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SITE-WORK DATE ID/SIG.COMMENTS (,WNER BUILDET DELCATATION <br />I rr.cl'y .fttrn unl.r FDhv oa Fiury rh,r I u d.r{* fto'n rh. cod.k(trr' l-itnc h* fo. rtt n,Io*ine E $n iss nr]l.J <br />lrusin.ss rdl Pbnl\ioo Cd.): Any Ci., or Cddy *hah r.quiEr . tFn'l ro .!Ntu. rhd. !n{row. &mirn or EFir y <br />{Rlm, Fs.r. iri i$urm.. llto i.Iuircs rhc indtonr l \uchFdirlu nhd rtn d {atmnt rh lIor {x n li..ntn nulaul <br />b rh. ri'lti.ni or rh. Contdd\ Lr.nrn Lf, l(1,hrt d 9. (onrmNin8 *ilh s.rrir 7(x[ ol Divrhn ] .a rl. ANi6s rnd <br />l}6r.sionr clrk ) or rhrl lror rh. n.x.nrol rtEEfnrlnd rlEtl\n r{rrt rllcS.rl.t.rprhn Any vioLri,n 6rkbn 70ll Iby.ny <br />.mlr..r r(tr . Fmi subFn rlE 0r'tlkrnr ro a cilil p.Mlry of ft,r m,ft rhdn fi!. h! ndrcd dol![s ( l5fiD <br />-1. <br />!\ osmr or rh. I,&Fny, .r my r.l,l lor.s rnh wr8.r $ th.tr qrlc cnrpcndi'n. *ill dd rlE rdl drl llr trrd@ i! ft, <br />iddrLii d olt r.d ft iL (Sc.?Ol,t. Bu(m( .nl Pr'r6\i,.\ (i'd. nE (bdrdm'1 Ltcns lis drF e{ qipl, k' an owF ol <br />rne poFny *h' h[ilils or inymh! th.mtr dn ub dr\ si rrnl him*lf or h..tll or rlmuah hn d lEr o*n.'rf blEr' <br />nrovd.d rh.r tuh ifin'wdr E d iddicd i, orld lir {k ll hok\!r. rlt hiBinS or inthEmnr is $ld *irhin .n. ,!d <br />or.onfLrin rh. Ormr Buit . sill tEE llt h!&. of lritu r,ul tt r rlr dd n{ hlrld G it{mE lh tn,lE, rd rrE F,IF of <br />I is oaftr n, rh. lmn nr, !m cx.lunvcl, .ontu.rirg riih licci{(l co.h{tfi n' drn.lrucr rll rl!{i ( Sft rN,l. lru\iN$ <br />t\nftrin (ird. Thc Contrkr'r t-(rns. tj* ddi ftr lmly to !. or nfl oI lrotEr y *hr huilds o mrrnrr thd.nn. <br />who.onlEt\lor{uchpmFh*irh,c(dncnnlrrli..nrdlxrunrrot,IConrrrlf\l-icntlr{, <br />$trR(l l{s' ( (ri\tPtNs.\I{rN <br />DlIL,r.BAl.Pf <br />I hcthv illunrtrn(ld tE lrv,,ltrrrtrr\ otr( olrhc lolk)utrrs,lr!hr.{xr\ <br />I tuk !d f,illdinr.i. ! (tnifrlic olCon{nr h s.lf In\or. n{ {dl6r. n'qEndi,n..r Fo\ ir.d fd bySdhn r?lD olllx <br />hkn Crnc. n, rh€ p.rtortun.c orrh. *) ntrshi.hrh.ps.ri n is\ucd <br />-l <br />htk and e ill mimain wort.n .omn€nsthtr inlurdre. s rcqut.d by Sdt i.. .17m .l lrE l,li, Cod.- fd .lt FrrnIrE of <br />rl\G * rd $hih rhi. p.mn ! irs.d My rnkd mntEnrlrhn inruriN .sin rn Frky rumh.r E: <br />I.cnilythal nr th. pcrntrmB-'. ol rhc*ort lif rhihthi! Fr.rir N n(ud. I .hlll fln .$ll,v ..t Frg'. in Dy mnrr <br />$ i{' r&nm bFr k' rlr trntd'mnlP.nrlti(6 la$r of Cllifnnir.,nd !*Nthlt if Isk,uld tE or hjcd rorh. <br />*0&6. on{Enqrhn tnrrri,.( ol Sdi,n l7(I) .l <br />'lE <br />I j}ry Gxl.. I lhall. ftrh$ rh !r,rplr-, r irh rhrr Inr ni!.i <br />WARNINC F0rlurc b ccuE *ork.n (,mp.ns,tun c.wfu!. i\ u.bsful. lnd \hrll .uhx.r s'r mrlor!, to $miml FMLi. 'n|(iril liFr uI' (,.8 nudrcd rbued dolL^ r3lll).Ilxl). r ,rll[i)n !o rh. cN nl cofllrneri.n. d.rEE r !s provid.J lir rh. <br />S.crtr l(176ol rl!.l.xhtr ( {xll i' .r.(nkt xrktrrtv \k2 -tuLLl. <br />DEOAXAIIr! <br />I h.rcby afilnn undcr J{nrlly .l rErlury rhBr I s , lnrnql onds prur^i({r oI ( hrl)lo 9 ( n 'rftin! wirh S(t iotr 7(Xx)r ol I )n nk{ .1 <br />oa r,r Bu!'Es .od l-tolsrkfl. clllc, lhl ny lf,.n€ n m full forc. ml cfi--.r <br />TNSIBII;II9IIIBIIIIjIGENCI <br />I lrEny .l[rm oid.. Ftuhy or Fiury lhr! tlEt k . mnntudbn lc'dins lg.r't rttr rk FnomN. ol !'t mrk for whicn lhn Fnl is <br />nrEd (s( 109r, civ c I <br />I.ndd'\ N,m <br />apPLtcaNT nFt:r Alt^rl(i <br />I hcd,y nrfinn undcr Fnalry orp.rjury.m oftlr lolt'wiu dabdi'n( <br />D.ml(ion PcrmNArt srorNorif(lrt,i lricrrl Rcerhbns(Tirl.4{). l'ln6l <br />R.q!i(d tr .r or Ndifuri,i <br />I ccniry rhar rr. r'cJ€rsl r.8lhlirnr E8!,{in8 .stE.xr rcm,yal s( ml ry i.t'L i. rhs pmFl <br />I edifyrhtrr I h.\. r.{d rhi <br />(rd'ntrNc\ and Srar.lr*r rcld <br />!10\c L-niiomJ pn,Fny ftr u <br />Apdlor c aol S,k lud <br />. lpnlirrbn ml sirr. rhor rh. etltr. infirNir n cmBr I iglaro(nf!!ysnh <br />inr ro buiHins condturion, uxl hrrhy,urtstr,c r.pr.*ol!rircr orrhh c,ly afll ( <br />BFlhn pqr&\-ae-{?\=--) <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVlnsulation <br />Roof Sheathinq <br />Shear Wall <br />Framing <br />ln su lation/E nergy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Beq. <br />Deputy Final Report <br />Engineer Final Report <br />FINAL t/,./tt BrrPlol <br />Certilicate ol Occupancy <br />Notes, Remarks, Etc <br />BUILDING- INSPECTOR RECORD <br />I rn .r.nq'l uftLr S<rion- <br />Flood Zone Certif .