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SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILOER DELCAR IION
<br />I hds!.-drm u'da Fdty of Fiury lh. I6 o6r4i tDD r|E CoturE Lxa& L:e fot ttE folh*in3 '@, {Sc?011.,
<br />auo63 lnd Profsio. Co<t ): A.y CLy o. Couily whih Eqund s Fir to oirnri .116, intFolc &blbn or r.ru o,
<br />r'!ci@e Fb to i! i!s!e., .lo rcquiE th. +plicst for $ch Fnn
<br />'o
<br />nk ! !i8n d nrG@r rhc tE or iE it lic..!.d pljlfd
<br />lo lh. FDlaiod of tlE Codr&16r Li.o!.d rl* (CI|4r6 9. CoMirs *nt Sdi,n 7000 ol Dvi.ion I of 0E BuUE ed
<br />ftofBio.! cod.) or llEl IE or rh. n d.mF tha.tron ed lh. b6! lor dE .lLs.d qdF.n Aly vi'hion of sdir 70ll 5 b, Dy
<br />.I?h(Dt for r FDh Nticrr rn. .p?lifi b ! crvil F.!hy of Nl mc lh- liv. huidrGd dolla (1500)
<br />l. u oeF ollh. FoFry. o. 6y dplold *nh v+6 s rh.ir $k onp.Mior wll {h rlE wt $d th. rdrE i d
<br />ddd.d or olH fm rL (Sc.?041. Bolir Dd PiDt6e6 C6& Tt. ( offid t Li.oE ti$' do6 @l @ly ro o oMd oa
<br />rhc Fapdy slr, &ild. or hr.ov6 tlEa( &d lln &E uh wt hirelf o. ls$lf or tluDuBh hir d hd o$n dp!rt6.
<br />Fn.iidj rhd sNh imFolsE !ed i,idrLd d ofrrld for $k. I( ho*ne, tlE buildiry o! dpNvdF' ! 5ld wil'ii oi. rd
<br />ol cotrplidi. dE o*G Builb *i! lIE *. hdar ofFovirB thr lE or iE dit El hrld q introE Ut FDFI, itr tlE F4or. oa
<br />I. s 0*16 of rh. Flpqry. sqcluiv.lycoi&ding *iih lilaEal codr-ld to @rdM lL Fje! (sd 70.r,1. Bi6nE
<br />ad Plolss Co&: Tt. (-o rdor'r Lr@. t w do6 .ol !ppl, lo d oM6 of FoFl, who blild! or ihPrcvd lts@..
<br />dd wh. @, Eii lor $cn Folr:l! rnh r Co'rri.(, ltondl Fr^ur ro tlE C.ffioar Licr L.s)
<br />I m .rmpr un& saron
<br />lqaf,.E8s:CaMfE sar&x
<br />DECIAIAIIA!
<br />I ha.by .mfl und6 FElry ot rqur oE otlh. follo*ss d6Ltr io6
<br />I h.!. rd will di' .h . Carifrd. or CoBn ro 5.1116@ ld *orlo @frFsniof,. u Frv'dd for by Sdlioi 1700 of lh.
<br />kbor Cde aor th. Ffollre. olrlE s for siah tlE Fin a ae.d
<br />I h$. dd will mlinl.u vortd cotFurFn 6ulrr., G r.qun.{ br Sdnn 1700 otrlE t bor Co&. for rh. Flolllffi. ot
<br />In. wrk for rhich lhi! psnil i! e.d My *orl4 onFnraior iNue. c&it 8l Colicy nmb.r I
<br />c,,t-, aVlA / (\ ( An 7'\.P\L ft
<br />P.ri"yN,.h-, w r =71( / Ll2.1.1e,o'.,.-[za
<br />I .dr!ryrh,r in rh. Ffortffir orrlE wort for whah ltt rffr it $t.d, I rh.ll nol mploy ey F$n ii lny n&nn
<br />$ sb lt$ru sut El to rhc Krt6 otrrFE rh. h*! ofQlifomir rd ryr lhc rll lhuld b{oE ot*( ro rlE
<br />$!116'comraurhn,m,itioBofSdio.3700ot$cllb.rcod.,Ilrull fonhwith comply wilh llns pov
<br />c!'rl tind up ro o.. hundr.r! rh.usd d.llm (t100.000). in
<br />s6r6n 1076 dfrh. Lr&tr Coda or6d ud dr,trq r f6
<br />I h.Eb.v tllm ui& Funy 6f FJUry $i I m l(d!.d u.d6 ( hapro 9 (conmd'n8 $irh s(tion 70m)olDiviJrn:l
<br />.t th. liusin* dd Proi6i.6 Cod., 6rl my liae ir i. full forc rn .fid.
<br />ata=5n5\2o
<br />,.,,, tl.lC I t zt (".,-"-, ( V lV i t/\t +1)\4U-
<br />CA!LIIB!LIqIiJi!dPI!GIGE!CI
<br />I hdbr .Itm u.& Frny of F,try thr rlE! !r . a'EMlbi Ednlg lac, aor tlr Ff(xffi ol llE wt 6r *tth rh. Fna i
<br />i$ual (Sd. 1097. Ci! C )ti&rN.R:-
<br />AffI.KALDECIJAAUq!
<br />I hd, ,trm und6 Fdtlty of pcrjury onc oI rh. follovinB dch.dirB:
<br />lkmlno. Pmne^lb.nos Norifrc.rion Fcddl Rquldions (Tirl.r0, Pln6l
<br />R.qutr.d l.lld olNoun nD.
<br />I cdrly rhd lh. f&ralr.sularoN E!.r,lins clEro3 @v.l e. mr lpglt.bL to rnis Fli.tr
<br />I .d ii thd I luvc r.al rh! .oplrnion an ndc 'h.orJrmc6 &d Stirc llws BLl,n! ro buildin8 .odru.1io
<br />I +Ero (onp! *nh dlCny ]d Couly
<br />of $i! Cny od Countyro arq u!o6 tl!
<br />.ntv. 'mrio..d rroD.iy ror E €l 2l<l\.\\ppli.rfl or.\!6'l Strrl!r.
<br />I
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathing I l{x)Pktrrtot +fl
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL ffi1+8 7
<br />Certificate of Occupancy I
<br />Notgs, Remarks, Etc
<br />f,)
<br />dL
<br />BUILDING. INSPECTOR RECORD
<br />".,., l? lslt^
<br />Pml* n.nctprtru: YA I,
<br />Shear Wall
<br />q 1t)
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