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SITE.WORK DATE ID/SIG.COMMENTS OWNEI AUIDER DELCARATION
<br />I lErby .fitm unlcr FMhy or Friury rhrr I m.rcrqr lnn rlE Co,rrun,n LNns t,w i.tr rh. ,olt,v6! Erf,), lsd 70rl.5r
<br />Bo{nB! r,rl Pn .rron C,rl.)i Any (iry M Counry *nrh EquRr . Fni k, con{Mi, altcr, ml^)v., d.nnnh nr rcFn uy
<br />nd.trrc. Fior t', irt rr!.kc, alr. EqulEr lhc +plf,er aor $(h Jtmir lo uLr n3n.d (.l.m.r rhilhcor slE it l&n*! pudor
<br />(, rlr F,v8i,n\ ol rrr (i,nrrkttr'! I-r.hr.1t Uw rclufl.r I, Conmtuing wrh Seri,. ?un ol Drv'rhn I ol rlE AunE$ ud
<br />A.!!i,hsCdhtdlhjlxM.lER.!.ni,rh.r.fnrmlrlrh.h.s(forrlE.lk8al.rcnFnr AnyvnLr5nolSdrDnT0.!l5bro,
<br />.tDl..nr lln d IEmn .ut Xtk llE .p0l{.nr !, . gvrl ,rM[y I ml mr. rlur l ry. hodrtJ &,ll& ( 350])
<br />l, .r owRt ol i h. pn{Enr. or my .mploy..r wirh w.fc! ri rh.tr {k uon{rnt.r on. *ill rh rh. krl nrr ltt neru ( n
<br />orc.d,roniFJntrsb(S(.7(x4,Butd$rmjPn,lcsi,'nrC*kTh.Conkrdrtr.tLa.n(tlwd€!nol.pdyk,mowmrof
<br />Itr Fll.dy uh) h! dr '{ ntmB rh.B'.. .rn *h' &s rEh str* hmr.lf oi krcll or thnu8h hn or lrr oM .r{l'y..'.
<br />FuvrLd rh.r r&h 'rr{n,wmd. e nr dcrldl dofidd lf r} ll, h,w, rlr t{dlly or urtmErll n sU *!hr oqtr
<br />ol rI,it,lin rlr O*Er B!fl.r wil hrE th hoiLtr of F*ue rhr h d slx Jrl n{ tlitl d nqnrE th. ImFy fq {r Fllnr ol
<br />L r\o*ftrolr,t InnFny, am.(tu{vcly (nkr('nr wih hrchicd.onr.duut,! n{rulr rhc nnl}(l lScc. i(!!. aurms
<br />rd ltDli'\snCo'l. l h. (i,nrradn'\ l-'..nr. l -a* Jo.\ n.r rpply b m owtur or |r'F..d y who htr rld\ or rmpn)r.r rh.^\'n.
<br />rfr, who d)nrhd!ntr!!uhF,Frw h i (i)nrB-n)d \ r l..n{d lu(ltr| n)ih.(itnt,.tf,'\ LL.n{ kw).
<br />I nc\cmr. u.Lr S!ru_. B APC lor rhr E&)n
<br />loaKl8stgrMfENsArllrx
<br />DECIASAIIA!
<br />I h'.6, rflnhond.r Fnrhyof F,lD. om or rh. n,Uo*nt t].rlsrr(,h\
<br />_lnrk!nw l tllrd ! Ccnirdr ol Coh{d ro S.lr-lnlE fttr srt6' oqrnrrM. .r F vrtd tu hy Sdr,. lroo orrh.
<br />l,hr CqL. fff rh. Frrolrrur of rlr k,t nr *txh rh rm ! Enkn
<br />w'llnnnr hsoA.h cn$$n\ nrlutrcdhvSe(rrrll{xrolrhcIrh'tr(iic.larrhrFrl'inr!(.ol
<br />rr hstrrn!.utrrr 0l F,l(! nun$.r rc
<br />GaZ realSa! ,r,tr.\1
<br />_.1r.n,l!rhl 'n
<br />r h. ,xr,ormnr. ol rhc enrt ttr whrh rhtr fmn( is ssuL'rl,I ihrll frrr cmpl,y rny n rwrn in any humr
<br />$ ri ll) t'cuom suhral r(| lh( wodsa (.mlE..illr L*! ol ( rlrnrnr- i ,!R rlEr f I rhuu tt!'nr \uhFct r{' 1lr
<br />*)rlcr ('qxner $n nn'trnni or Sor 0n l?OO or rhc |jhn (ix]. l {sll- ,'f h*ih (r'n{ly q [h rh,c l'fi vlrb.s
<br />Kr n, t:mml FEls .rn
<br />.Nn nrcr uI' lo oE hudEd lhou.r Jdh^ rll@.{Il)). r dl.
<br />S&ri,n l(,16 ot rh.lrhtr (iri.. ur.^.( mJ rr k
<br />lgrtJld[qN
<br />I trE6, rllm uLkr FEI, or p.rpry th. I m lctrrrl ud.r FrvnDn ol Ct F6 9 (oIlrlrl[--_-Lrlt ,!rh Sdrr, 7m, of t ,vtrm ]
<br />ot Or Adlmr! rn! PNldsDnl Cd!.. lrl nv l..k 6 s tull lore !r1.fl(l
<br />5
<br />a/-
<br />!:qlsl8llf.laNLElDllcllilll1
<br />I h.Ehyallrmu l.rFn.llyolr.rjurrrh,rrh.t nad'ndrudnn LnJina,s.*y ntr rh. Fdomh..rrh.wnk r',,r *t(ilhE lrmir i!
<br />ir\u.d (Sc. 1097, Crv C.).
<br />AITIICANUIEqId8A.IIO!
<br />I lur*,yallimtrndcr Fnrlry olpcrjury o ol rh. tulb*m! d..l{rron\:
<br />l).nrrrnhn Pcrn(rA\hc{.( Nol','..rrr l{J.rrl R.fuhr0n\ (l
<br />'rk
<br />4{). P,nt)
<br />R.qu!.al lJt.. trl Ntr'riaDn
<br />I (nrfy rh{ rh. Ldcr.l rrulati,n\ (,ldJrn, a\hc(otur'vrlrE
<br />y .Bl Couniyt'.nr.r uF,n rh.
<br />52
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Ene rgy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Certiticate ol Occu pancy
<br />Notes, Remarks, Etc
<br />BUILDING- INSPECTOR RECORD
<br />Set Backs
<br />Pool Fence
<br />Flood Zone Certif .
<br />FINAL
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