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ID/SIG.COMMENTSSITE-WORK DATE
<br />Set Backs
<br />Forms/Steel/Holdowns f hrgJ-
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Boof Shealhino
<br />,..-:\lz- l7:lg x"wldFraminq PArur-
<br />lnsulation/Eneroy 1 ,/Drywall f .n)- lz4*lg rw4'?-,,'./'E
<br />Ext.i lnt. Lath I (I )1.-'
<br />Brown Coat
<br />lt/lasonry
<br />IT-Bar ilt474 l4.A "1errgHandicap Req.t)I
<br />Deputv Final Fleport
<br />Enqineer Final Report
<br />1
<br />|wtZt/eFINAL/l/lu -i-,tt',/
<br />Certif icate ol Occupancy ' u/ 0
<br />l0-ro-tt@ f
<br />Notes Remarks cr^
<br />Io
<br />It
<br />,I I\I
<br />BUILDING. INSPECTOR RECORD
<br />OWNER BTJII,DER DI]LCA RATIoN
<br />I hcrchy linm undcr pcmXy(,fncrjul lhrr I ckr|nfm lhc Conardon l-i.cn{ l-{w li)r rh. irrll.w rg ruson rsc'70115
<br />llu\inc\\ rnd Pnnas\nr Cdcr: An! Ciry .r Cotrnry shich rcluirc! r p.nnir ro cotr(rucr. alr.r. imnrovc. dcmolth or rcqfi inv
<br />nru.rurc.|nior b lrs i\{'an.c,trkorcqtrncslhcinplicxnrirsu.hn(anitlolitcr\ilicdi[crrcntlhllhcorshc$liccn\cdlrursnr
<br />r. rhc Ir)visions nl rhc Contrcror'1 t-iccn{d Lr* (Chxnicr 9. Cd.nncocitg wirh sc.rhn r(xro ol Diviln'n :l ofrlE Busl'c$ rnd
<br />ProllsioDsC.dc)orrhd hcor \hc i!txcmpr rhcrcfromntrd rhctrsh litr rhe allc8cd crcnrDri{'n Atry vnndrn ol S(tion 70:l I 5 bv dtrv
<br />rpplio nr aNrnnr suhjcckrhc r!Pli.dnr to rcitilPcnrllyofnor 'frtcrhrtr Ii!c hundrcttd.llt( (S5rx))
<br />-1.
<br />as owicr or thc fl otEny- (tr m, .n l,,ye\ wth w+cs as rh.n v,h c.n$trldi,rn. \'ill do rh. s ort .trd lhc srturtt i( tr"r
<br />i'ncndcd oroficr.d n, \olc(SE-',7(!r4. aui,rsand ltoitsbns Codc rhcCn ncxtrsIicc\cbqdoc\norlPllvro.rowncrof
<br />rl[0nD(ny *ho 6uild\ or ninn)vcs rhcNn. aDd wh, d).\ {rh qr)* iims.ll o. hc clrorrhoughhisorhcrownc.rloy..s.
<br />providd rhnr skh nll|,Dwft m mr i cndcn o. oliiEl for sulc Il, l{,sev( rlE hriHinB .r nnprorcrEnr t v'kl wirhin o c )ctr
<br />;fco'np!:riotr. rh.()wrcr Buildcr willhavc rhc bunl.n oftn'vnE rhlll nc or shc d d nol tnrild or i'nFovc thc lmptnv r.r nr tuqns oi
<br />l..toqNrollhc pn,l}cny. rmcxclusiv.lyconlrtrinS $irh ll(nscrl conlftcror\ kr connru.r thc Pn+cr tsc. 7(!-1 Bu\inc$
<br />and t\n1s\ion Cod.: Thc coflracrois l-iccnsd l]w d.$ tror.lTly lo xo owncr off)p.nv qho hxilds or imProrcs rhcrcutr.
<br />and who . it!.ts lbr such tn(li.h wirh rCortrldono liccn\cd nuNuonl l,'rh.Conrrc(tr's l-iccnt l:rv)
<br />I rncxc rt, utrdcrSccri,)_.8 & PC fnl[]s rclv,n
<br />Dl|r ()yner
<br />wollxl'k{' (:{ )Nl PENSA'l IoN
<br />lEct/rtauaN
<br />I hcrcby rr'iirnrundcr pcnrlr! uf Erjury onc olrhc lolk,wnrg d.clrltn'ns:
<br />y'lhr.sird*ilr'trbi'r,,i'rhi',n rr'c,l.i1\'nrrns.lr'l'\urcl.rtr, lc''.'{r.|..tr'ir'on.J'
<br />L,h, a,"l+. lor rN ncr,,,n"n,. or'h. tr^* 'n' wh'ch rh. rmrir \ h\uLJ
<br />ff:;iir workcr' con{rNnrn NUr r.c, i\ r.qtrnrdlrySccli,)nl7f[)olrh.t-rhotCodc.lnrhcNnormn'cof
<br />lrnnir ir hn'c.l Nly q.rkcrJ ..nrEtrr ior iNurrn.c.intr lftIIx'l'.yiunrh.rrc
<br />t ccnilyrhir ir lhcpcrfortuiccol thc sork ior *hthrhis Fnnir h is\!cd.l shrll norcnDlov trnylcrsn in rnv Inrnm'
<br />$ sio bcom $bjcd t, rhc *.rte^ conrPcn{trn,n !nw.ofcnrittnia rnl4rcc rh( ilI should hc.om \ubjcd t' rrt
<br />wtrkc^ compcnsarn tnivhion\ofSccrion l70l)otrl'i, t-$.r Oic- I \ltll. tuahwithc.nlply wnhlhoe Pnvi\irnt.
<br />WARNINC Frilurc ro sccurc so ts .onrpcnr ion ovcngc i\ rtrli$ful. !!{l \lrll \ubrccr in enrlovcr h diDiril Pcnrlri's 'id.ni l,{\ nI ro otrc hufdrc,l rhotr{ rl
<br />:::'-' 4 /<f dl'
<br />T
<br />I,,L
<br />I lrr.byxlltnoid.i Ftrrhyor p.rjrrrhrr lr r lnrncn un(ler or ( hrntr 9 r(nnnu.iI! \ih s.!rif r 7(xrrr.tl) I ntr,r l
<br />c.1 ct (-1!ilfal +
<br />q 5 drl x{at{"-
<br />A.P&rcANLDECLAEAIION
<br />I lEEhy lilnn u ndcr FnrhyofPerir, onc ofrh. f(rlowirra dcclmlio.\
<br />txnrliri Pcrn,ir\ Astrslos Notilicalion F.deral R.8ul{ions (lille.lll PdO
<br />-Rcquncd
<br />Lctr.r or Norin.ilion
<br />Icc ifyrhnr rhc 1!(l.rr1rcsul r \ tllrdnra i\h+nos rcntrn rl rr( Nrr|rpliahl. n) rhi\ pr.$.i
<br />l.cnilv rhir I hr\.rcM rhN rrtin rlinrclhdlrhc 1h'vc ir I x!r.c t, (nnt,lr Birh xllCirt rfd (in,nry
<br />o roinc.\ trtlSrn.liu\ tol irtI
<br />shADDIi{anl o' ,\,:ulSi!r lu 1 &.e
<br />n.s ofrhi\ C vxfdCouitr ro.d.r u|lnrlr
<br />,,^,.<f tfra
<br />Erection Pads
<br />Shear Wall
<br />Pool Fence
<br />Flood Zone Certif .
<br />or rhe Ilrtrin..\ rnd I"olisitrr C!r1.. xn,ltr,y li.clc i\ ir tulllnr.. xrkicllc(r
<br />I I
<br />issucd (Sec ll)9?, ci! c ).
<br />hndcas N.mc _
<br />tr lci. Addrc$
<br />Wlt4-iil
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