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SITE.WORK DATE ID/SIG.COMMENTS OWN9R BUII.DDR DEI-CL\R TION
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<br />I,nnc(rn( C.Jc) .r rhlr tF or rh. N . r.nll! r rh@liom dd rhchinr ntr thc allcs.d cicn{r('n A y !(tbn n ofSc.rlh 70.r l l hy a.y
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<br />L !r owrc!ol rhcJrqrny. orny.htl'yccr wnh *,!.s r h.r !n. . nlt'cnt!|tr,!. * do rtr q(i* aln !k {ElE tr fr,
<br />hrorhl or o,l.nal l,n qh lsa 70aa, BuoF\r .rJ th .cikrr (ir.k: llr Ci,ntrkr r Lrtnc L* dB frn qDlv h of,rr ni
<br />rlr FIri, sE, t lr (, oImB rtEcr. .lj *E' &s {h a)& h'm(ll or rFr(ll.r rhn'ufh htr t{ h.r o*n.if*'}at.
<br />ruvllcJ ih.r nrh mlh,mh & ftn hrm,.d d ollchl ft, r.L Il. h,*.Kr. rlf ltu Ju8 or mFnlrmd n n l * hu ok
<br />'sol lrnltlLr$tr rh. (retur Bu'ltd q l hrE rh. honl6 I novo8 rh, hc ,tr {r Jrl nn lni! or m!n'E rh. On'Fny ltr th. IUIrtr ol
<br />-1.
<br />r\ n*Mr ol rh. nn,|ril y, .m .(lusiv.ly conrr(ruS onl' l(nEJ $htd('n nr c$ndru.r rh. ImF.'r ( S.r 7(xa, lturm*
<br />rd Pnftrrh(iiLr lh.(.odBkn's Lxtnq truJ,.i D, rtlrly n, s.*'F. olFoFrry*hr hu,Lr( rmtm rcr rh(qrn-
<br />rnJ *k, u,nrrkl(tr$(hF,Frlrw h , Orfltrr,)(n lr.n{J pllnuMt t' rh. C.nra ttr s l,r.n{ llw )
<br />_l m.(mpr unLr SAr.n
<br />ItaEf,Eer:glull:&$IratioDl]dEarlr!
<br />I hcFty rllrn! urJcr pcnrlryoit rjurydr.rl rhc I',ll',rr! d(lddon{:
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<br />Lrhtr C,ilc, [x rhc p.rf.mmc ol rtu wtrk l *hEh lhc !Em!l is i\{rcd.
<br />-l hlw.nJ wrllmmr.rn *ork.ri ..ryrntrr$n h\urrE.. r\ nalurcJ I'ySer.n !'7lx)o, rh. lrtir GiL, ld rlE Frf,'llr]&c o{
<br />rh( wtrklnwhrhthspfln i\ Fn'.n Myw,,1.^ lor{EnlurtrD 'n{i.nc clrrr ul })lry nomtrcr e:
<br />-l(d'lyrh.rrrh.lxrtlm.kcolrh.*o
<br />ror *hrhrhBFroir F tr\!.J,I rhlll Rn.mnhy.nyFrson h.nynrn*r
<br />a, $ 6 tE$m {uhJftr b rL vrl6'onFnqrDn llw. ol('rllomr. [r.t a{E rhd
<br />'1
<br />I rh,tld h.e.m $bFl t" rtE
<br />R,.l(i (r,n{Eneru th'vsxN ol s&l,r lfi ol rrE L.hr (iil., I {ull. tdh* h ( ryly lnh rh'c PnrYnrnr
<br />WARNINGT rrtur t, GlE urk^ cor{Enqri'r .r,vcn3c rr uih*rul {tl rhlll nfiFi e c,{ 'ri b tm,l Fmns.tul
<br />.,v'l 1trtr\ op t, on. hui(lrcil lti,u\!nd 'lllr\ rSllrr.lxxlr trr rl']rktr, k) rlr ro{ ol (! \r u8c\ * F,viJ.d t'r rhc
<br />sdrr,. :(r?6 ol rh. bhr clrL, u crcq lri.thrv r 16
<br />ucL-\lI4!!IIl!!9IDEgta ra!
<br />I hcEhy lrl_rrh ! nJcr p.nrlry ol t rjury rhrr I cn lccnqt uRl.r F)vnrn ol Chrpr.r I (ofrmkh8 w(h Sc.rnn ?(xx]) or Drvtrnn l
<br />or rlE BurEn .rJ Pnrdri'n! C.,L. r,n hy lto( n 6 rull rod rDl clrer
<br />c e
<br />I hcNl,y rllrmtrnJ.rr(n yolf.rrtrryrhrrrhcrctr(on(ru(rr$hBlrir8ctr.yktrrh.!.'l(imkc.lrh.wr[lnrwhlhrhtrFilnis
<br />F.kJ r.$( .v)97 (\v C I
<br />IrlLi\ A(llrcs
<br />A.tIlllANLIllgrlEAIlON
<br />I IEII1 rl,im unlg Fn:lry ot Fipry oft.l rlr ldt'*rn3 h1.r.ri)n1
<br />l)cfrn k'n P.rnnk-A\lxios Nord'.,rk'n l(,cr!l Rc3ul&"n\ rlilc 40. Prn6)
<br />R..qurc,l l.rr.rol M* i.rr{
<br />-l
<br />r.nrfy rMr rh. lirl.d rceuLl.,m FSrdnS $h.{os ,.o'v.l ar. n$rq{l.rhk tr, rh(Jlnlral
<br />-l(.nyrhlrIhrvcR.drhsapnl'.!rk,ns^l{sr.rhzrrh.rh,wdf(rmrrrrc,'lRrI!8reb(,mplywhrllCy.BlCounlyohlDtucl {rn Srlrc tiwr rcbring n, hu lint (onntufurn. lrl hLFhyzur {rc r.|nrv.nr,itr.\ olrlrr (''rv : kl (i{n v rr.ntr trtxr rh.
<br />.rr,r lmkrmJ pNl'.ny lif, niFrno lurF)r
<br />ApIliffnl.r Arrnl SaEtrrlu
<br />Set Backs
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Roof Sheathino
<br />Shear Wall
<br />Framing
<br />lnsulationi Energy
<br />Drywall
<br />Brown Coat
<br />Masonry
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certil.
<br />,l-l --ZFINALt I /t/'?la.ua (P<sY
<br />Certiticate ol Occupancy I I
<br />Notes, Remarks, Etc
<br />BUILDING- INSPECTOR RECORD
<br />Ext./lnt. Lath
<br />Pool Fence
<br />T-Bar
<br />l)$fu:
<br />--T-
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