|
DATE
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsu lation
<br />Roof Sheathing
<br />Shear Wall
<br />lta!!!ns -qq /srqblfu /"1
<br />lnsulation/Energy ,,|
<br />Drywall W uq r{_-tz /,tY
<br />Ext./lnt. Lath t/1f&zdL,cy
<br />Brown Coat
<br />M asonry
<br />Pool Fence
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />//
<br />F\N^L 4/ (7f7 rul '/4//f/L.//)7
<br />Certilicaid ot Occdpancy
<br />Notes,rks, Etc.
<br />u ()o
<br />OWNER Bt'ILDER DTiI-(ARATION
<br />I rERhy rlltn u s Fuly,,r t.iFry rh, I a.\c,r{ krm rh. (i,dn.n{r llo( Uw !,tr rlr nnt'*o8 r.rr lsd r0.ll 5
<br />Itunnc* anl Pn,tc(si,n c,ric): Af,y C , r Coudy whkh r.quncr r IEm r n' drn(fld. .llcr, rryr'tc, .dnrh or Bthr My
<br />{turrorc. Fr{ t! rrr trrurN. :lv' r.quftr rhc rj'I'lrrr n, ru(h Fflsn h llk r ll8xrl {d.md rni ,r or dr 6 lr.nql NFlrr
<br />b rh. F,vtrr'n( ol rrr (irrr nxi l-r.nBl lrs r(lDI .r , (i'n,mEE3 $ h F(r.n ?lXXr ol D'vnrr ! ol llr Aune( rJ
<br />Pnn.rnonr CoJcJ or rhar lt .r \h. F.rcqi rhdclr.tuarulrh. hri,s lar rhr ll:!.d.(n{r('n A y{k,l,kin.fS(rhnloll Jhydn,
<br />lI'I,lk!dntr.trnnnohFlsllr.rtl.inrt,.LrrrlFMlrydln"nrtr.thsrtrchud.d,l.lkrrtiU,)
<br />_1. lr owmr olih. ttnFdr- (tr hy.npl()y{i wrrh wrr.s ri ilf,u v'lc $nl[l.n\!itr'n. w'llJu rh. *(rI ar! rh. {tunR r nn
<br />drdkJ ornll.r.d ld ek rSft ?(l.rr. Burm(..J Pnn.(r$r Crri. IlrC dr&1na.I-.tn€t:*&rsftr.l'J yn, o*mr.l
<br />!h.lnyxny rh)tI !or rqn,ElrlrNln. rn*h'J.f,rq-.-hsln hm(llorh.r(lfor rhmugr, hn,' lrr o*r.6til,r..r,
<br />pnrvrkd rlnr \urh ol,l'BnrdlF rrn trkrl.J o..[.tol nn lrh Il. h,k vc.. rh tidhng r rqhrmnr r q'U e hr oE rr
<br />{l drqi.l'r rh. ()*Nr 6ult,Lr * l hiE rlr &^ln ol pNvh8 rh, h. or {F dd r hu d n{F,E rrr F)Fry li,, rlr IrnF ( ol
<br />_1. r! .sftr ot rh( rx{rny, dn .r.10!v.ly ronik rr! w h h(cnRl ..nr!rlo^ r, onq n'.r trf, tln,,.d (s( 7(}&. l1$rB.
<br />.d lh,k<.rn (irL llk(i! r&1or'r Ltr..{ t^,li\ dn rprlvh$orn..or ll.Fnvuh hurl& or mpn'vctrlH6,n.
<br />{J wll'.odr*kntrr*hpfl,F.h*h.Conrtut'nr)|..n{drBurnrt'rh.Cinrr!.ntr'!l$.rh*)
<br />\\()RtitR\'( 0\ttt\s\ I t0\ltgdtS r.lor
<br />I h.r.hyrlltrnur,l.rlr rlryollrUnryoncolrlf,n'lL,*1n3,lrtl riitrF
<br />lhrE.r lnlmd.o.Ccnrlr.r.ol(irc r, Sclf- lmur nr k{tn (.npcndrh, Irl'yrld nl. fy Sdrr$ 17qr ol rh
<br />hhtr (i{.. ntr rhc l.rformftc ol rlE uo* rttr whf,h rh. Fnn ( rru&l
<br />, hr!. xnd r'lln'rmirm snrkt^ rohF q tr.tl l[S.(rnn:rTlrrnrrh l:h,(ixn.nnth.|rrnnuL.ol
<br />rlr so'k l,n rhkhrhtr Fr trr ,\ r\ki Nlv *or
<br />-l!.n'ryrhrrmrhcp.rrortur.rlrl**o
<br />krch.hrhn8.rm n h\{rJ.I \hall dr .hlloy .ny F,.. , "nynr.0s' $n'h..m {,$irlt' rhc w.r k( s, lnnll.n\rrrr hw\.1(llrldnB. in(l.3ra.rh ill \hn'lJ h!(om $hj.d n,rh.
<br />trort.^ (.n{i.nql n. F,rri,n\ ol Se. (trr tr(t)or tlr lrhtr(irh.I {r,ll. nFhtr(h$n{iv * hrh,{pnrrrrnr
<br />TVARITiINC l.rlnrc t' c(ure *.rlcr'd,nD.ns
<br />(Nn rn.1 up n, rc huolr.J rhni\nfrl 'loll{c (
<br />..nrDrr h urLlrul. rftl .lull !'hf\, rn flTl.'nl L,.nnhrl F'Mlr\ rni
<br />rrr.rw,i. , .,tld[! r r, rh. tirr ,, ,""'p""-,*,'. ,r,.,.,1.. ^ {J,.r..r r,, ,r,.
<br />I
<br />DDCI {R TION
<br />I h.Rhy rlltrm und.r FMhrn{lirltrry rhd I.m l'($r{ uml.r |h,v(Nnr IChinr(I(r'nntrfrrn!r[hS(rr'.7llxr)olDrtrh'nl
<br />ol rlf, Brsms rnl l,nrl.(di\ (ixl.. url hvh.n{ F u lull n,^r l.l,b.!
<br />2o6- tz-tc1 t
<br />!:alEralqllalJJuulis.AliEN:r
<br />I herhy {lltm und.r rEull y ol n r jury rh{r rh.E ! a (.$tnEr nn lcn lms .seR y nr rh. Fdol.l*-. or th. *t,k ldr qhkh lhn Flm n
<br />rrudl rsd. !(}r?. crv. c )
<br />AIILISANLIEIIAEAIIIA
<br />I tslhy.,lin ud.r ncdliy i pcriury dE ol rh. nnlt|vmi iL( lt rirr
<br />D.m,l[i'. P.rmnrA{E{nr N(rnr.mn t(kBl Rctuhrxrr ( Iik.ll,. Pd6r
<br />Rcqumn lJtr.rdl ll'lridhtr
<br />I(('r'iyrh.i rltr l.n.',n..!,l.ikrn\ n'!)nl,n! xnr'{,,rrf irrlr'. irml'(,I'lcr,rh^n'!!i!1r
<br />I(. nythrr I hnrc E1lrhFrfltl.rri'n ul {rc rtur r,t rhr( rnn{nurir ^(nm.r l {N ., <,n{lv f, dh rll Cry r lCdnnrv
<br />,'nlmrn..\ rd Srrt l rw! (hrrng n, h 'ld'n8 .nnnn'.r no. rJrl h.r.$yrtrrlrtr'r.rtr.a.nrrrr.\olrhs(iry!n Counrt(,.nrcr trFmitE
<br />rlr'r nrnrtr rJ orn nv n!
<br />Appli.{ o.A(.rlSilmlo IZ la,
<br />BUILDING- INSPECTOR RECORD
<br />SITE-WORK ID/SIG.COMMENTS
<br />T-Bar
<br />Flood Zone Certif .
<br />-l
<br />dcrcmfl udcr S&rnr-, B. & P.C. nn ihu Eag,n
<br />o.r.
<br />-
<br />o*rcr-
|