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SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq
<br />Shear Wall I I
<br />rila4ktFramino
<br />lnsulation/Enerqy 4';{A{,
<br />Drywall ,|F I utu/t)
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />Masonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />I I ,[r
<br />7)FINAL
<br />Certificate ol Occupancy II
<br />Notes, Remarks, Elc,
<br />L lvct)VS ,
<br />a+lr-
<br />BUILDING- INSPECTOR RECOHD
<br />OWNER B('II-D[T UI:LCARATION
<br />I hcFby rfinn undcr pcn.lry oi Frjury rMr I d.rcq)r li.nr lhc O,nrrrrh^' LNnsc Law li,r lhc lnlk,wr! rc.nrn (Scc.70.11 5
<br />Ilostrcss a Pnrlssi,n Cdde): nyC yor C unly which rcquirc\ r !.rn nl condo.r. alr.r. imProvc. dcmolish or tp,r atrv
<br />(o.lltrc. prin n' ih isnrmsc, also rcquiEs rhc]npl(,nr tur suchtcmrirb tilca n8.cd s.rcnEDr ihil h.dr rhc ( li.cnk'l Pu$a
<br />t,, lhc porni,'ns ol rlE Conl!^cnr's l-i.cnsql lf,w lchaprcr 9. CtmrmncinA *irh Serion ?UXr ol lrivtnrn I or thc Btrsim* 'nJ
<br />I,roli\sont codc)orlhrt,Eorshc i\ .i.htr rhcreh)m.nd rhci.sis lnrrh.,Ucgcd cxcmflion Any lnn,riooolS.clion 70115 hv,nv
<br />?ndunr tu r,'crmrlsutjc.r rlr rntlicetloa(ivilnenalryolfr no6 rhin iivc hundr,l doudl (S5m).
<br />l. is o*ncr ol lhc l,uJrny, or nry cnlJ)l('ya\ *ir h wxg6 ri rhc,. $lc conp.nsari'n sill do tlr wolt an lh. dtunm t nor
<br />idcBlcl or ollir.d lnr slc (SN.,U4. Br\ihc\\ and Prohsi.ns Cii.: I ne C(,nktld ( Li.en\c llw Jo$ nor alplv b a! o*n.r ol
<br />rh.pn,|rny *ho huil& or nnpmvcs rh.Rr., aBl *tu J(B nr[ k,.t hinNcU or hcr\clfor rhDUCh hi\ or h.r own.nDlovc.".
<br />provdcd rh.r such inp.oEnrms N ,nn i.tc'rlcJ or olittd tt r.h Il, h)*cvc. tht hriuin! or nlpovcnEnr is sid wlhin nc rr
<br />orcotrphridr,lh. O*Nr Builibr w'llh.w rh. buidctr ol Pn,liq rhrl h. or shc dil flr ltr i or im{RM tn.I'mFnv turlt NrPo* of
<br />L r\ownd olrlt lln,pcdy, mr.\clu{vcly.onkacrins wtI liccns.{ contrbF t, ..n(fl'cr rht pn)J.rrls.c 7044. Bu\iJrc\\
<br />rki th'ltsson CoJc: 'l hc Contrcktr ( Lrcctrsc l-nq JrE\ noi rnlly ro M.wncr ol p!,Pcny who hurlds ot iml]ftrtl lhcrc'n.
<br />,nd *ho conrru(b ntr su.h ps+.rr wnh r ConrDchn s) liccnr&l Put\m n, rht G)nt&l,tr s Liltn{ Irq )
<br />- a. & P.C. for lhn'.r.un
<br />Drt :- O*ne.-
<br />!98tr!8S:Cq[tPE!lAr!]N
<br />I'ECLARATION
<br />I heicby aflirmundcr F,!ll) olFrjrry6ncorlh. ioll'win3 dccl{arionr:
<br />-lluvc,xiwillmiorahdC.ii,ficrlcofConsnrtrSclrln\urcntrPotkcs.onpcnsarion!srroridcdforbvSccrio'lTIrorrhc
<br />A{A\;Htil';
<br />litr rlrc p.dbmraNe of rhc work litr shi.nl[e pcnn i\ tstr.J
<br />willnrainrrin wolk.s' .omlcnrrln'n in\urrn.., ar rcqu rcd hy Sar(,n ]7D ol lhc Liho. Ci,,rc, n, ihc Pcrlomrmc of
<br />'dmn n$r n uFurikc ff'.r a,rl noll y numh.r m.\<i u:L:rt05 ao a(+
<br />\rv3 5aJ \ .'\ \ 'r ,,- la-t
<br />I ccniy rhdr in rhc pcnnrman.c otrh. wotk Lr w[i.I rhr Pcrmi n il\tcd, I dEll not cnfn,t rny l[son in anv han^--r
<br />v' N l,) hcd,m {ftjccr 6 rlr wxkcs compcnsar ion lrw\ ot Cdldonrir. {ti !!rtc rltd 'I I drr ld hsomc \ohjfrr k' lhc
<br />eo*cs ronrpcnulon pnrvsions ol Se.lion .IT(]O ol rh. Irhn Ciilc. l shill- l{hhw h omtlv wilh rlru{ Pruvrnon.
<br />WARNINGT Frilurc to sccurc workcB cohpcnsdton covcrrse is (ohwtul. dnd ddl suhlc(r ,n chtloy* b .rinnnrl Fmlri.r a l
<br />.ivil ,nr: rp nr dnc hunJrcd lhouranJ 'lolles r5l00,0(x)), rn
<br />Scrri,,n 1076 otrhc Lahtr ahlc, inrcrcd r.d orrcy s Lcs
<br />DECLARATION
<br />I hcrby alltrmnnder pcndlyotFJjury ihal I im lien$,i tnlcr ptuvrn'n orCh{nlcr9lcohmncine vilh ScrrFn 7m0) 'rDivision 1
<br />of rh. Bt,Ns anl Polcsions CoJc, aft] ny lacnsc is in rull tJ(e !fli .!litt.
<br />1 ?:
<br />CONST'IUCTION T ENI'IN(; AGENCY
<br />I hcrhy allirn und( rctrdlyol pc.jur] rhar rh.rc is, uonstdcrnln hndins 38cncy hr thc I'c t,,rnutrc ot th. work f{ whichthG p.thir ie
<br />issued (sN. .l(rr?, civ c )
<br />,:nic.. A,i.te*
<br />-
<br />AI&&ANLDECLAEAIIII!
<br />I rr.5y.nim undcr !.nalry oire+ry onc ot rhc,all,rwinr dcchEridtrr:
<br />DeB)lirion P.rniteAsbcnos Noliic nn F.dcrdlRcSulations (Ink 40. P!n6)
<br />_Rcquircd lxllcr ol Ndiiurioi
<br />I r.n,lythrrrhclc cfllrceuhrions r.rnrd'n! rdt{dr rcnr)vrl rt Dnr rtlfl(rlrlc nJ(hk F)jccr
<br />(cnrtyrhd lhrv. rrtrd rrr( rt'ii. i,Dru dirc rhr rhcrh,vc nornrd r\ .omd I rsre h comlly *irh ill c y,ndCoutrry
<br />s anJ Srarc l!0r nlxrinS kr build auv.\ drrhrs C y {n'i Coonry h cntcr uP.n llE
<br />rl$. n{dtrrtrd fr |r y,nr
<br />Aptli$nt o. ,\gr l SigMn,m
<br />tiz_
<br />l -9 - 24:)
<br />D,n. _ I ^q-2>
<br />o^r": \ -.* -7O
<br />Forms/Steel/Holdowns
<br />b*W)t
<br />Pool Fence
<br />Flood Zone Certil.
<br />'DUIIN)
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