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SITE-WORK DATE ID/SIG.COMMENTS OWNTI' AUII,DT]R DEL('ARATION
<br />I h6.!,.mirn unda pollty olFjurr lhd I m.\dnB non rh. CoardooF Licm llw forlhc tollos'io8.@{,n (s670rl5
<br />ttGins ntd Prol*Fn ( od.): A.! ( il! or (ou.n, *hkh rcqlu6 a Fnir l,r oBlrucr. .lin. itFd\.. rrm[rh .r ErEn in!
<br />qrudue Fiv ro ns isllu.. .l$ (qur6 rh. qDl(d ror such Frn nr fik. qsn d {nnEtr rhd rE.r s& a lE.Md poed
<br />ro 'h. Fo\utB ofrh. ( ont&roi! l-(di.d hw ((tupr6 s, c.m*r.! $nh S<tion 7(x)0 of Drnxrn I otlf. B8inds td
<br />rrordiof,s (-o&) or lhrl lE or sh. n.rdrpl lhftfrem sd rh. hrn for lh. oll.s.d .rdnption A.yvioldioiofsdlr.T0ll5ty.n!
<br />qiplic.nr f{r i Fn {bJ<l! rh. !rnl'c!d ro.civilp.@ltyotd,r moEthu nr. hundid &n l&! (151x))
<br />L a o$F of rh. I'oFly. or ny mdolc *ih *!EB 6 rh.tr $L oniFldior $ill & r,i rui &ld lll. lrtar@ ! mr
<br />i'nqxhl o, or6rd lor el. (S{ 7044, Boin* ed Elrdio ( ode T}. C6dh.ror's l-icd. l-* do6 nor 6pply r. o o*nd or
<br />rh.Fopqt, shohi!!or iqm!€ rlEot !d *tn.trE sh Fd hi@lf or h6*lfor rhowh hn or hd os sIpLy6.
<br />ForiLd rh.l r.h mtm\ffis Rd iddrll m olH tu sl lf.lDEq.lll htildil{ or irr'o\EFr a Fld $iim om td
<br />of cipldir( tl! (\E ltuildd * h.E rrr hnbof Fori,E lhd lEdih.dd d hitd €,np.o\r t Fqdt 6r rlEIi'FEot
<br />l. 6 o*G oa rh. p..Fry. m d.ld'*ly .6dmts3 *irh hc.&n .onrdo6 ro codtud rlE F!l.d (56. 7044. Itar6
<br />rn hltsh Cod.: Tt. Co'{rrlor'r l,E@ tly &E mt {l9l} o n o*F ofprorstr rtn hildt., npror6 lhdan.
<br />! *hn odres tu kh F.r..r3 $nh r Codrfio(i) l.dE<n po,.0 o rh. condd ! Ltdg lra)
<br />I m.rmrr undd S(rion
<br />D.t. o.trE
<br />woxr(r{s, ( oitPENsA i toN
<br />DICIAAAIIA!
<br />I hd.ty rfirn u.d,n Fshy .fFjurt .n. of$. ldh*ms drk,rioa
<br />I har. sll r'ill Ni.ru . Cdr'rf,lr. otCoM't ro sdr-lNrc a( tr!*6' sftFdion. a Fo*,.n for bt S<lFn r7(xl.lrnr
<br />ldor CorL, for lh. pafomua of
<br />'h.
<br />tro* lor \ hah lnc ,qnn i! isu.d
<br />I hr\. rnd * ill na'n!!'n * ort6 .o'nrasrk'n iNur.m.. N r.qur.d tl sdi Fn 1700 of th. t,bor (-od., for lh. Fromoa .a
<br />rh. $nl ld $hrh thir Fmn 6 eld My *dkd 6mF6ririn rMrN. rair .rl pol(y numbd ic
<br />I cErirr rh,r r lh. Fformak. ol rh. \ orl lor whih$EFft 'r a3u.n,I shlll no! mpnrr".n) F$. maoy,ur6
<br />s' 6 lo bc..nr ubjat lo lhc wolt6 composdim lsw! of (ilinrmis. Md esc lhd if I should b<omc luhjd ro rh.
<br />trlrl6'coFrcsrirnp.oririoEotsar601700olrn I ltxf, (-od.. I lrull. ronhsirh comply snh dhr Fsr isioB
<br />\aARNIN(;: F.ih,. ni s6. * ld .otrrFMi.. frrc+. 6 unL*tuI. .d slBll suhFr s dphts lo miMl FuhB tnd
<br />.Nil 6n6 up ro om hu*t.d ihouenl d.rll6 (llrx).u)l)).
<br />'n
<br />rlddh. ro rh..oi of comFNlion. drds6 a Frd.d for lht
<br />Schon 10r^ of'h. tltn' rixL. drdd Md dofti'r 16
<br />o.E, l\ - / u' '' :>a\--y\-J r2.
<br />Lif'6isf, ( oNTrAcroR
<br />DECIIf,AIIOE
<br />I hftby.m.n und6 pdslry o f Fjory lh.l ! m li.mlal u.d6 troltior of( hirn6I (smmtrins {irh s.<rion 70ml oal)iviion I
<br />.f rh. uuind and PhasioB c.d.. dd ny li..M b if, tull ntr(. rd.ild
<br />cad f,ulUarr}:tDltg.A(i[!(l
<br />I fimby.mln unds pcEllyofFiury rhar lhsc n a (oElrucltu.lodi.s tsdry nr rh. tcnrnnmc. ofrn. $ork for uh(h lhls Fm( s
<br />$u.d {s( t007.cir ( l
<br />AIIII(IILDECI.AAAIIA!
<br />I lElb.rm tr.dd Fn,[] of Ft(y on. ofrhc folk\\ m! drl,.rnns
<br />lx'holirn,n P.nnirs Asb6r{*Notlic{i.h F.ddsl R.8ul.rio.s(1 1..10. Pd6)
<br />R.qtrtr<rt t.drq of Mritudhn
<br />t.drlr rhd rh. f.Jddlr.8uhthnr rtrfdins f,ihes(os rmor*l . no' a$nrahl. ro rhn p,or.cr
<br />I csrit rhd I h{. rBi rhi qdi.rion rn nd. rh, rh. .to!. i.fonn ior ir .or<r I rse ro @orry *hh .ll cilr .nd Co! rodlffiB ud Slrrc t sr rdilB ro b(lild'ns.o'drudbtr r'd hElbr llnltro. r.Fsrin6.f rhn cn! rn Count, ro 616 qnn rlE
<br />$ovc ,6rion d ptuFry f iEpdtbn pGFs.
<br />^pp
<br />onr o,
<br />^.6r
<br />sburur: [ 1r. -,! f? orr Iq .oJ-- 2'r-)
<br />Pmhi n.a. (prlno: (.1t \>'
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Fram ing
<br />lns u lation/Energ y
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />,I
<br />FINAL t,Itt lW W'!lW
<br />Certificate of Occupancy /
<br />Notes, Remarks, Etc
<br />BUILDING. INSPECTOR RECORD
<br />I
<br />I I
<br />UFER Ground
<br />I
<br />I
<br />Flood Zone Certif .
<br />I
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