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COMMENTSSITE.WORK DATE ID/SIG.
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathino
<br />Shear Wall
<br />Framino
<br />lns u lation/ Energ y
<br />Drywall
<br />Ext./lnl. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil
<br />I
<br />FINAL .f /z /u /44-.1r /
<br />Certiticate of Occupancy / -\'(-/
<br />Notes, Remarks, Etc.
<br />BUILDING. INSPECTOB RECORD
<br />OW ET AUII-DER DEI.('ARATION
<br />I hcrcty rlluo uftl$ If,rly ol tErr!.] rhd I m.rci{ fom rh. ( o.rkkF' Lro* lrP l,tr rhc tolltwr3 rrq,n (Se70115
<br />Buu.\! id PRnasion C,{.): Any C y or Cou.ry *hrh ,quucs r Fm{ to .lnnrucr. .lrs. improv.. &nrltrh or Epu .ny
<br />sru.tur., pntr lr) (s issuaNc. al\o ftquftr rh. rtdkMr nrsu(h ltrmn l0 riha risnqi dlr.mnr thrt h.ot thc is lE.ns.{ por tur
<br />6 ih. !6vr(,ni ol rlI c.ntr.cr,tr r l-icnEJ llw lch2rr.r 9. ConmR.^m! wirh Sdlir ?Ul) ol DivnEn .l nr rh. Burirc$ .n'l
<br />PNL\rx,nt Cd. ) or lh.r tEnilE tr.rcdpr rlmlioh ri rlr bln5 nrrlr rlk!.d.\.ft{ri'n Arr vx,hrliofScrr'.?0.!l5l'y.ny
<br />rff'lranr nn . ,f,mr \rhFrr rlr .tt'lE.nr tu . (ql p.Mlry ol nn mtr. rhr n!. hunlr.J ,!nbr (!500)
<br />I..( oDRr o! rh. F)Fny. or my.nq*,)t.\ w h *+c(.r rh.r (,k n,npcnqrion. *rll &' rrt kf,t.rl rlr (uis ^ -,
<br />mrcni or oliird rtr ek ts(.7(r44, Bustr$ .tu1 thr.sons Cii.: ltu (nita.ttr'( LEn( I rw d{s m $ply(,.nowrof
<br />rhc pop.dy rh'hd \ or imPn,t\ rhc6,n. lrl uh, d(8 \kh vl* himtcll or h.rcll or rhn,ush hc ot hct ovn cnfl,y..\.
<br />nruvrl.d rh.r (u.h rmlrt'Erdr m r, d.nlc! or olt.ftl ld ek It. h 'w.w. rh. I'oiLlmS or uqhrEmd s aru *ihr otu ttr
<br />of.orpfrrr rO*drBu j.. vill hrw llE h{t&, ol lr'vr8 rrEr lr or dr Jrt nt tolll (, lrtnE rlx l,tFny tu (lE ItrtFE of
<br />-
<br />L r\ .rmr ol ! h. I'(lxd y, .nr cr(lunvcly .o.irr.r h3 $ h i.cn<i rod rr(r r) c..{dd rrr r(,j.tr (Se.' ?(xa, 8u(rcs
<br />a Pnn6lh (i)dc: 1llc Cont!(,'s L,c.n!. I-re Jdr nnr rtply n) .n ow..r ol I)()a. yrh,hlrldrorrmrn)v.rrh.'con
<br />and *ho o ri.hntrnr.hIn+.r!wnhs(i' r.n)(,henrdr$ui r 1,, rhc Conrru(ntr s I -f,.nsc bw)
<br />I m.knd unLrs(lEn .A &PC rorth E.s'n
<br />Drt.
<br />-
<br />WORXFRS' COUPtsNSATION
<br />oEct aBAulr!
<br />I hcr.hy illmr unLlcr pcnlhyol t^-.rjry o.c olrhr tulk,w,n8 dcclurrilns:
<br />-I
<br />h,E .,n rnl d!*.b t CtnltIi. or Co^r b S.Iflntm rd srrd! otrp.Eubr B Fbvilal ror hy S.rlEn ]700 oa rlt
<br />t tIr CuL, f rlE p.rrm! ol lh. s,* fn *tlll rh. F rn ir nlE !
<br />Ihrv..ndDrllm.ml.m*.rr'romltnsrr$nm.urrLc.i\rcq!'RlhyS(rnn17morrh.Iiitr('d1..litrrh.FnoIrutror
<br />thc *o ntr *hrh rhis pcmrr ,i trrkd My eork.6' omtEnr on rsur.tr rrn a F,lxy nunh.r 4c
<br />Pulr t Nulnrr,
<br />-Ftnu.\
<br />I(.d,lrrhtr rn rlE lrrforNB! of rn *orll whrhrhr|Em n 6.8-i.I \h:ll nn .nqtby .n' IERI hrny'u*r
<br />s, ar k' rrror rubjdr b rh. v rtcF onrrEnr0llr Lws o,CalJomE. rnJ r8r th.l Il rhrLl t'.{om slt'rer brh.
<br />woA.^ .rmlxnrllon F)vrrrns ol Sc.rio. lTUr ol rh. Lrhtr Cdlc, I .hill, hnhwirh u'm0ly wih rtuk povni,ni
<br />WARNIN(; lailuE b Truc *ort.rs comtEn( i'n .okn3c s nnh*lul. rnd shau .ubFr .n .mPl,r!r b 6tu.l rEMx.. rnl
<br />url hncr un t, om hrnl(t! th)u{El d.lld ('tlln.lrx}r, m ,lJ k,n omFner[n. dms.' r. pntvn.d ntr rlr
<br />Sdr&n .k,'16 o, rlx lrlr clxk, hl.Er ltn.rlom
<br />I h.EhFrlth und.r p.rly or Frjury lh, I .n lE.cd u .r Fovnit or Chrflcr 9 (omftftins ,irh Scd,h 7(xr, of Divnir .!
<br />of ilr Bulrs ,fi] PmLs,nr CdL, .,n my h.n< s tr tull for.! .rr .akl
<br />? 8? (sc
<br />lQ!flauqloNJfd,IllllilcrB.ql
<br />I h.rchy rrtlm uiicr FMty ol Frify rh, rls ! . Nnituri,i Lnlo! .!.Ey nr dE FnollrBt or rlE srt fttr *lut rhis Fmr .
<br />N0cJ (Se 1097, Civ. C )
<br />AIg.ICAtsLDEllaXAIA!
<br />I hfttt rll'tm lnLr Fnrhy of Fr,llry o* ol OE nnbwn! &.Lr.ronr:
<br />D.mrlin,n lcrm rAstE{o! Nrrrlrt'o. Fcdcfll R.tuLrbns(rnh aO, Prn6J
<br />_Rcquircd l-(.r ol Ndff, {r,n
<br />-l
<br />(d y th.l rtE Li.r.l rcsuLrnn\ (rrJht r$.rtx td,vd e r{ {Tl.rbt to lh! Frj.ir
<br />I Ldrly rh, I h.E rcrl il8 rl?la'd.r.rt irk rh:r tlE.bow rfolmrln !r (Eer I rsB ro dnply w h.l, Cry.nl Coury
<br />.nlhlRcr.rl Slrr. L.ws Elrul8 k,br,lj'ne csn{r& EF.Entrxkr of rhr Cdy rr C:{unry t} .nrc' nIrln rlt
<br />dho\r mtrrir.d Pn,Fdy f(r an(rfn
<br />Appli.rnl rA*enlSiEnxluF ^' ////y'?,
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