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SITE.WORK DATE ID/SIG.
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulalion
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lt/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL glqlA a ?.9 )
<br />Certilicate ol Occupancy u IIlI
<br />Notes, Remarks, Etc.
<br />BUILDING. INSPECTOH RECORD
<br />OWNEN AUILDER DELCAR IION
<br />I hcrchy anirn ondcr p.tulry ,,f F jury rhrl I m cienl|ll fnrm rhe Conrr.ir,a Licche Li* for ltc rinL,winS r!{in (Sc 7031 5
<br />Ilxsimrr rrn Pn)fcrdrn CnLr Any Cny or O,o,rt, ehrh eqriB r |rcrnr lo mn(rucr. rlls. itrrilw. d.'mlirh .r EIun uy
<br />ntu1R. Fi, n' nr iisuur. .la, .cqors rtt {tpliit [i, ruh Fmi b 6l. ! \isrn {n.mnr rhd rE or slE i! litnrd ponsr
<br />ro rh. F,vti'nr or rlE Co.k-rd ! Lkcncrl lru {Ctuplcr 9. Conmft'ng s h lE*ri,n 7(xlo of [)nni,n :l or rrE Blriftss ..d
<br />Pn,fcsrrnr Cdl.)orlhol lEor \tE n cxenll)r ih.r.ftr,m rnd rh. hsis for thcullcs.icrcnplioh Anyrbhri'.ofSdi,n70.ll5byrn,
<br />lpllica tu a pcrnir \ubj.{k rhc apFlicanl x, i livil n ruh y of ftn m,E rhd fiv. hudt d nolbrs ($5G) r
<br />-1..s
<br />o{Erolrli FoFny. or my.ngloF snn q.86 & llEi {L oqtndio.. willdi, llE urt nd r,! {rdE 6 d
<br />idsi.J d oflcrd ftr rlc (Sd ,o{. Aoiim! ud Ptof6ioni Cod. TIE Gndn! LitR Lr$ &a mr +ply ro u owE o,
<br />rh. rmrdy whr hoilds or infmB Orur. rrl who dra uh H,rt hiEEll o, h.r.lf o. rhmu3h hF n h.r o*n .nllor..t.
<br />pNvid.d rh4 r!.h inrmEmnlr e ml i cnd.d or DrTdld rrn {b. ll howE, rh. h{i!i.s or iqmEmnl il $ld *lhh oE )t*
<br />ofclll"lrbtr th. (xm auild.r vix llE dE hds of Fovil{ Gr rE d !h. dn d tuitl {t inIEE d. F{6y for E F,trE of
<br />Laru*ftrofth.pml.ny.B.rclu\i!.lyconkrcrinawirhl'*n{d(!nhcb^b$n(rudrh.!n'Fr(Sc7(p{.Bu.ift$
<br />!,i t)r,lssin, (odc The Cunkelor's Liccnr.l,!wde! nol lptlyk, unnrncroipmPcnyeho buildsor inprov.\ lhcr.on.
<br />lnd who (rdrdl for {hh |n0rds $irh r Codtu1dl, lacn<rl Pururr n, rlE Cont*ktr s Lt.nc I i* )
<br />I m.r.nnt untd Sdrrr .a &PC lorrh.r.ntr
<br />Drk ()*n.r
<br />worxrtt\. crr,rtpl;ts,rrrol
<br />Dlgrrxrltur
<br />I lrr.ht rl lifln uitlcr ,Enrlrl_ ol tkrjurl om ol rli knk,$ rn8 ,l{lxihnr
<br />lhrvcdrd$Lll Btr rflr(-.nrrlcrcof(in,* oScll ltr\u(ritr$orkt^ c.n,Pcn\rr(n,, r\ p()utrlc l,trhySccril,n l7(xrofrht
<br />litrtrCGlc,l,nrh. $rfomrftc ol rhc *ork tur $hih rh. Fr nr trniucn
<br />-l h.r !d *ill minEi. *orrn onFNtir insu6m.. r EnuiEn ht sdt.n l7(n orl,E L.bor G'&. ror rlr IEdm ol
<br />tlE tr,1 lor *hich rhis pcmir ir iNrd My uortdr mqEnsliotr in{l.m cMar !n InlE, iunlEr &
<br />I ccnify rhrr in rhc pcrfonMr. of rhc work for which rhli n rmir ix islucd, I *h,llnor.nliloy any p.co. i. trD, h8nnrr
<br />$ *io kroft rut*cr ro rtE worlss'@tr{f,n{rion h*r orCrlifumi4 ind {3r lh ifl lll'uLl t tom lubFi blrr
<br />*,*d! &n{E.qthn t'ovnn.t o, Sclion l7{xJ or rtE Lrrrtr (irr.. I $nl. tunh*nh oryry wnh rhc FnYililtrr
<br />T,VARNING: I.'niE ro ru. k,l6 RJnFn{rhn cortns. ii unbstul. .ni rhrll ruhFr dt't)F ro oimiMl FMii\,,n
<br />(ivil nn.r up r,,.8 hurnEri rlt,uend dolllh I nslion. d,tuB.r rs llnrvdcd loi lh(
<br />Y^u'w'tl1"
<br />utll.!tsuru)
<br />I hflcbt ,ffinn uklcr lcnllly n! Frjury I rn, l'..tr{n rl., t)',,r(tr, r or ( hrnrtr () l.' nntn.nrs nil'Se.ri)n 7(l(r)r f l l)'rn(n I
<br />of rh. Bun,r\rnd Pn,fc\no rB (i)dc. rl nryli.cnE i\ tr,':'""61ryr
<br />,i..ns.crari: C-1,.,.344,
<br />I rEahy airtrn u.dcr FMlly of pctjury rh{ rls. k a mnnddir. tndis ls.(y ror ilE Fnolllre or lhc mr* r.r whkh thk Fnh n
<br />irru.d (se .lrr97.civ. c ).llrkr'rNrm
<br />-
<br />l.nd.a. AddEti:
<br />-
<br />ATTI.II;IIII.IECIJ8AIII!
<br />I hd*,.r'mun Lr F lyof FFryoE o,rlt rolrlrin*.L.lt ritn.
<br />Dcm|nion Pmjh.A.b.sror NdlfE.tion tu rl R.*uLhnr (Thk {o. Pd6)
<br />_R.quncd kll.r of Ndirk.lbn
<br />-l
<br />c.n ity rhd d! r..brl E8!!ti.s ESadin! artBlor ltmtll E r, aPli..bL b lhi. I,oFl
<br />rk,n ircorer I lirr t,$hrly qirh oll Cnyod Co,nrt
<br />prc{nrrrir$ ufrhn Cdy ( ('.utrryt'.nrsuBn'rh(
<br />"rck: o*Tf
<br />2- 7x-
<br />COMMENTS
<br />Flood Zone Certil.
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