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SITE.WORK DATE to/stG.COMMENTS OWNT,R BUtI,DEX DET,('ARATION
<br />I hd.$v rff@ undd FMIJ ot Fjury rhi I e .!nnF 6nm
<br />'hc
<br />(nddor' tt.E L.s for rfi. a.llosm8 llsi (s< 70:rl 5
<br />IrBind .nt Profdion CGL) Ant Citt or Coudr $hkh raluir6 a Fmn lo co,E,u.r. .lls. iEForc &imlih or rctrtr uy
<br />srudrc, riorlo ils rsiu c., slso r.qur6lh. ipplicd h.luch Fti k' nbt !is..d dddmr rhd lEo. CE i,li(.c.d F sEr
<br />k\ tn pn,ri35N of rhc ('o.keto.3 l-kn*d L.w t(-i,pt6 e. (_ommcncinr *nh Sdion 7000 of l)ivtioi I ol $. BlrilB od
<br />PR'ldhns (i'd.) or rhd lr !h.irdm rtd.iiom !d rh. b6a for rlE lllcsd.r@pion Ant viohrionolsdlio. T0ll.S hyrny
<br />imh(or aor ! Fni .ulr.<B rhc rpplr.nr ro ! .ir il Frkr" o f ntr frtr. rhd nr r hun&.d dolls! ( 1500).
<br />l. B orrs orrhc ForEly. or lny drlord w h $,aad 4 rhcn 3r. comFGal ion. f,ill do ltE e ck rd llE rnxir i 6i
<br />ddrLd d ofi6.d tu $! (sd 7044. Bci,B sd Pmf6io6 Ccl. Th. ( onrr$r.ir Lt.@ rl* rh6 nor .ppl, ro u otrG oa
<br />th.FnFry $ls bik!or an'For6dEatr id trno (tE kt*r him$lto.lErlf q ll@ush i. q ha o$n mPh,6.
<br />rovidolrhd !!.h inF.rEEr . R ml inlaxLd or ofiacl for xt. lf. 1N6 a. dt hlildi'B or itqlrtGr a $ld *ilhh ffi Ja
<br />otcof,pkia rlE {r$n6 lruitia *ill tuE rlr hnln of p.trrus rhd lE or lhc d'd m hlld or i.'tioE th. F.Fty for
<br />'lE
<br />purB* oa
<br />I. No*F oIth. Iroray. m dcluriv.ly.onlr&lirr wilh li(dr.d c6.'n 1.*lo otrnrud tlr FoFl (Sc. 7(x4, Bund
<br />,d fbisi.d ( o&: 'I h. ( 6drarol-. Lic.e tr$ &B mr 4pl, ro d own6 of lrotdry who blrld! or idpr!6 rhdon,
<br />.nd who odEl' for ru.h I'lj.rlr *nn ! ( o'ndb(r) lt6E d pr6Mr ro rhc (bdraroir Lk.e t ! )
<br />I rtr.\cmrr u.da sd'ont)lq lzn(
<br />I hdlbt.mm undd FBlre oapcj- r_ ok ofrh. fdhsm8 d.(ladioB
<br />I h.r. .d s'ill tuinr.in , cdr'tfll. olco@r ro s.lfJ6urc tm *nrt6 onFBdion. 6 rrovidcd aor by sd6n 1700 of rh.
<br />Llbor ( ode ftr llE FfM. of llIG s* f( utich llE Fdil it Bu.d
<br />Ihrr..nd$illn.flrinio d comFns.t n n iNlranc.. s tcqunld b, Sd ion l7(r0 o lih. L!b6r ( od., f.r th. Fa(,iru.. of
<br />rh. "ut ror $ hkh inir Fn ir isEl My so.i6 comFstrn 'Bitr. ffi td Fliq ,uobo @:
<br />I cdiry rhrt i. rh. p6lom.m. of rh. $ork aor shi(h lhis Fmil is Lssu.d, I shrlln l dploy m, Fs. in &y men(
<br />$ B hr haoft str.d lo dE qqt6'soFBdio. h*! orcllifoma .,i l{R
<br />'hd
<br />if I 3t uld tE(om,ul'Fl lo rh.
<br />rortd' c.oFqrion Foririod of Sdion 1700 of rlE t bor (-sh I trll ronh nh oEpl' s nh fi& F\ irioB.
<br />WARNTNO f lilurc lo Kuc erl6' co'nFldn. .6vs!{. i! u.h*tuI, Eld 3h,ll 3ubFr u .nphF lo oinid FurE !d
<br />$rl li.d up t' oE hundr.d rhouuri &lls {lluo.( 0), 'n ddd ron rh..on ot comp.nsn'n. Jmsca s rrov'd.d for rhc
<br />Sdrhn 10'76 .f th. l.br ( .d.. inrn i .nd tarEy . fc
<br />*", l;of o(fa$
<br />I hftby lftirm unds FElrt of psjury thd I m licar*l ud.. Furi.ioi or('hafl6 q (onmcin8 wilh sdi,n 7mo) otDiilhn l
<br />ol rh. B*ins Md P$fsioB (-od.. dd ny licd. n in lull lorc ad ralel
<br />CQNUAIICIAtrIT:NIIIIJ]IAIICI
<br />I hftbl. aflirm unds polally ol F.jury rhal lhqc i3 t cotr{rucli,n bndinB asdc! lor rh. Ffontlm. of lh. *otk tu trtrch
<br />'nir F rir
<br />Eu.,l (sd !097, (ir (-)
<br />APIIKAtrLDECIJSAITA!
<br />I Eur+ .rd unl6 Fnrh) of Fjur, orc of rlF aolhtrin8 d..h,abG:
<br />I )trmh i,n Pmne^sbdro, l.lorific{i.n F.da.l R.sul,r ioG ( I arL .10, ldt)
<br />- Rnrui'ld l.lla ott{oifr.rii.
<br />I qrily th, ih. a.ds.l r.8lhrioB r.grdiiB at6l6 rmvrl E 'd irlic.bL to lltii Fojar
<br />I c6r"y rhr I t6'c rad fiit !$ltriio6 !d nd. thn th. lbovc iifotuion i! cmd. I .tr* to omdy eith !U Chy ..d Couily
<br />0.ltl@6 &d Sr!r.1.*!..h"* ro &'ld'ng .(iotr in hda:.|.!&rrn. rcF.ddi!6 of ltu Cny Md Counly l. 6ld uFn llE
<br />ah,re nE{Fn.d lnrpd}
<br />Appll..nr or Agfil SI*m
<br />Huil6 L€
<br />tqo?/?_,rn
<br />Set Backs
<br />Forms/Sleel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />Subfloor/VenUl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lns u lation/Ene rgy
<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 />FINAL b-8 - Zd /Zc- ts t- gtto \?_)
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc.
<br />.(.r-.4 6 /L/D
<br />BUILDING- INSPECTOR RECORD
<br />SLAB Floor
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