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SITE.WORK DATE ID/SIG.COMMENTS OWNEI BUILDER DSTTARATION
<br />I ho.hy .lIm u.d6 pdrlr, of ,Gjur, $a I 6 ddp tlD lh. C.nrrlor' Lt* Llw tor th. follo*ins rs)'l {sd.?oll.J
<br />BullB .,!d Pref6io. Cod.) Ary Cny or Couty f,nkh r.quiE ! Fni ro oitriar. .n6. irlFovc d@li$ d q.t 6y
<br />sru.1@, Fu ro ilr igu6€e lbo Equi6 rh. lp?ltdt for !u.h Fmir ro 6b ! r'Siol eaoEt lhr IE or dE a licaB.d puBrn
<br />ro rlE FuiioB ol tlE Conrm r La..!.d L.w (clr4id 9. CoMins *nh Sdb! 7000 ol rriirbr I of E Bui6 rxl
<br />Pmfdiotu Cod.) d rh.t L o' ih. ii qop( rha.tom dd rlE b.rir for rlE dl.8.d .xdFion. AIy viohion of S€lDn 70l l ., by &y
<br />rrpli@r 16r r FDi $b!cB th. ,ppli.ut lo r dvil pdhy of rcl M( $d fiec hu<!.d dolls (1500)
<br />l. s owE ofrh. propsrn or my mployd wirh was6 6 $.n eh comFNrrion, wi[ do lh. worl dn tlt drEle i! rcl
<br />mad.d doiId.dloreLtS<7(),t4.BdiErdPmf6bBCod.Tlrco'r..inrLalelsdo66|Tptbeo$Gof
<br />$.FlFry *rsb l or 6pro6 [Ean. id whd dG sh hrt hilellor lEslf or rlrcu3h hir or ns oq aptoy.6
<br />proviLd rhlr sh hFoEErs E Bl lrsd.d tro&rd lbr ol. I( rnM, th. b.ild,B or inp.!\ald n -ld wihin on. r{
<br />ofMpriiF. dE ot.G Dolb liu lbE tr h4d, ofFovir8 di lE tE dil d Ldd c iqo\t dE FoFr, fo. d!. FrF.c of
<br />t, sorGoarlrFoFry, naclundycodrdhs *nh hcoB.d conr*b6 ro.ontld rlE Flrd (Se 7ou, B.!dB
<br />dxi hotriii Cod.: Tt. ( bnrrclor'3 Lic.@ 1..* doa nol lpply lo e owns of prcFry who build! o, improv6 lh6@..
<br />&d *ho dtu*Ir fr ach p.rFs enh r Codrrdonr) lio!.d F6ud r. rlE Co,I'*rd! LiuE t e)
<br />I m .tmpl utr& Sa-rion
<br />]taaf,lEr.cqMrEssauq!
<br />DFCI ^rtaltoNI h<Gby imm undd F&lry ofFjury on oflh. follo*ins dcliErioNl
<br />I hrv. ri will roirrin r CEriaEt. oacolhr ro Sdf-lNr. lu tr,k6 onFEdio., ! FlviLd aor by Srlion l?0o ordr
<br />t !o, cod.. fo( lh. Ffolre. oa!n. m for *tkb lh. FEn i! isu.d
<br />i,./luvc ua witt mainrain wo*d comp.tu ion iBufuc.. s r.q!i$d by scrio! l70o or thc htor code ror thc Ffoliec of
<br />rhc wl lr *td rh! FE4. d/.d My wld @,p6r.n iffi. dia rn Fliy Nmt fr:
<br />cm tfuru t-
<br />P.,*yN*bo,-&t {?-!-J!1 131 ,*"*.(- L '/'
<br />I c.n't rhd in rlE FfolM. otrh. wort ar whEh fia p6nn s i$u.( I !h.ll rn arlpt , at Fsn in my .DF
<br />$ 610 baoru iuqd ro
<br />'
<br />h. wrtd ohpqlarion lau of C.lilohE od cBE tb.l if I rhould beoic aubjcl lo lh.
<br />*o d 6mF6dbn Fo$iod otsdrn 1700 oad. t td code I ltEll. fonh"th omrly wth lho. F!\BiB
<br />WARNING: Failur. ro Gw mrla' ompoliiof, covs.s. i! uilrwtul. r.d ltEll tubjd D @pl6F b aihir.l Frnir .nd
<br />ol (omFNrion, d.,rBB s providcd for th. t.ril fr6 up to oft hur&.d ttougi dolla tlloo.()o). in ridnrn $ rh.
<br />sd.n 1076 ofth. Lltor ( odc d.d rnd dorE'! f6
<br />1 E - 1)
<br />llcEllEDlaNuagaf,
<br />DP'JLIITATION
<br />I hdrtr .llm uods F.ty of FJUI, ln, I @ kq6.d un& pntilbn of Ch,Fs 9 l@ffi'ry unl S<lD! 70@) of DNsbo l
<br />of lh. Buin6 Md PNf*iod Cod( s'd my licw i! in ftll loN aid.ner.
<br />(-tc l0oVlG)
<br />Dr,.:- )-.!!a ()
<br />COIiIBIJIfIA!}EIDIISJGENI.A
<br />I hq.ty ifim u.d6 Fdr, of Frury$r Er i.. @dnrdbn ladiis rg*y for rh.Ffollrl.eofllE $o tu *'lth tlt Fni it
<br />iq,.d (Sc. 1097. C'v C.).
<br />AIIUCAdLDECLAAAIIq!
<br />I h!*y.frrhu!d6 FrXy ofFjuryokoftit fouovils ddLt bo
<br />Daelition P@il^.tdot r,lotifi.lbn F.da.l R.SuldioB (Tnk.l0. Par6,
<br />R.qurld Lrl6 of t{oriidbn'.,
<br />-l .dr,tr rM lJriG_d,.s,Lrbs r.srrJ,j .rb6rd lqErrl rc m! .pplrtblc to lhr FF
<br />LIl,rttfrhd I h!v. Ed rhB $9lrcdiJn &d ll.lhd $..bo!. infonndhn i!.016 I.gclo@npl, whh.ll Cny.rd Counly
<br />dt6E6 !d $d. t s Eiits ro tuldiry @tuD(Fd hdrty.rrhorie E?.sriE ollhir Cny rd CoEr, to d- r+drh.
<br />ibor. 'ld6n n mdv t dEldbdm I*,- --'"r"--=.--- L/ ---\-- L_ t - u,ApDfro.l o. ^aE SlDlli ^ I _ lht./a)lL
<br />P'mrr-Mn.rDrr,tr W* '''7
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathino
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drpvall
<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 />lola-tr 2'2Q-z \-,,ufi\U'V
<br />FINAL 2* zE-)Nd,
<br />Certificate of Occupancy \-/
<br />Notes, Remarks, Etc..
<br />/-
<br />lt tll
<br />BUILDING- INSPECTOR RECORD (.
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