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SITE.WORK DATE ID/SIG.COMMENTS Ol't NEB ITIII,DFI DEI,CARAT'ION
<br />I hcr.by ,mnn unL. Fnrlry ol FlJury lh.l I m .r.nr,i fn n rlt O,nkrnr' Licnr lis lltr tlr lolhwins i..on lS.. mll iJ
<br />Bunk\r lrt Eot.\nn C{nc) Any Cily or Coud, f,hih rlu'F! r Fmi! 16 $ndtucr. ilr.r, inlltovc. &.r'lirh or rcpin lny
<br />strucllr. prir ro itt i$!aft., rLw, rcquirr rlE lpt tlnl ntr lEh Fmir !' frk ! $Ed {{.m.r rh.r h. o, rh. ! lrcn<d p!@nr
<br />t. rhc nmvr.nr nr E Conbe-ftr'r l.Encd ljw ((-haFrcr 0. CornmRin8 wirh S(rnrn 7UX) or Divnion I orrhr Burincn $d
<br />Pr,f.*i,)ns (idd ( rh.rlt o nE i.rcmpr rhnrffirn and rlE hc\ir fq rh. dLS.d.rcryri.,. Any r-rLrionolS.d!n ?(r.!15 bl!.ri'
<br />.r'lianr ro. a ticmli {hJ..h lhc anFlicinl ro . riril Fnch y or R 'ftlk r hnn flvr hrndrn dolltrr i $5oar )
<br />-1.
<br />$ o*'8. or'h. FrFny. r, mI.nioloFs with *iscs dr rtrt c'lc.onD.n{lhn. will&' rtr urk !i tlr $d@ ir nn
<br />inr.dGr oroo'crcd lo {L rsc.?(x4. BuriErs r.d Phf.ii,nt Co& Tlr (h rdor'r Li.n< l^ d.rt d ttrly !o m 016 trl
<br />rlEFfsy *tr tuHr(n tqF,E rlE$n. rrrl *h rtB *-h slt hin\clfor hcrclf or rhn'uah hh or hd own.nshy.c!.
<br />l'n'vi:l&l rhlr ru.h nqh,Erdrfthr id.r*d olI.Ed lor sl ll. tntr$E. rlr tnillilr. or inrmEr is$HlihinmJd
<br />oronvhli,tr rlr OxF BuiU.! $ill hE rlE h,iln orFlri,t8 rhd h. M slE dil n t iHorinlh c rh. rhFny ror tlr plrlr)E or
<br />-l.
<br />arowncr I r hc l[,trdy. rn crcru\ircly..nrGrins tr ilh licTn(l ..n(&1.^ b o.(Ml rL ln)Fl rSe 7lx.r. Bu{iE(
<br />rnl Pn 6sin('{xlc Ihc(i}nraror'!l-t(nrctiq dG\n rntlvn, !nof,ftr olpn'Fny rho tuildr or impovct rh.rEo..
<br />otul lho ."nru.h r.i lu(h tir*.r\ snh u Codnck"r r liln<i puru lorh.c ntrrntr.L..nct$l
<br />-.
<br />tl & lC &rnn.c!e,n
<br />l)src. ()Rrr:
<br />$ 0Rti r tl\' c( I\rPr\sATt0i
<br />ulst tBAllla
<br />I rr1.hv nlniirnd( txhlrr or Fajur\ oN,,r rhc r,,ll,!\tr,8 crLrrrn\
<br />-l
<br />h.E !i $illminr.in r C.nif.i. otcon* lo Sclf.lnrur. f( r\116r onyE ubn. r F,it d lor hy Ser$n l7(Xr of rlE
<br />trtrf, Gi.. fI, rrt Fr(tutr. nt rhc *o* ntr whth tlE Frmn 6 nrlcd
<br />_l h,t rnd rill,urnt.in $orlci!-.onDrnsiri,n inrurrNr..\ rcqutcd hyScdiqr.lT(Xrofthe Lih.r(inle. fo. rh. t'slhmumc ol
<br />rh. sork lor shi.h rhn F mir i. ir.eal My $dlcn' d,qf,nd$n in!uE-. qar .rn Frlrt nunixr d.
<br />-l
<br />ccnily rhlr itr rlE FrinrmR! of rh. sorl fu rhih rhi! rroir n nsFLl. I lnlll mr.q'[)y rny IE(,n in $y m.F
<br />$ - ro h.om.ubjNr ro rlE $o 6 a'r{Endrr h*r ol Crlifomir. rnd 1!m thlt it I rbuld t*$m rrhFr o ilx
<br />w.lrdc .Dml.h\art,n tn,ri\ioo! oa Ssrirn l7l D oI rl* Lntr C {nc. I lhrll. fdhwi'h 6nply } kh llrc F,vkion.WARNIN(; l. uc h sc s$rd. onyxnerDn orn3. n unhstuL ona {h.rl ruhFr .n nlI'IoFr ro nninrt FEtris rnd
<br />riril li..s up k,.rF hutund rhoren ilnlh^ (tlrr).rxxl in nldili'. ro rh..o!'ryxn{r,'n. drB8.1 rr F n.d Lr ltr
<br />.scrt6 ]076 .f rh. Ilkr C(xi.. 'nr.rN 'd !(ffrv r (
<br />t\,&-_aOn,U.r,Yt
<br />I hftby slllrm o'xlcr lEnulry ol Il( riury rhrr I un lnctredorxl.r truri\ii or(h4ro9(( tu.ring sirhS(rbn Tit rofDnnha.l
<br />of rlt Bu\E* tnd l,rol(n.( (ild.. rfil !h) li..ns n in full nnr Md .afdr
<br />@-ee(tm'ru.'ir)<
<br />I lERl'y rrrm ufrlcr FDIy or lt.rlry ltul rlEE N r d,.reln. hndin! r8try r(, th. Ffomm. .r rh. Iork for *hf,h rhh tBmir a
<br />AIEUIAILI]EI;IJSAIIIJ!
<br />I lt dry ,I'hr rnd.r lEnrhy of rErtlry .r oI rlE folk,r in! drldar x,.a
<br />IXmol'linn lcrnrilr AslEnos Nolrli.urion ltd..rlR.tulnri,,hr ( l irlc 10. Pd6r
<br />-R.!u
<br />iEn L.rr.r ol f(,rl.{!'ion
<br />_l.difyrharrh. fcdcrul rSthix'n! rc88rdju 0{r{o\ nriFr rl trrc tror 0nIlrubh h, rhi\ Dn,l..r
<br />.omtny rirh rll( iryrkl(-ounrt
<br />hr (ir) aBlCoutrr\ b.nrc uFn rll
<br />I d'ryitur I hrvc rcd rhirupplanrrn ukl isr.rh{ rh. trh'yc inlanndn,n iscorc.r l a8k!n'
<br />unl'tuL.\ rBlSrdc I *\ (lJl'n3 r,t{rldrn3 c.n{dx,n. mt lh.t} 4!hrrc '.Frq.rrtr.. ot I
<br />rk*. rn,nrJ nl,incd) r,{ ,n.r<ry'?,m,*. n
<br />^pp,ion,o. ^R6,sirE,uE >Y-.R+- \@ _Kp-
<br />p.d,F.m (Drrn,): (-fVara (1,/\(-€>.-. ".a--t
<br />,.'.3\8[F
<br />Set Backs
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVlnsulation
<br />loqf Sheathing
<br />Shear Wall
<br />D wall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Pool Fence
<br />T-Bar
<br />Handica p Req.
<br />De puty Final Report
<br />Engineer Final Report
<br />Flood Zone Certif.
<br />FINAL lolu ln -(/1ql D
<br />Certilicate ol Occupancy I
<br />Notes Remarks Etc.
<br />BUILDING- INSPECTOB RECORD
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />Framinq
<br />lnsulation/Enerqy
<br />Masonry
<br />issu.d rs( 1097 civ clIinLisN'r
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