'r.rrtr &'
<br />slruiur., Fitr ro ih isumc.. ,1r, rcqutrB rh. arphc$l fn su(n Fmil t' 6lc r srs..d srdod lhd lE or yhc d lic.B.d plmad
<br />ro rh. Fovirhc oI rh. $ildckr'r l-ic..qd hs (Ch.pl6 s, ( om..cin! $irh sstio. 7ffn of Dilision 1 of rh. llusin(s a.d
<br />Prol*ioft ('od.) ur rn3l ,r m slF i!.tmF rhs.iioo..d th. t6ri t i
<br />'lE
<br />llts.d (nq't'on An) \Fhronots.nnn 701I5 ht ai)
<br />applicanl ior ! p.mi! slbjd3 th. ippli.dnr lo a(vilp.ndhyotnornor.rhM fivc hundr.d dollur (1500)
<br />l.B oundofrh.FnrEny,ormrd olG trlrh s ax6 d lh.tr $1. comp.nnior. q I do rh. *orl drd rhc nruciuc 6 mr
<br />irndxLd or ol[6.d nn sk ( Sa 7or4, Borind dJ Proadi]6 (ixl.: Th. ( 6nr&rori l i.tu l ,s d(4 mr n rl, t..no\n( of
<br />rh.rn'pq$ $ tn tu'l& o rthr€ rhd@ dd \ n, dB sh tri,rt h'ni.lf or h6*lf o' rhFueh hri o, hd .\n dt .r6,
<br />pruvid.d rlEl such nnpmvmors @ mr in!6d61 or olr(J fo. $k ll h.* 66. rh. h(ildm* or inprordrn' is snd $ irhin .nc )Hr
<br />of(ompkntr rlE (,$ 6 Bliild *ill hr\. rtr hrdo, ofFo$ns rhd lE or llE dd mr hiu .r trrFo\ c tlE FrF! for tlE Fqne.f
<br />l. BorE ofth( rmp6r!. D.r.lcn.l! conrdi.e $nh [.6E n..drddnro mdtud lrE Fo]ar tsft 7(]lil.Ii6I6
<br />.nd ltDtshn ( od. r h. (i'nl*n .s r-icdc l,ir do6 not E ply lo D rf,r6 or prerdy who blild, o, improrB lh(sn.
<br />d uho conlr.d3 fr rch F.Fr $nh. ConlModsl lr6a.il Flnud tolh. codr&ior'r l-i.ds I^ )
<br />I m.rdnB undd s6rio.
<br />D.l.
<br />aa8tr!8s:(autftsallaxleclASarlll!
<br />I h(.t, amrnlndd p.nlltrof pdjuryo..orrh. lolloNins d..bilio6
<br />aAr-h.t. rn w'll rumum . C.n'fE,r. ol ('ntgt to S.lr-lmE tor *.116 FmFMon. s tm\l(kd ror 14 sathn uOO orln/fihr codc.l"r lhcpslorun..of rhcunrl lor shEhrh.p6,ntr s BL.rJ
<br />cAi1l .a.d trill mrnr,,n \ frlm' comr.Nar if,o Nu.nncr, ar r.qun.d h) S(()n l7(x) otrh.lahor (i !.. tor rhr rh rt mxnc. or
<br />rl lor $hi.h rhis p.nni' i! i*u.n Mr work(!' comF&rn,n ,Nurmc. cntr'{ and lrn'cy numhE r.
<br />7.*. STATe (uN)D
<br />fa,*,*-t. \ ag'blbQ - 2o\< r'pa J$$\ Zl>\1
<br />I k*:x ;r&rl;rffi'J'HJ:ff H:l]: r#; ;ft*u ]r trr;'#:ffi!r,T,H*
<br />*ortd' codFMl ir. prolnirB ot S.don r 700 of llE I itrr ('od.. I rlEll. lonh$ irh c.nplr * ith lh.* p.oirhN
<br />$ARNIN(: F ituE ro ts. u!rl6 smFsinn @\@s. ir urLrtuL ud snall rubiel x ophls lo (minll FEh6 rtrd
<br />.ivil nn6 up lo on. hund,.d lhouend dolla (t100.0m). in.ddilion to th. cort olcomFMlion. d!ma,{.r !s povrdcd tu th.
<br />s.(lnn 10?6 orrh. l.bor Cod.. 'nr.d ud .rorEl r fc
<br />-.1(,.r.,5/36/ r-l
<br />DECIAMIIQN
<br />I hs.by amrm un&. pcahr of psjuy lhd I m lir.nsd ufrLr Fo\ ilion of G.rad 9 (.om,ffiiry snh Sdion ?O0o) ol DL ilnn I
<br />of rh. BGi'B dld Pt fsilB (-od.. nl m) r( * a m lull forcc en drcl
<br />l,*,,,"*B,L
<br />&,.qaor.r
<br />can a.LCItQN"tEEtacltcr:N(I
<br />I hd.lry amrn undr Fnaliy.lFlu']rhsr rh6c B a cons1n,.1ion lrding ry.rcr htr thc ldromorc orrhc sorl nr rhi.hriis td'n'r s
<br />'r!u.d
<br />(s( 1047. (i\ c ,
<br />A[TLl(AILll}:Cll8A r!
<br />I Hr.trmnondd Fnrhy of Fjury om of rh. aoll(J$ins Jftle.id.r
<br />l>mlnirn Prn r,Arh6ro! Nd'li.d bn F.rtdrl l.sularirn3 { l nb {. !5n6,
<br />R.qtr&rl Lai6 olN.ricarn,n
<br />I cdilv lhar rh. Ldaalr.3ul0noB rc*rdin! .sbcsi(rs ,dtu\ !1tu. nor rppl'cahl. b (hF px).d
<br />l.d"b rhn t harrradrfi!rrrl'c.'ion elsrdr.rharh.rhr\. r.romdio. kcord l+rero$mnlr qnh.ll ( n) i.d Counrt
<br />ordrrn($ rtr(l sr,e rrns chrrn! n, huil.li'r!.onsrtrcl(r. itri hc'ch\rqrMldiv6 of lhh Citynd (tonry lo mls nFrn lhc
<br />rhn d pmFn! fd 'BFdN. puF s
<br />\'.rn'n,!hnrt|fn ):
<br />6i30/l 1
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing ollli+WTF@
<br />Shear Wall
<br />lnsulation/Ene
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />tlandicap Req \
<br />D eputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL ,/.D.',6\
<br />Certificate of Occupqncy
<br />Notes, Remarks, Etc
<br />BUILDING. INSPECTOR RECORD
<br />I I
<br />I
<br />I
<br />Framing I
<br />nrr,,-,, Sorlcrrrf.c .. Qc^r. /u(ttsto ((Jr r8"^( tot
<br />31 r.rrB.Nunhd: 6(a12.\S.
<br />c-,-"- rl L. RA\ Lsyn€qtc,rt-
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