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SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />UFER Ground
<br />Subf looriVent/l nsulation
<br />ngRoof Sheathi 7-z?-/8.D.Jnf<ffi
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ir/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />/o/"//,r 7/trrE / l2--
<br />FINAL /--z_--
<br />Certilicate of Occupancy :=-
<br />Notes, Remarks, Etc
<br />SUILDING. INSPECTOR RECOBD
<br />OWNER I}UILDER DEI,CARA ION
<br />lJti:lr *'":lli'::?ti: lrr]1"'"il'Jllu,l];,l,lt'i-il;,.':H:t:l;:lH:rir"INl '
<br />iflclrtrc. pritrt,lls tsurtrcc, aho rciutc\ llrc aFpli(nnr li. {.h t^-nnir r) lilc r s!tud irrd,tuir rh h..r sh. is lnctr{'d |['n..
<br />11' rhc povnbns of lhc Conrrfurors I l(trkd lis (Ch fl.r 9. Co nncmns vnh Scclion TOro ol Dili\ion I or rh. aunnc'\ rtrd
<br />Pnri$nnNCo.lc)orrhnr hcor \h. scxsmprrh$clronatrd rhcl)asn lor lhcrllc3cd crc,nprion Anyvi{nrri{n,ofScdrrl03l 5hyatry
<br />npplicitrr rbt i lEmir rutjcchrhc orpliclnr ro !.ivllpcnanroinor morc rhitr nlc hu r dollrrsIs5ft))
<br />I. N owkr or rh. l)tuFny. or my cnrploltcs wilh w.Bcs ,s lhcr slc conDcnsrnnr. sill do rhc ktrk dd rlr sMm is nor
<br />i, cd.J o! o,Icred (tr sk lsa ?Or.4. Bnsincs lnrl Pm{cs\ion\ Gdc:'l hc Coitr.k s Li.cns. Ijs docs not atnly to on o*ncror
<br />rhr pnrllcny wh' hilds or irptuvcs rhtffin, Mlwk) dds \uch wlk hnnscllor hcscllor lhmu8h hh or hs own dn'pkDtc\.
<br />trovidcd rhrr such impmEmnh e rn intcx,cd or offcEd fo. sh ll hoecvcr. rhc tlildin8 or irymlemnr i\ $ld wilhir onc tqi
<br />ofconph(iotr. rh. Ormr Auitkr willhorrhcburdcnoforuvinErhd hiurshcdiltul bu l or iqrmrc rh. pFpcrry lor rlt prII,*.f
<br />-1.
<br />!s omr o, rhc F)pcn y. rd crclulivcl, .onrrlcrirg wnh li.ri{d .o.r,.ros ro otrnrud rtE l,!oj.rr (Scc 7044. authcls
<br />.d Ar,f6ran Codcr lh.Contucror's Li..n\c Lrw do.\ norrrplyro owncr ol'trotcrly who l,uilds.r idtrovcr rhcrcon,
<br />od who conrE.k lhr such pn*ck sirh a ConrrachnO |tccr*d !!6uanr tr rhc conrhct rl-i.nscb*).
<br />I rD.\cnror und.r Sc.ri
<br />IABtrDSLSOMIENIAIIQN
<br />D[CLA.8A]]ON
<br />I h.rcby dflnnundcr rcnrhy 6f tojury onc orrhc r{,lkJwing dc.learions:
<br />-l
<br />harc lrd willnui ain a Cxnili.lrc olConrenl l. scll lnsurc f.! *.,kds comFn\.lion, d\ rrovidcd lor by Sccin,n:1700orrh.
<br />tibor Codc.l thc lcdbrMncc ofthc w.rk ior whi.h rhe Dcrmn n hsled.
<br />I hdvc rtrd wi!lnrinrrin wolkcrs .onf.nsarion insuran.c, !s rcquncd hySccriof 37(X)ofrhe lihorGnl.. fd rhj PcrlonMrcc ol
<br />rhc work for whi.h rhh p.flnil is hsucd. My Borkcn .omFnsar nr imurancc c!tric, ,nd Ix,licy nx dbc. dc
<br />I ccniiylh hrhc p.rfoflruNcol lhc sork iu whichrhis t^-.rmit k i\nBt,I \hrll n.r .mlloy ,iy lctson ir onynunncr
<br />v, sx'iicoft \uhFr r,, rl'rsorkc^ ro 1l.n\arn hw\orcalinx.i , xklrgrcc thd ifl shou( hcconr subjcd hrhl
<br />sorkcr! onlncisrrionpmli\n,tr\ofS.crn 3?01).lrhc ljh)r C.{c, t shrll. lonhqirh comply wil h llDE povisn,n\
<br />WARNING Frilurc k, surc *orkcm'conrp.nsdion covcmsc h utrUwful. od shrll subjftr nn cnpbrtr ro.rininrlpcMlrics 0
<br />civil Iitrcs u,, lo .trc hundrcd lhousand dolhs ls,oo.(rlo). in rddiliotr ro rhc.o\r dr nlll. \rln . dn.lers r\ nnilid.,l |,tr rhc
<br />,.fi14
<br />nundcrranolryolpcrju.yrhd I rm liccnnd!trdcrpn,vnnn.fChqrr$9lc.n f,ncir8 silhSc.li,n 700(D ol Div(iotrl
<br />a7 ?"",,,",e+
<br />COBSIAICUONIENDAGJ(iENCI
<br />I hurby nriirn xndcr pcnalry ol p.rjury that lhd. is a onslrurlkfi hMnrs aEocy for lhc perlonuncc or rhc work lo! which lhh 0cmir n
<br />iqskd (Sc. 109?, Civ C.l
<br />AITLIIANLDICIABAIION
<br />I l[[by inn undf pcndlry.rp.rjury onc orrlr lirllowinB ddlnralionsl
<br />Dcmlirion Pcrmirs Asticsloi Norific.rioo FcdcrulRdauhriohr (Tnh 40. Pd6r
<br />-Rcquned
<br />lxner ol Nolii'rarion
<br />I cddiryrhm rhr f.dcrll e8uhriotrs atrrd rE Nb.nos r.N)vrl nrc mrlpplicrnl. k, rhi\ prcicr
<br />_l ccnilr rhd I hrvc rcrd rhis applicrrion arxl narc Ihrr rhc rh,rr nrhnnr.or i{concct. la8rec lo conrlly wnh rll Cnyrnd Coutrr,
<br />ordi.nnc.s rnd Srarc l2$s r.ldin! k, huilding coniru.ridr rnd hcrchynuthoizc rcl]rc{nlllivc\ olrhi Cirymd Coutrry b cmd ulDn rlf,
<br />rIx)rc nEtrriotrci nropcny tur inrplcri,,, !urfl ,\c\
<br />,\pplir rl or AA.nl SiAtrtrlu q)t 2
<br />a:.----
<br />?oS/ SYof lhc Blsimssand Pmlc$ionsCodc. ed nryliccnsc is in lull tucc u cflccr
<br />€-+>
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
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