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SITE.WORK DATE ID/SIG.COMMENTS OWnEt aUlLDEI DEITCARATIONIna4.rrmuddFrnyofFju.ythdImdnfltoEllECo.ti6'Lttstfllorlh.f.llowitgt@tr(54.70]1.5.
<br />acind rd PmEsirn Cod.): Ary Cn) or CNny *hrh r.quic . Fhr lo odn l. dls, ibFotc &Fli$ or ,t,.t r)
<br />irumrq Frr ro arr Butrc. .lo EquG rhc .ppker fo. Mh Fhn to 6k r nsn d siffit lhd lE or rlE i li€!.d Fein
<br />b ih. prDvirDd of tlE Contdors Licdrd Lw (Clurrd 9. Comntrin8 *nh Sdhn 7000 of Divirio! I ot Oc Bc@s dd
<br />PofBioN Codcl or rhn h. or 3h. 6 dmpr rhicnon od th. bBir for lh. .lks.d ddFion. Ary violtlion oasdtbn 7011., by uy
<br />rppli.!.t for . pmn rubjds lh. .9plic! to !civil lcuhyof.ol @..lhD nv. hun<ltql dolla (1500).
<br />-1.
<br />s olrG .f rhc FF!y, or my .mplo)6 wnh ers6 s lh.n sb onFla.tr *i[ & tlE m* !d llE rttlle i! ml
<br />idad.d or ofldd fr sL (56.?0.1.1. Bll.t,s ed Piot6io6 Cod. TIE (.odr-lor'r ttaE Lry 66 ml {,ply lo d ouG oa
<br />rrE FoFry l1r hoillltr,qDE *E!E !n uho d6sdr w,t hilMrf or h.*llot lhmq} hi h- on.!i{'hr6,
<br />Foya.d rhr *h !rr.d!lE6 E mr ddrlal notu for sl.l[ to*6s. tlr h]ildrg d !4.&t!d it ild f,ih, m Ja
<br />oto,pldira rlE()xr B!*b *i! l!r!dEhr&!ofFriB thi lE iE.ld ml build tr iq,ur &. FnF &. dEF,r6.ol
<br />I. soM6otth. pmpqry. m.rclusNcly conr*rns *irh licctd.onr.dds u.odrucl ltE Forrl (Sd ?04.l,llBrB
<br />ud Pof6rbn Codc Th. Conlmclol s Li..nr! l-dw do6 nor rpply lo d owni o I prpcny { ho buildr or imPrevd 1n66tr
<br />md who mtnr.cri fn $ch prdccl! wirh a ComBlo(, lic6.d tuRM ro rh. conlEdois t,rc.e liw)
<br />_l m crdpt uidd Sdion _
<br />DI. O*.t
<br />\ronxxns' coriiPElis^-nbN
<br />DICIJSAIIO!
<br />I hg.b, dIm !.d6 F!b, of Fjrry oE oa tlr follo* hg &.Lr.166:
<br />I ha* d will roi.r.m . cdrfc.r. of aotrHt ro s.la'rNurc for wrk6 .on,Fad 6n. a Flvid.d for b, sErtun 1700 of th€
<br />Ilbor Cod.. aor rhc p! lom .c of th. wolt for whi.h Ihc pmil b islucd
<br />I hrv. .rd $ ill n.htln s ort6 (omFullEn rBurin(., 6 Eqlir.J Lt ser ion I700 olllE L.bor Cod.. lor lh. Ffoflre. ol
<br />th. so.rl!*$h{h th! D6r( E sd M} sn'Io (onrDdsion ilM*. c.rc rd polry nMlE E,.*,_awv\Luy\
<br />*,'.,",.0-l hJLcSD4l
<br />-l
<br />cdirylhit in rhc Froi1@.oarh. w6rl
<br />,'*tllt/W
<br />*, *, -,", .,1, **, , -, .-lraoT
<br />fff whkh thir Fmn L! isu.( I
<br />e G to b..omc rqd lo lh. "rlt6' cohp6$tn,n h*J of Colifolm, ed .sR rhtl ra l should b..om subjet lo llE
<br />*o d' compaurion provisioN of S.d ion 1700 ol lhc I {t{r Ccda I ndl, fonhkilh comply wilh lhoF povti.N.
<br />WARNINC li^'lur. n, sr. ror*ft .omDard r)n mvr.s. L urh*rul, ud !h!1, iubjrrr m 6ploF r, oinrml FEtis and
<br />ciyil rn6 up ro oG hundrcd rlbu$nd &ll8 (1100.000). in adCnBr lo
<br />\d'.n (176 6f ih. llhn ( rk'nrdd
<br />^,,,\1 l4ll4
<br /><-
<br />I halby lIIm u.da poahy of Fjury lhdt I m !'cs.d undd f (-h.plq 9tcoMdcins rith 5d1oi 7000) of Divdion l
<br />of rhc ucins md hof6rions Cod.. dd ny ltlM n in tull forc 6nd.ftd
<br />LlO
<br />-rr, {A ,1 \flA/* a\4?
<br />I horb, lrm uid.r Fn lry oa Fjury tld rh6. ir . .o'(ocl.n lddi.s .sdy ror ll! Ffoili@. oarh. "od tu $irh rhi! FEI it
<br />is!.d (Sa.11097, (''v. C )
<br />aftlllalfpEclJSArro!
<br />I hor!, .ffrn ur& F.!, of Fjury oB ol rh. f6lbw6g d6lrrb6:
<br />Doolitior PdxneA$dor tlorifMion F.dd.l R.gul{FB OiL rl0, P.n6)
<br />R.quiEd L.rrq of lloriftrion
<br />I .dif, lhd rh. a.,l.r.l rcgul,lioB rclredh8 Nt :tE rmovd dc nol a$liclbl. lo lhts pml..t
<br />I cqliay rhd I &!c rdd lhis lpplicarion !d rdl. thll rn..bov. io it con.d I llra lo compl, wilh .ll Ciry md Counry
<br />I r.F6dnd iv6 of lhis Cir' dd ( oury ro alq upon dtordiDe6 dd SGr. h*r ElruB ro boild
<br />nbo\. Eflrnql prlpdv ru
<br />^,;L".1qll4
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf loorA/enVlnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />lnsulalion/Energy
<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 />Enoineer Final Report
<br />Flood Zone Certif.
<br />FINAL
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc.
<br />BUILDING. INSPECTOR RECORD
<br />t)
<br />Tt4T-
<br />UFER Ground
<br />Framing
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