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SITE.WORK DATE ID/SIG.COMMENTS OWNCR BUII.DER D'L(-ARATloN
<br />I h@t'y anm undd po'alry of FJury ihd I m .r@O nom rhc cotudoE Li..M lrw fu lfic follosins r.en (sd 70:ll5
<br />tiBin< en Prol66n Co&) Any Cny oi Coudr *hih r.q!'E 0 rsnn lo o.drud. ,11d. itlgrove damlirh or EFtr &t
<br />il]udu€. rtu ro iG isuocc. dso rcqun6 rh. e'i( l tu ]uch Fn'1 lo liL r 3,s..d 3rd.t6r
<br />'hd
<br />tE or sh. i lic@d pledl
<br />lo rh. Fnebi.N of tlE conlrtor! Licd!.d tI$ (Ch3fl6 e, Cof,hecinrr $'th S6tnr, 7000 ot Dirnio. I ofrhc Blrind Dd
<br />Frofsions Cod.) or rh,r E ( nE . qqnF rh6.Gom rn rlE b66 for rh. .li!.d ddnpri,n An, violdnnofs.(ioo 7011 5 b) !n)
<br />ippltm lor d p6En 3ubjdr! rh. a!pli.&r rr' . ci il !.@x, of not mrc rhln 6!. hon&cd dolldr (t5@)
<br />l, s own6 of lhc F$Fly, or my 6pto)6 wilh $!a6 6 lhd ik NnFruaion. *iI (h llt Mrl id llE slMr. i! ml
<br />hadal orofald tu $L (sc 70,44, nriE!&d Pi,asioN Cod. llE (tntr*iois Lt@ L.w &6nol4pl) ro e o*ffi of
<br />llE FDFIy slD hill r irylrG dEq ,n who dc sh ua* hirelf or hg*lf o. tlEough lir or lE o{r mph}6.
<br />providcd fiar 3uch 6l'orc6n! ft 6r id6d.d or dfiqtd t]. sL l[ ro*G. th. triliil\3 o. i,rF,ffi i! eB sittin orc )@
<br />of @n'0lrio'! tlE O*E Ao&a *itt hv.l,t hnh orFulg rhd lE d !b. dil d hild or intrort th. FoFy tot llE F rEor
<br />L s oEE of rlE t'DFr, m .rcluircly coddos *'nh lEoed conrdoB nr enrtu(i rlE FF (Sc ?o+1, &d!B
<br />rnd Pnrfisi{ (nd. 'rh. Conrdo Lkru t s d.6 mi .!pl, b e os.d o f rroFn y who hollds o. rnprov6 rha6n,
<br />&d sho odncr3 for such FljEr! wirh . Co .rro(, ltrds<l rEud re th. ( otudori Li.@ L.*)
<br />,",',.T"I"f[p7 olflL!
<br />I h6.t y rmrn' und6 ,.n lry o f pqjury on. of th. aolLf, iry &!l{ol io6
<br />Ihr\.al*'Urui ri. . ( sifkdc of (-olFr ro s.lal@E for rrla omFBdna c FoliLd lor h, s<rio. lruo of rh.
<br />tibot Cod.. for th€ rqfolllre. of th. *!rt for which th. pgfril i! isu.d
<br />I lB( &d snl minrlin *orkd- .omFNraf, iBur@., 6 r.q!n.d by sdbn 17@ or rlE l.hor Co&. tor rrE Fftllr]@. of
<br />rh. worl fo. which rhi! Fmn i! isd My wortac conFMbn iNuuc. tris ud pulicy nmbr e.:
<br />I .diry rhx
<br />'n
<br />tlE Ffo,mft. ofrh. *0t f6r rhah rhir Fmn B s!a,. I 3h!ll nol @Iloy ey Fsn B ay ma6
<br />r a to b<!ft ubjal lo llE *ql6 onp.tEdnn Lr! otc.lifone dd 4€ rhd ,ll dnuld h..tm 3!bjd to rlE
<br />w,t6'coiFtsdio.provilnrBoasdio.1700orrh.LrEnCod..Iddlr.nhwilhcomtlywnnlhospmvirb.
<br />wARltlNC r_illE b se q$Id' ompddhn 016.r.. t unL*'tu! od idl ebiJl u qr't)rtrn l. mi..] Fsii6.nd
<br />.ivil lin6 up ro oE nun&.d rhou.d dolls! (1100.000), if, rdjirrn ro rh. co3l ofc66p.@rtun, d,rusd a prcvid.d lor lh.
<br />salnrn 1076 of rh.l,hlr Co&, inldd md dbnr--
<br />P lz,/ta'-7 -4 .r.
<br />Dtu.!&[to!
<br />I hacty alIm uidd po.ty .f Fjury lhrl I o [.sa.d 6do Fsvirio. of ctlrra 9 (comcins wilh Sdion 7000)
<br />of lh. BulilB od ltDf6ioB Co<|.' rn hy laoE t i. tuI fora dd.lT.d
<br />(oliraiJ(rlolrll[tlcScfdq
<br />I nd!b, dlm u.& Frn, of,cjury thn rlE ircodMioo lddins.smy lor lh. Fforll@c of lh. *ort 6. shicn rhi Firn k
<br />i$.d (s6 1097.Civ, C )
<br />APPI ICA]IT DECI Af,ATlON
<br />I hcdJr rtrin uftb lE.lty ol Fiury oR of rlE f.lh*i.! d6lrd i.Nl
<br />Drmolirion Pffit!-Arb6lor Norili. ion F.d..l R.suldion! lTir l. .10. Pe6)
<br />Rqun d l.rrs ollJori6caEn
<br />I cdifr rhd lh.l6ddal r.Bll,lfB r.Sadir{ Bb6rG rmov.l r. m' rr,f,li.obL to rh! Fojd
<br />I cqrit lhd I hsr rsd thir 4'pla, i,n rd {!rc r hd !h. !h,E irromirn i cord I .grd lo 6mply sih !l any r (-ounry
<br />odrn.r.6 dd skrc L!trsEhlr'8r tuli'ns coNru.lrr uxl hs.b.ulhon,. Gpr6dtdiv6 oafiit ( n, Md colnrt to al6 op.n rh.
<br />ltF\. mdlion.d rroD<dy for i
<br />^Dplicrnl
<br />or ,\EMl sktr.t (*vtt4 tqkfi
<br />.8t -/ t1
<br />€z--
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsu latio n/E ne rgy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL i-l-/7 )Jr{th fin\
<br />Certificate of Occu pancy
<br />Notes, Remarks, Etc
<br />BUILDING. INSPECTOR RECORD
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<br />Pool Fence I
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