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SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground \
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Rool Sheathino
<br />Shear Wall
<br />Framing
<br />lns u latio n/E ne rqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL 1 'lottlr 7 E/h6rA '1.&1-
<br />Certificate of Occupancy Y I
<br />Notes, Remarks, Etc
<br />OWNI'R BUILDER DELC RATION
<br />I h.tclty !fiinn undcr Il.noh) oi pcrjury rha! I !'n crenrpr tmnr rhc CoihcroE Lkcn{ Ltrw rd rh. f.llowira rcaq,n lscc.?011.5
<br />Bu\i.cs\ md Prolc$io Cod.): Any Cir! .r County whkh rcqutcc , Fnril ro cnnnrucl, fllrcr. inDrovc. dcmolhh or tnnir rny
<br />nocrrc, prior ro irj issurrN. also rcquircs lhcnppltmt iitr such pcrmit ro filcarisncd id.m r rhar h.or shc h liccnaal punuo"r
<br />x, rhe nmli\i.ns or rhc Cont,cr.r's l-iccn\cd liw (ch0ptcr 9. connncNirs wilh Sccrion ?Oln oi l)ivnn'n I oflhe Butines 0nd
<br />Ptufc$nrr aid.) or rhar h. or shc iscrcnDt lhcrcfronrnd ihc h$k fo! Ihc llkSed rremprion Any vt,hrn,nofSR_rion70ll5 by.ny
<br />Irynr'r'nr lor rFnm( n'hN.rhc Jn!trrnrro0ci'il|cnalr),lnnrnxrcrhrnfi\rhd'd'.dJ.llr\,1rft,,tltt'
<br />d(-f ^ "*ftr ,,1 rhc pblcny. or my.n'ploycci \ h w,8c! rr rhcn sk (on{'ans!li('n. will d{) rhc sork arld rh. dutuE h ml
<br />inEtu t or n(crcd for slc (Ss ?04.1, Busincs and th,fcsi.ns Cmlc, l hr Conk&irtr s Licctr{ bw des nol .!rly ro m osncr o,
<br />rh. rspcdy wh. h{ilds or i'rlisvcs rhN.. Md who dcs (Eh work hnnscll.r hcr{lfor rhnugh his or h.r osncmphyccs.
<br />[ovidcd rhrr snch inpr.ktunh m nor inrcnddt nr oficrd for slc. ll hoa.$r, rtE hril.lin8 or inp(nrmnr is $ll wirhin .nc Ftr
<br />.tco''{,brion- rhc Owncr Buikld will h R dr hnrJ.n of pmving rhr h. or rh. did mr hulU or i.{roK irc lrmpcrly lhr rhc !urF){ of
<br />L r\owmrofrh. pmr.dy. rncr.lusnclycoMr.rin8 sirh li.cn\.d coMadors ro.on(rucr,lE poj.{r (S\--. 7C}j{, Bu{nc$
<br />0fr1 Rntr5shnCodc:ThcConlracloasl-iccnscL!+desnornprlyroannstrcror|n,pcn,*hobuildsori provcslhcrcon.
<br />rnd who conrmcrs for skh pnlcck wirhrCo d.ron\)liccn\cd pursurnt othcCo ra.toas Liccnr La*)
<br />(D"'"'
<br />^-;ili,; x.. )Z:iZ &.--,t r- ,, *llf}hTH,n^IIIl*
<br />I lrr.hyrllirrundcr lrctrrLiyor Pcriryon.of rli. n)lk,si',9 d..ll'r.oi\
<br />I rhor ({nll.,nr rhc pcrloflui.. ofrhr work lnr qhi.h rhc |f,nnir n i\suc(l
<br />Ihrr.rndsill rir 0in sork$s coml.nidior in\uron.c..s rcquircd iyssrion.lT($olrhc ljhntr Codc. nn rhc Fllo nrnccoi
<br />rhc work lor whi.h rhisl)crn is ksci. Mysorkcrc'conrpcnsilidr insurmcc.lrirr rnd [,lic] 'nhdr
<br />rc:
<br />e .cdiryrhrr hrhd pcnaflnin.c ul rhc qork tu whi.hthisl)c.nril is hruc,l.l rhrll 0or dnlnl,'y riy tcN)r irr 0trynrtrncr
<br />lo trtonr sul,j.rl lo lhc workss mnr.nsdion lows ofcfllirbrnil u.d re(t rhd ifl xhould tEcom suhicr lo rhc
<br />w.rkds com|[trs.lion pn)visions or Scdnnr:lTOOnirhc Llhtr ({nlc.l \rrll. ranh*irh.onrtny qilh rlmsc ProviriirN
<br />WARNINC, t:rilurc x, sure qork.n .onll.n\ 'nr..vcrr!. i\ utrlr\erul. rnd \hill suhFcr !n cmnlorcr ro din,inxl FMlra\ atrd
<br />t),trrhr drcd rhousnnd {tolldrs lSl(x).0(X)), i'r ldiriotr ro rhc co( oic.nrnc \rlidr drmrlr\ s!n,v cdlarrh.
<br />Scrrnnr.1076 ofrh.lrtrJr (d1c, inrcrc( alrd oary'( la.s.*w
<br />t)t( l_ \rt \ I l()l
<br />I hcrcby iflirn undcr Fnrlryoipcrjry rhd I am liccnql utrdcr pmvhion ofChxpr.r 9l.onrnf,mirg *irh sc_liotr 7000) oll)ivkio.:l
<br />or rhc Busincss Md Pbr.*ions aodc. and nry liccnsc is in full force anlcffrcr
<br />CANSIAUETI!)NIIjNDIXIjTI!;I,NCI
<br />isrud ( s... 1097, Civ. C ).
<br />Lendcr's Nn'rc
<br />-
<br />d-PlLtc NfDr.cLAnauoN
<br />I h.dbt linnuidd l.nrhy ofNrjury onc orrhc nrhwnrS dc.laririonr
<br />Dcnxnirion Peirnirs Arhc\ro\ Norifi.rrn Fcddrdl R.Sulariinrl (Tirl.,l(r, Pan6)
<br />-Rciluncn
<br />Irrrcr ol Norifi crrion
<br />l.cnilyrhd rh.fcdcflIrcAulrrions rcSrrdinS ashc{os rcnnvrl arc for apnlic lct,rhisF+.r
<br />-l
<br />ccnilyrhlr I harc rcadrhi\ arplicrinnrnnd narcrhd rhdahvc nrfonmrion iscotrNr IrgreroonDlyw hallCir'rndCoudy
<br />(".*u1*.",0n,,, lbr@-li3b4e, hcJ"l*,*i) < /"L+,1 t,' t f,L-*'",, {t 6*Ju< L) f"-<?
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<br />BUILDING- INSPECTOR RECORD
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