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SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loorA/enUlnsulation
<br />Roof Sheathing
<br />Shear Wall /-l .l t'7
<br />Framing I 4^lWl-afV/..A
<br />lnsu lation/E ne rgy ,t r{l \!--,.
<br />Drywall I
<br />Ext./lnt. Lath
<br />Brown Coat 7wI
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Final Re rtDeu
<br />En ineer Final Re ort
<br />Flood Zone Certif
<br />FINAL 3-t - /s J)zd.-t tr
<br />Certificate of Occupancy
<br />ul.t
<br />Notes, Remarks Etc
<br />I
<br />{Q
<br />O\INER'tIILDER DEI,(-ARATION
<br />I h6.ty .mrm unrt r ,.nihv ol poJUD- lhd I d .rmpl 6om th. Co,nr!.loE Lic@ liw for rh. lollo*ina r.s'n (s< 70lrl 5
<br />Rurn6s .rn Profeion co&) An) ('hr" or (ounD rhth r.qr,6 r Fni io.odtud, rhd, 'mFo\., dc,hlilh "r EFn d)
<br />ntudu.,Fhrro r su a,.Lso r.qltB lhc 0poli.dl to!su(nrEmiltu lilcrlkn d dslodl lhd lEo. rhc n licaEd pursanl
<br />u itr rm\lFs of lrE ( onrdor s l.ros.n l,r (ch.Di6 e, comtri.B qnh S<rbn ttm of Diltnn I of rlE lturher tnd
<br />ftor.sionr ( od.)or lh8l h.or rh. is.r@pl rh6c6oo ed rtu ba!! Ior rh. alt r.d cxdprion A.y lrldnrofs*lion7u1l5l,y!n!
<br />lpDhc. ror r p6nh shj<B lh. .p''lker ro r ci il FBt' of mr mr. rh.n tu. hurLn.d rhlld { ltoo)
<br />l. B o\E or'lE F.tEiy, M mt mplo\6 sirh srs6 a rllt $t NtrqE!.ri.n. trill <h rl! *r,t ri'lE.rlxrc i. hr
<br />'ndri.d orolt6.!j forsk(Sd.?Ol4, B6ilK ed Prcfdiod Co&: Tn Codrdor! l.iaek$ &6nor.!pD io oo\n6oI
<br />lh. rmFty wtF h & or i"rF.E tlEBr !d utF {,(E sh *!,t hinElf or h*ltor llmush his..lE o$n 6r!L)8.
<br />FovxLd rhd sfi mForlllB e m ndi.dorofid.d lor $k l[ tbr6a, rlE hlildm* d mlr.rtld B $ld *rhn.ft ]*
<br />ofconlPLlDn. th. ()"6llllrlda $illhAc th. hid.n oaFovins rh, h. or !h. did mr hllld or inF.v. rh. FoFty for lh !{rpo*.i
<br />l. Bo$ffi ofrh. FotEry, @aclunv.ly conrriics uirt licEu.d corrrsroB to conrrud rlr E!r6r (S< 7olt. A6[6
<br />dd t\ok m Cod.: Tfi.(ntudoas Lrcdr lr$ drE rol.prly to & 6wno ofFopdl) rho build! o nproyd rh6n'n,
<br />dd qho m r*rs for sch FnjErr { irh . (n reo(r) lkdE n DBd to rh. Codrdoir lj.ru tt*)
<br />I rtr'.\.n,tr trn,ld s..rk)n
<br />w \toRt(lI{\'( oltP].\s \t (l\
<br />DI:(!t&!rQ.I
<br />I h.r.N rflnnr und( !..ahroflujury onc olrhc lolliN i.3 d<lertions
<br />I htrv. Erl will miinraitr . Cdr ncol. ot Co.hr r. s.lalNur. tur sort6' compasrion, I Fovid,nl lor t t s(l nJ. r 700 of rh.
<br />lltFr ( od.. for th. Ff(l'lr1a. of
<br />'h.
<br />qort for {nrh rh. Ff,i 6 e.n
<br />I h!\ c ud *ill minitin *orld' conp.G{ion iNufucc. 6 r.qun.d t'y Selion l7O0 otllE t U,i Cod.- for
<br />'h.
<br />p6f(tu. of
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<br />Cm\
<br />Polk, Numb.r l - Erpr6.
<br />l.<di! rhll i.l& Frolrucc of th. *orl tor uhichlhir Fmir is isu.d. I nrll mr mphy m) p.mn in any mDn6r al.harft t<r k] rh. $0116 ..mFnrdhn l,* ot Crlitom{. a.d lsr thd if I .uB b(om *t!.cl lo tlEso d' comlastion a,.vliion! o I s6 ion :r 700 .lth. trbr code I rhru. aonhwilh cofply s,nh tbs polirioB
<br />\'tARltlN(; Flilu. !o sE. "116'mmFdhn or6.s. i! u!&tuL di .inl $hj.!l d dnllh)d !o cimnsl Fuha ad. l,ln6uptoon.hun&.dihoosrnddollm(110o.0o0,.inaddnio.roth..onor.onpcnsarion,d.mas6a.rftovidelturhc
<br />Sd1x,n 10?6.frh. r,tn, (.i. flrddi.dd
<br />trr.-?k'/?D/)o€2
<br />Dfd:l.A8arjq!
<br />I H'r .mrm u&j.. F!!h, 6f Frury rh.i I d [.6.d undcr F\ airn df ChrFs 9 (.on1fuins wrh s.cinn 7fln) of lh ieFi !
<br />of rh. BuJn* ud PFl6'oG Codr. i.d my li.6k is in tull for(. dd .ll..l.
<br />[:::"?-L-,-#""*#€:)4-.E AZrz.ntedoez
<br />(aNilaugtotl,l;lDldliacENqr
<br />I ha.try amrm !,*r Fd,6lFrJ ry rhd rhd. n rFlgrudF" lddins istrr for rlE Ffolm. o,rh. $orl tu, trhrh rhis Fni !
<br />isu.d(S( :1097, C,v ( )
<br />AEUCALLDESJAAUqI
<br />I h.!.tt r{im undn pcnalty of rsjury o.. or rhc folh! ins &(ls!r nrhs
<br />Damhbn P@tu.^!tE rotNorifi..rirn Fcd.rrl R.slLr hB (TnL a0. Id6)
<br />R.qun rl kr6of Ndifrllion
<br />I csliry rhar rhc Ldo al r*uhtions rc8sdh! astEsros Eno\ dl d. nor altlicltl. lo rhis a,ojd
<br />I (61iaJ" rhd I ha\cradrhis.rrpli.artr\nddsrarcrhtrr rh.sl{vc infomErn,n is ('Ed lrgrarocoDtlyw(htrll('iryatrd(\,unry
<br />od'B(6 and Sl.rc Lsr rlirB n) boildln8 c.dtud rrtr &d h6.t^ &rthr,. qr.sdn 6 o r rhB (_'! ) rd ( ounr\ ro dr6 urhn rr.
<br />atu\c mrio..{ pNFn, nn
<br />ADpli..nl or AAdl Si*n.ru
<br />"{".r/441
<br />^;7-.92'Jc17
<br />BUILDING. INSPECTOR RECORD
<br />I
<br />9?tqro
<br />P'mh(m0'rPnrrD/
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