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SITE.WORK DATE ID/SIG.COMMENTS OWNER DUII-DEX DEL('ARATION
<br />I h.rchy .ilirm uBlcr Fnolly ,, rErjury lhd I rm cx.m h'F rh. ConrreloF' l-{cn{ lr* d rh. n k'w,n3 Ersn (S(.7{rll.s
<br />Burnesr !trd Pnnision Cdc): Aoy Crry or Cirnr, whi(h Eqoirs I Fm ro dn{ru(, !lld, mtn,v., &mlirh or rFn uy
<br />nl4*rm. lrrtr n' s Ftlj,n., dr, rcrtrft\ rh. +plf,ur nr reh Jrmr r' llk. r4Ed {{.mnr rh.r h or rh. 6 lEn€J psuul
<br />k' r,E Frvnnr ol rrE Conrrritr's Lr.nBj lr* (Cn Pd 9, Conftrm3 * h Sarxr 7fiD or D,vtrr,n I or
<br />'lE
<br />Burr( .nl
<br />Pn,l.s[nr Cqk) ir rhir lr or rh. ..r.rl0r rh.rtNm.fll rl* tuai ro. thc rlk3(1.\ctr{ion Any vrhii'nol S(rEn701l5 hydy
<br />,p0l'Ld hr rIimrrul'Frr rhc rppn.nrr,rrvrlpcnrltyol ,r tuJ( rlHn Ilv. hunJr.J dtrtl{s tl500)
<br />l, r\ {wBr ol rlE FrFlly. or mrcq'l'y(r *(h *{.r.s rlEr g,lc (qtnur.n, * l th, rh. uf,t an rlr (ulr. nn
<br />'d.nLi ir ofi.rd ltr sl. i S{ 7lX{. Burn( .nJ Ptur.r\xr! (irL TlE Conr&t iL.c.clr*dxr rqrlyroeorErol
<br />rlr I'$Fny *h!tx ls d ''qr,6 rrrRr !n rh, drt qh *l* hrm<ll or h.Blror tls'rih hr or h.r o*'n.nplorc\,
<br />Ilnrvdcd lhd ru.h hF,hmrr. e mr d.nLl oroiiNl l,tr elc ll hr*6, rlI hi'Lls3 or lrlnrErud tr r)tl w hh.m F,
<br />olcoripLri'n. rli owrr Bu lc.w hav. r& hn.ndrptuvus rhrrh.or\h.Jrl mt budl ur ur{n'E UE p$Fny li,r rlr rlrF,s.,
<br />l. a1.rur.r rrr FrFny. ..r.(lunLly.orir&r u3 *(h lr.n{d Lonrrro^ r, on{tud rlr |r)Fl lS( ?or,r.6u(m(
<br />! Prr6rrr(,xi.: Th€ C,,nt(ttr'r L(.n\.1-r! d(. n.( lftlyro o*Mr .l pn,Jrn y uh' I'url'is .r mpn,kr th.rd,n.
<br />dn'l *ho ! ntlr'isl,trn'.hpn,lccrs ' h { (i)nnrn'n 9 lk.n\. punu! n'rh.Conk&tn \ l.Kcn* kw)
<br />I n{.n u Lr S6..lr'n
<br />J--t
<br />t2!(taEdrla!
<br />Ihrrhyalltrntrn(1., pcnilry I n(rruq ua. 'nrh.l!nhwhB JNLfurk)ri
<br />-l
<br />h,E rn *'ll m'nru r Ccn'fr:t. ol Ciln€ io S.ll-l.a.c nx kntda onFrdr'n. .r Ftvrlol l(tr ty krur .l7m or r&
<br />l,trx Oic, lor rh. Frfo,l'.[_-. of r,E s,t ttr wh.h rh. ,.m'r ! tr!!.J
<br />_lhrvcrndsrllmlnr.Dwlt.'..mFnirk,rnsunB...rrcqulqthySalrrnl70Oolrh.t:borCuL,ttrrh.IErtamfr.of
<br />th. uork ntr *h.h lhs Fmn rr !qal- My rintdi onFnslr,n hru ..dE ,rl f,l.y .umb.r &:
<br />l1)l'.y Ntrnrh.r
<br />I(.n'lvrhd'nrh.Frlornrn.orrh.*!dl(tr*hrhrhtrBrm[6r\ud,.I<ru!n.ry,r)v,nyIxR,n'nrnvtuntur
<br />!'r\btB.n*ruhr.rn)rtk,rt6Nmnnsiimh$!ul(rl'lomE,Jrlltftrhlnt\h!uHh(dnluttFltbrlI
<br />*rlleF .on{xnqr[n pNqrr)n\ I SRrrtn \7ixl oi I lI I rh, (ii.. I dull. l()n hw h ..fraly t[ h th)( tn'vNi'n\llARNlN(; l'r,lur. r) k!u,. wdkcF $nrFn\dr)n (vdi8c ,\ trtrlrwlul, rni shlll suirc(r rn cmtl,'rr r).nnmrl litulrrr .tu]
<br />L'v'l I'n.\ trr t) oN hrnJr.tl rhou\.nd dnlhh r1l .Bnlrtr,n n, rlr lxr ol (on'Itn{rrkn,. 'lrnr!.\ x\ Iln)vtrlc,l n* rlr'
<br />sersn 1076 or rh. lrh, GrJ.. !t.cr .rf jr{ttrf
<br />I D8J;IJBAIIIIN
<br />I h.dhrlrr!$orkr pcn{hyol Frjory rhrr I m' hrhrdtftLr llnrvsion.l r)r!n utrtr'g w h S(iDtr rrxrl) olI)'\trBr I
<br />r, rh. Bu\m(.il Pn'r.(i'n\C!xi. rnl my li.nt tr u lull l(tre .d cllrlr
<br />l-NnscClN\
<br />-
<br />Ihl. _ (.nlB
<br />r(,!l]!r.sr0tl,r!!lN(iJt!ili!rr
<br />FtEd(Se.. .1097. Civ C )
<br />AITIICANLIIECIAEAIIO!
<br />I h.dr! :nim unLr Fnrly ol F.rrry od oi i lr k,lk,*h8 de hhr xrh(:
<br />lxfr)l Dn P..mrcArb.finNorrl(ai$n licJ.rrl R.guhrr,.rrlrilc.lO. t'd6r
<br />It.ttrni 'r lr(.' ol Nditr.irtr,
<br />_l cd'fy rhi/tu reLrrl eluhlnn! E3.nlrry .slEsln( rcm)vrl & B, .r'dr.lt!. b rhn rn'Fr
<br />_l rd'l!rhlrl tuk r.rd rhtr .2isnrn{rr. rhrrrl* rh,vr r.ft'tukr N.rllBl.I {Rt,lrDl'l,* hrllCny.,r,(.()u y
<br />(n(ru(ri)n. ml hcR.hy rulhnrc Eltr.s.xw!olrhncn
<br />,nrr. nf,fr0nRl tr lrnr htr
<br />lppli. Y,)r '\r.nl Sign.lu Q.5" &--
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Shealhinq
<br />Shear Wall
<br />Framinq
<br />ln s u lation/ Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />,r lz" /,.
<br />Certitic ate of Occupancy
<br />Notes, Remarks, Etc
<br />BUILDING- INSPECTOR RECORD
<br />D.L:
<br />Subf loor/VenVlnsulation
<br />FINAL
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