|
SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation t
<br />lW,tM{tRoof Sheathing ?66
<br />lShear Wall I
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />lVlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />,tlLl;tbaFINALtJtr x/1);X\
<br />Certilicate ot Occupancy
<br />Not Re Etc rlxd)
<br />AI
<br />{--r---- --'--'
<br />OWNtrR AUII,DF:R DF,I,C]ARATIoN
<br />I h.r.hy.tirm unJ.r pcnally ot lcrlury ihar I tm.(. ifl ltum rlt conraci'h L@trr ,-rw tnr thc n l"wine rc!$r (Scc.7oll.5
<br />Ilusircss $i Prni\non Co!c): Any Ciry or C.uniy $hsh rcqotrcr r n mrl r. ..n{n'.r. alt.r. iBplrvc. dem'lth or Er,rt .ni
<br />ntu rurc. pflor b irr trnrbc.. ako rcqufts rhc ,pptirxnr ,i,r n'ch li.m t, ,ilc r \isncd n,r.,ftnr rld h. or fi. s lrcn\cd J'urirrnr
<br />r, ihc 0ovi!n,ns or rlE Conr,rul,, r l-j.cnsol l,aw (( [anlcr L Conrnrn.i'rs *ilI Sc.ri,D ?000 or l)ivisi{D ] or rhc Bu$ncs ,nJ
<br />Prnas\tr)tr\CoJ.)orrh.r h.dlhc (cxcnlt'rlhcrcliDrnkl rh.h\i\ turrlF.ll.!.d crcnpnon Anyvidrri,rolSccnotr?0J15hy ry
<br />rppli.rnr rorapcm subj6..r\ rhc q'r,licanr kr a.ivilpcnrhyofnornucrun rnr hunn,e'l Jollan(5500)
<br />L N owncr ol rh. F)0cny, or hy cmtkry..s w h wr!.\ r\ rhctr nn .onl.nsr idr, qill do rh. r'dk rnd rhc (nrclurc $ nd
<br />n cndcn o, .lli, cJ n)r Qlc (Sa 7ll,1, Bu\ircs uJ Pr 'lc$!)n\ C(ilc l hc c.Dllr(tr s Ltcnr l-aw i.$ n.r apply h fl o*ncr or
<br />rhc pn'tr' ry qh, huilh or mDnnr. rlEExr. !i wlN J(s nrh soA h Nclf or lDr{If.. rln.tr3h htr or h.r uwn cr.pl,'y.cs.
<br />FNi'l!.J rhar {rh inpr)v.mnr\ n nor mrcnJcJ r oi.rcJ lnr sxk ll. h$d d, rhc htr
<br />'Umg
<br />r ht' otrmnr r sru qihn on }r&
<br />_1, r\owmrolrh. p'ofany. rn,ct.lusivcl!ronkr.r ! wirl, li..ns.Ll ro rri ir ri cotrnn'.r rhr lnt.r lscr 70,1-,1 Bulncss
<br />dd Pnncs$nrCodc Ihc Contr$l'n's l-iccn!.1-.w dos n,i rmly () r.wncr ol B)!.ny who huildsor rnrnr)vcs rhcrcon.
<br />rtrJ who ronta.rrlnrsuchpn,F.k$irhrConkad(s)li..ns.Jpur$r brh.O)nrn ktr\ l-i.cnsc Il*)
<br />_l ao.x.ntr rnJcr Serir_. B. & P C. larrhir rrn,n
<br />!!.q8([85:lO!ltENr4rrON
<br />DEII6BA.II9!
<br />I h.rchyrfrtr rtrnJcrp.nalryotFrjx'y.icnlrltlnlLrwmBJc.larrrtrnr:
<br />I hr{ril will rinrrin i Ccndicdrc ol Con*nr tu s.llln{rm ntr woik.rs conrpcn\ nr, r( fovidcd nrhyScchon:l?{ro.frhc
<br />L rr Cirlc. lnr rhc Frlnrhdnc. of rhc wort Ltr whth rhc pcm ir nsrc'l
<br />Ihrverndwillnrdr$workcrs cotrIrnsdln)n nr\urdrc. rs Eqrirr hySc(rtrrt lTmofrM lr$orCix,c. i(tr lhe Nnnrnutrccol
<br />thc p k k, wlrichlhN lrcmnt i( rsud. Myworkcr! omFNrrn , trr{tr$rccma ind Fnicy truNhcrdc
<br />)6,",.S+q./<. Cohaatnsq+ral. {hsq r,-,.,ea Hrl(4!,""."". lq., Eqts u,*,, q f r /2.o2-o
<br />/gfr*n'ry n,' ,,r'" p*,rron\c.l rhc roa n, whrh'his p.rnn is irsucJ,l sh{ll an cnrlt,y.nyll.rir r rnymanEr
<br />\r 3!i) lr..on{ {,h!.rri rh.vnk.rr conr|{nrxr()n hs\ olcrl,torrrx. rr,i]!Ra.rl,xr Lrl \lxn,1,l lf,ronf, \rIi.(r nrrh.
<br />wo.r\'.on,I).n\rr(rIx)v'\i0tr\olsc.ri( l700olrh.l.rlitr(ixl..l \lill.lhrh(ih(oDrplv q h rho{ nnr1\i('n\
<br />.'!'l ltrr\ trp n, ok hutr,ltual rl$u\rn,l Jollrr\ rllu,.lxx)r. iJ ,n h rhc.on ol .onlc6rri('n, 'lanDScs rs F,Ytrl.J f(tr rhc .
<br />S.rriin,1016 ol r1E l-rhrC{rj.. dclcn anJ rftrrf,y s li.s.
<br />r-l1!!!lB!tot
<br />Ihcrchyalltnru d F_n.llyolrciuryth l anr li.cnsJ rtrti.r pn)vision otcha er ! (cdnrnEn.in8 w h Seron 7000) oi Divisnr .1
<br />I !h. aurncs Md Pft,fc$ions Codc. rd ny tic.n{ i\ in IUU fo'xc $rlcll..r
<br />c-3?q t7z1l
<br />.<rt"'",r- 3^ /'i at/ r2.x-Jn ^ ze6-7
<br />SINIIAu(IIqN.LDNDIICICINII
<br />I hcrchy allirnnnJc, pcoahy ol Frjrry rhlr rhcrc n a condrull$n bdirs lsck-.y iltr rhc FrtnrmaN oi rhc y'Ik tr *l'ichihis !.mir is
<br />nsucJ (S.c. 1097, Civ C.)
<br />APfLICANLAECIAAAIIA!
<br />I lul.hy dlnu unncr pcnallyor pcrj,try onc ol r& tullownr8.icclardnnrs:
<br />Ilcm,l !)n PcnnrllAsh.slos Noriti.alnrtr FcrlcralRcguljrtr,n\ arirk40. Prn6)
<br />Rcquirc! L.rrcr I Noriti.arir
<br />_l ccnilvrhar rhc fcJchl r.grh n,x fta&liog rsh.dos lcrfr)vrlrc..r{'pli.rhlc i, rht fl,'r.rr
<br />VEzl ccnrryrhn t rra'c rct rrrsrpplrdtr,n i {rrcrlmr rhc rh)vc nnonn{on Nc.ft.Lr Ia8rccir.omtlywir[.llCrlyrftlcouniy
<br />ordinano$ann Srrrc LrwsrchrinS k'tuildrn! L1,rsn.tidn. md h.rcby rtrrhorizc rcpr.se rrriv.solrttCnyrnd Counry x) cnrs nlxn' rlr
<br />y^.,,,i,,,,r,r,YX.* 2*y )-1-?-o
<br />f\,^."ron",, Welov DartdS
<br />I
<br />a_
<br />BUILDING- INSPECTOR RECORD
<br />UFER Ground
<br />t/1)4b,
<br />Brown Coat
<br />6l
<br />2"*,q
<br />---+--
|