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BUILDING- INSPECTOR RECORD
<br />ID/SIG.COMMENTSSITE-WORK DATE
<br />Set Backs
<br />Formsi Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />Subf loor/VenVl nsulalion
<br />Rool Sheathinq
<br />Shear Wall
<br />,11 lzo P ko)at {rYFraminq
<br />ITlnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />IVlasonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />tl7(lu))0. n0 'otFINAL
<br />Certilicate of Occupancy II
<br />Notes, Femarks, Elc.tlzql2D -c/tl - P/w
<br />OWNETI BUII,DER DH-CARATION
<br />I h.rhy 0lttrn u.'lcr l..alry or pcrjury rhar I @ cxcmfl li.nr th. Cilr(mrk,r l-'ccnsc tj* lilr rhc rallow'n8 rc0sr (Sc.70.11.5
<br />Bunness rRi P(rc\non C,'.le): Any C , ot C.trnry *hi.h r.quilcs r lt.rnnt l. con(rucr. rlr.r. inllrnt. ilcnlllish 'tr r.r.n ,nv
<br />Fluircs rhc imlianr i,tr $rh Ixmir 1,, Iilc ! stncd narcmnr lhir hc or si. ic I'ccn*d luNunnr
<br />i! I-lccn\cJ l-Jq (Chrl cr I, Con,m.nutrg wih S..r(,n ?lxlo (n D'vriu I ol rhc Busnc$ M
<br />l[{ hcor\r'c is crcmpl rhcrcli om !n'l rhc tun\ turlhc le3cJ.\cn]l i( Atryri.hri,rol Sccrion T0
<br />hrccr\ rhc rapli.anr r' !.illp..,hyotnor mmrh lilc htrndrcd dollan ($500)
<br />{so*rcrolrhcn'olEriy,ornrycryrloycc\wtrhqrecsJsrhctstleuonrNns otr.*i11dorhcworkddrhc(Blurcistror
<br />inrcndcd or diltrd n)r srle (Scc 1044. Btr\ircrs.nd Prule$i,)n\ CoJ.r'Ihc C nrru.ntr r l-ic.n$ If,w docs norlPply o.n dqner of
<br />rhc tmncny who huiu\ or m{BJvcs rh.Rm. nl wh) d(B {'!h M)d( hnn\.ll.r hcF.lfor rhmugh hi\ or hcr dwn cmdr,rcc\.
<br />pr ovdcJ rhsr su.h inlln)snrnt m not i enJcJ ot ofltt{ lar sk lr tx,ftvcr. tlI htrdo€ or itr{mvcmd r sLl * hm on. tti
<br />I uoqrlcltrnr rhc Ownd Btrilhr rill hivc rlr l r,Lnofpn)vurgllhlhcor\hcJ nor huild or m0nrt rho !) !F1v lnr rir Puqrs of
<br />l. rs own.r of rh. pofcdy, am c\c16ivc1y $nt,crm! wn h lrcnBl .onkr(,6 n, on(ru.r rhc Fl,j.d (se-. 704'4. Bn\in's
<br />aBl hslixsi$C:.dc: lhcContdck{'sLrccnsc l-{*Jocs nor apllyk) rtr uwncr ol nr,Fnv whd hurlds orinprovcs rhcrcon.
<br />dn! wl$ $nrrcG tu such Eojc.rs wirh d c('nlncki(, lcctr{'l plrtrxnr h lhc Conrladn\ t-'(ns. Ltwl.
<br />I rn.rcnllrr un.]cr Sc.r l"-rz-*t'
<br />t\()R(t,Is' ( olIflaNs,\' ()\
<br />t)tl t-,\R,\ll()N
<br />I hcR'hy !llmr undcr pcnrlryolrtrlury.nc ol rhc n,l[)wre 'le'ldatotr\
<br />-lhdvctxdwillmlintrinrCcniliat.olCrnNcnlbScllln!ur.tarworkncomp.nsalidr.rsFoviicJltrhySc.ri'nl?U)olthcl f,trr Gxl.. hr rhc rEnnmncc ol rh. wo in which rh. lcrhir ir i\$cJ
<br />thc sork Iilr e['ch rhi\ Nrnnr rs t\\ic'l My workcs' cotrrFn\drt)n n$urrnrc crrd (lBnirynunrhcrd.
<br />_E,airc.-
<br />crirly Ih.r r lhc pcrnt, 'un.c ot rhc work li,r wn(h rhR P.m( is t$'c!, I \hrll nor cmplov anv PcEon In mv mdnncr
<br />s) drotNonr \rhFd h rhe wortcrs coml.nsrridn hwrofcililornn. an.lasr. rhd iIl sb.Ll hccoft Nhjcd lorh.
<br />workcs..n{.nsdrdrlrn'lhnrns.lScdbnl?00ntlhcL&trCulc.IsMll.kxrh$rlhomplywrrhrhoscprovisio!\
<br />WAI(NINC: railur. n, *curc work n .onll} nsdnr..vcri!c is utrhwtul. ir th,ll suhic.l u.'{lov.r h.,inimltrmht:\ Md
<br />civrl lilrs tp b ot hutlt'.i thot\a J.lla^ (Sl(x).lXDJ. rn aldirion b rh. cdn d umpcn\rrR,r' JNu!.s as ln)virlrl nt rh'
<br />Serion 1016ofrhc tlli* C(ij., ilrcrcd anJ a(o ,--- n *\L4J lLry
<br />t)nt,AR,\ I l()\
<br />I I'c(lry rllrnrutul.' p.trrlryol ttrluryrhlr I rD lru nJcr pnrvsi()n ol Chrprci 9 (c.mmnuin8 w h Sc.rir 70tr0) ol t)'vrin l
<br />CONSTRUCTTON LENDING ACI'N(]Y
<br />r(ucd (Sc. J097. C,! ( )
<br />APPLICANT DECI,ARATION
<br />I hctr+t rlidnund$ Ftrrlly oi F-^'jnt otrc ol rh lnll,,wi',! Jc.lrxrrns:
<br />l).n.l'rnn l'(' rir\ A\ltno\ N.r,lL.lRcruldkn$ (l nh 40. PMO
<br />_l rhclilcralr.guhrons rclddirrg .drdos r.nn,vrl M nor!p i.,hlc k,rhl\ t'iojc.l
<br />o conllly *[h all Cirt rnd connry
<br />rhrC(yann Ondy k, cnrcr qmn rh.
<br />SLAB Floor
<br />Pool Fence
<br />o*,", at,/o?,/ z-...o
<br />**. n r/"q />o zo
<br />ol rh.lnrnNs Md P(nt$ion\Codc. d nry l(ctrrc i\ lull ,,tr( rikl cil.ur
<br />l.icensc classr-I. Ecnsc N u ab.r: .-.-
<br />u,, r^ tr/ogr/. w^o
<br />I
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