BUILDING- INSPECTOR RECOBD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />t^r0 /o,btta*8/t lrs
<br />FINAL Qlc ltt D.6qa /ot
<br />Certif icate ol Occupancy
<br />Notes, Remarks, Etc
<br />(,tINER BTIILDER DF:I,('ARATION
<br />I hcrhy illnnr uNlcr F-nilry ol Bturyrh I rmc\cmpr liomih.(i)nrrrlnal(cns('IiwturrlrLlk)*trr3r.r$n(S(r01l5
<br />llhtrr$ r Prn.sndn C*1.) AtryCiryor Counrt wl,i(h '.qtrtrcs !lrtini b.onnnkr. !1r.r. inDrlvc. ,hnnn( "r RPrtr'sv
<br />nnrrruk'. pB,rrJ rs r{in.c. rlv' rcqti'.( rlt rDnh(xtrr ntr uh p.rnnr() lilt I ngncJ drlcmnr rhJrlror nt s li!cn\.J ntr^!
<br />b rhc p'ovNon\ ol rlt Cntrti.itr \ l.tctrs.J l-rw lchxnr$ I CdnrnNn.in! * h Sccl.n ?(xrl I t)ivstrin I ol rh. llNin.s rntl
<br />I'nnc\v 'n\ C.rl. ) d thirl.n or\hc '\.\cnltlrrhdclr.namirhc hr!is trrlt xllrP.d cNnnrrr Anyv(nrr('notsccrrrnT(,.rlth/xnv
<br />Ufhcr ld r nlrnni suhjRr\ rhr tlPlltdtrlro !crvtlPcnrlryol'x n!tr rhi lrv. htrnJrcJ 'lollxd(i5ff)
<br />--l.r\own,dlrhclrnlpclly.,trnrycmp[,y.r\whwrs.\i(rhctrn]*rrorl.n\rron.wldorhc]ol1rxlrh({nrrm'l!r
<br />rh. Iln,tR y *k, h0ru( r n!n()vcs rh rcotr, rJ who(ll{\\uc[sbrl |'nN.ll !trh.'nllorr]trdu3hh'\ or h.r own .mpk,vccr.
<br />!r ovrldl rhr su.h mfn,v.'ktrr{ N nor lrlcnh'l or or lirc'l Inr \aL l l. h 'tr!]cl. rl* htr m! or m{nJvcmN s {rB $ ih'n dic \*rr
<br />otconll][1s'n. rlE O*n r BtilJcr wrll hdv. (h. htr'ldr .l F'vrn8 I lur hc or \lN Jrl,Dl nur[l or imPnNc rhc ln)tr{v lrtrlE PUrIi'e of
<br />l.,rown.rolrhc Ooliny, ruc(lu\rvclyrontacr'n! w h l'..n{d onntrtr!r'(.trnnkrrlx nr')r.d lS.. ?01i. nu{,r.r\
<br />xul ftnl.srmC",lc lh.(,)nrrrrnr's I-'Lcnt Ldw'lncs mr rmly n, xnortro ol F)Fny*ho hu,l'lsor inrnrrv$ rhcturrn.
<br />rnJ {ho $ntd$ftr \ueh pr)jclrs wirhJ (])nt(t'(\rll.ctrtallrrrurnr n,rhc(irnrr(nr's l-i.cns.l-rw)
<br />I )m.r.n,fl !trJ.r s.(r0r
<br />rV(IRKFRS' CONIPENSAT!ON
<br />uEeLudllg!
<br />I hcklryilltrmtrnd.r0.trrlryolltqtrryon .lrhcl,n[)wnr3dc.ltrrrruN
<br />-l
<br />hr!. ul wrllnrr(lm a (.nil!rr. ol Conwn t) S.ll-ltrqn. nr *ork.' (' conlF_nsltnn. !\ !o!'dcd nn hv S.L[)n l7(Xl olrh.
<br />tihtr (ixlc,lirrh. pcrlrm.k. olrh. trork lnr whi(h rhc F_nn i\.{rcl
<br />rl( xtrk l,tr BhL.h rhtr |rTnnr '\ ^{rd Mv Fdtrri c.n,Nn\.'rkr trtr0rrr. (rrn drl Fnty n n$(r d.
<br />CMrcr-
<br />Pol(y Numhcr:-
<br />-l
<br />rcn,ly rhrr i', rhc lad.rnnn(e olrhc work ntr *[i(lr rlri\ t'.rnnl i\ i!strcJ. I \hrll tror cnrPloy ury P.^on n.nv nrinn.r
<br />n, i{ I', }E.ont s,ftF.r t' rhc *.rkcrr r.nltnvrtr,n lxws ol (ihnnnir. rkt !-!t! rhrr ', I \h)ul1] tE.om $'h]ctr brh.
<br />w r(cn .omr.nsxrx,n F,v6r,n\ ol Se(ri()n.l7lx,otrh. Lhr (1 c.1\hrll. n,nhwih$ lllyP hrhoeF'vi\tr,n\
<br />larhrc i) \..urc w,trk.^ ronlrtr\xr rtrr.dvcnlc s u Lstul. rtrrl (h
<br />n) .N lrn,lr rtunNn,! Ll,nlx'\ r\l(xr.(xri)r. tr .trl,linn' nt rlt
<br />S.rri,r 1076 ol lhc LhtrOri..,
<br />"",",\: /t4 lt t'
<br />I h.r.l,y rlr(nr tlcr |rnrlry,'i r^-.rlurtrhrr I r r l,.cniaturl.r pnnrk,n,'l(hiu.r 1)r(on,n'.n.ng w
<br />oi rlt Bunnr\! ]trd Pnnts{.n\(,n1.. rnl n,y h((r.t I rlullnr(.rxl.1l(r
<br />r'o\sTRt(_r()N l,l,.NlllNc A(;uN(-l
<br />sn'cd lsc(. l(,r7. C'v C )
<br />htrd.r\ AJ(|rc(
<br />-
<br />ATILIC NT DECLARATION
<br />I L\$y lll n. un,l.. r^'mhy dl rt(rluty oN ol rhc nnl'$'n3 d..lddB {
<br />Dcnk,l(rr P.onItA\hcno\ Ndr'nLrrDn lrc.icr!1 Rc3n[r!,ns (1'rl. {0. I'rdtr)
<br />RcqtrrcJ llI.rol Noriln{r)n
<br />I..d'lyrhir rh.lidc'!l(gulxr()n\ ttsdJ$! t\rtnd\,.nr)ulrr. nor rfl'l(dhl!'r, rh,\ Pntl(r
<br />I r. ',vil r lhrv. r.kl rhArfl)l(Itrnr rl r1lr rlL. xhr. ,nl{{ Lrnr r\! n(r IrgR\n)..nrtly wirhrllC yrid(irrIy
<br />.r'1trrtr,..s in(l srrr. l-rsirlrrs! r.pn {nr irc\ .1 rln\ (lly !trJ Cotnry !'.ntcr otr)n rhc
<br />rlxr. n{ iNlfl!,p.ny kn
<br />'n\7,tpDli..nl or AEenl Sistr{l}ft
<br />q
<br />Forms/Steel/Holdowns
<br />T-Bar
|