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SITE-WORK DATE ro/q
<br />Set Backs
<br />I coMMENrs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subfloor/VenUlnsulation
<br />Shear Wall
<br />Framing _
<br />lnsulalion/Energy / / ,)tJL '- rL/(-/u7
<br />Drywall '/>t/lofu fz.Ldl)lty'W ,e/4L
<br />ft'tlt,Ext./lnt. Lath
<br />Brown Coat VnrrTtDP 7'{'F4rn4
<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 1'-f -u 71. c /91"'z.e+ /-t7
<br />Certificate of Occupancy
<br />N Remarks tc
<br />2/,c
<br />OWNf, R BUILDER DEt'ANATION
<br />I h.r.by !lI8" uxd6 paslry .l Ddjur-v rhlr I e ct.mfl fn'm rh. Cotu. d6' Li(.M t * lor th. fol'adg Y r'tic 703 1 .5
<br />&Gilld drd Pn,asion Co&) An) C(y or C6uiy *h'.h r.qdE6 r Fn. ro odrud .ltc, 'hForc, dtuEi or Ep.n e)
<br />llru(rc. prbr lo s isuM... rlso raFn6 rh. rpplicml for such rEm lo fiL i sun d srar.lMl rhc h. or lhc it licaEd p{NMl
<br />rt, rlE For i3ioN of {r Co.u&1oa! I-i..tr*d tiw (Cfi.pr6 0, Comftin| *'nh SdlFr 7000 or Divilbn I ol rh. aultB !i
<br />Prof6ionr Co&) or rh.t h. or sh. s crdpr lhsctom Md llE tair fo, llr tlh*.d .r@Fioi Ar) riolrionofsclhn 7011.5 by s'
<br />dprric,nr for ! rEnir subjNl3 rlE lp?li.ant ro ..ivil p.dlty of mr nor. tha fiv. hun&.d dolld (1t00)
<br />l.soMnoirh.I,fopdlt,ormt.htlorEwnhwlsBsrh.ir$1..omp.$tion,$iu&,rh.wo.drhclrFflwi5ml
<br />i d,la, o. ofidrd lor d. tsa 7Ot{. Builr ud Profdil6 cod. Tlr codrsc r I i(@ l^ {i'd mt rpply ro e orE oa
<br />rh. Fqdy qlF hoilds or opmls llEqr( rd *tF d(6 s.fi sd hrelf o. havlf oi
<br />'hmu8h
<br />hi! or ha os oPht6.
<br />p.ovidul rhlr such oFo\E6r e er i,lod.d orolIdld hr sL If. lErEq.lh. bildins or itFolarct{ n $B wihh on. rd
<br />olorpldbtr tlE o*c Bdtld *iI h.E dE h,&r otForil{ rhi lt or,. dn m hlll or!,gDt! r FoF,6r tlr FrFo!. ol
<br />*'&s orE of rh. E$rEly, u.rclNr.ly cofidds trnh l'(.rEat co tdoR ro cordNd rlE F\.J.n (S< 704.1, Bdi6
<br />hoisM Cod., Th.Conrr&ror.! l-i.6s.l rw do6 nor rpply lo u oerd oipropd, *h. horldr or impbvd th66n,
<br />.nd *h. co,rn 13 for $ch rmirt! u'nh ! C.6r&ro<!) li.6!r.d n) rh.c.nrd.r t l-tru lrq)
<br />t .".*.,r 7 .,t.' s.y', -
<br />r." /2/ l/'f 20 la "-*,
<br />Dfl.L &u&.t
<br />I h6cny.rlim und6 Fnlhy of p6Jury on. of rh. Iolk'*,n8 d(lmti,rns
<br />,I h.v. !d wnl mhl6 . Cdtif.d. of Co@r ro s.lf-IBu,. for $st6 conF!. nn. B FDrd.d for b, Sdion l7m of th.
<br />I rtbr ao.L. aor th. Ffomuc. o I lh. $rt for wh'ch lh. panit 6 iillcd
<br />I h&c dd will nai.ut. sorl6' ..mFG{Fn iElr.ncc, s r€qln.d b, Sdrcn l70O otlhc llb(rr Co&. lor th. Ffm. or
<br />rh. *o tor *hich rhi! pqmi i! iscd Mytrorld omFMion iMre. cMi6 8iFli.y.mhs d.
<br />Prq Nudbq . rrp!6
<br />//-r*,Or*.* *^ffi orrlE *'orl rd s'hKh rl'i! F6 ir ilqL I ih.ll mr dpky ,Fer66yi1lleV 6b bcnm ruq< lo dE wrt6 onFsdon h{ ofcdrfomr,..rld t8r lhr il! dEuld bcoc lutt tt lo$G
<br />woltaj (orDcsllion Fovtsiic ofsdio.1700 ofrt Ldo. Code I ndl tonhwilh conpl, vilnlhoc FsvilioB.
<br />W{RNIIC: ritur. to s. f,orld' omFsibn orEls. ii 6L*tuL t d tl $bj.< D oploF lo siniD.l FdE ad
<br />.hrl 6rd up r.' n. hundr.d rhrusd doll6 (1loo.ruol.'n d(trnr r, rhc r.s fl.omlENlrotr. damg6 a provid.d foi lh.
<br />Bts6r ud lrlorrEv t f6
<br />I hd.by dr@ u.rra pdhy o r popry ,* , * u.oool ffifficurro e (comftin8 witt sdriotr Tooo) or oivi.ion I
<br />t
<br />"f llE,(a:lB.nd Pinils.€ Co&, nd h) li* ! b 6lll lor !n Gfid.
<br />cqlll8l]cuoxrafDtlc-dcE!(r
<br />I hd.by lIrm u.&r Ftlty ol Frlury thd tlEr t ! col{ruclion lqdEg .sdcy aor rh. prfoffi. of lhc {orl fo! *lrrh th! Fn'l u
<br />n$.d (S< 1007. Civ C)
<br />AIIIICANfDECIJAA1IO!
<br />I Ee* rltm untld po.i t oa FJrr. orc ol rh. iollowhs dcclJll bN
<br />l)onolirion Pdnits'Asb6tG Norificarirn F€ds.l R.ruhrion! (TnL 10, Pd6)
<br />trr.d ld16ofNonfi.d(,n
<br />ca,ry rh, rh. fal$l Es,l,rb6 r.s&di.s Bb6ros ron.v.1 s. noi aplE bL lo ihis F.jd
<br />I .dr$ rhn I h.v.6d fiir !a,r t.lion &d rh.rh\c infornrior i cor<r I+B'oonl9!Bnhr Cny.nl Couly
<br />onlm.c6 rnd Sl'rc b$. Eldr{ ro buildi '':^".'^);/#;1stnv. nB(nrn€d ,ropdq lor
<br />\l,pliQnr or \rrtrr Sisnrrtrrr
<br />a./E f'tLO2n7r <1.
<br />BUILDING- INSPECTOR RECORD
<br />I
<br />Roof Sheathino
<br />I
<br />L(.e Numbd
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