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SITE.WORK DATE ID/SIG.COMMENTS OTT'Nlf, BTIILDl:R Df, L('ARiTION I hd.rb amrn trnd6 pdrlry ol tnjury rhar I ffi .rdpr fNm rh. ( od8ro6' l.roa Ls lor ih. folk sin! r6n (Sd 70rr 5 It6inai 3na Frofamn Cod.) An! (-irr or Cou.r\ {hih dquns . tEnn b codrud, .n6. inFove danolish or Eret uy rrudu., Fu lo nr (!uc.. lls r.9un6 lh. .arlic6l for 3u.h Ff,nil lo fik i sisncd sidffir thd lE or sh. 6 lic-*d puEuan kr rh. Fo\.io orlh. Conhdors t.ic6!.d Lrs (( hqir 9- CoEiftiry $ h s(i{n 70m.l D'ri.i.n I.arh. aori.6 lnd ftnt<FB (.d.) or rtd lE or nr B.rnfl rlE.nom 6d rh. bdi. for rh. tlkr.d.rdnprion An,viohlionoas(tion70115byan) ,mli.!nl for.pm Nbjdr rh. .pplrca loacivilDft0hyoimr orc lhM fi! c hundEd d.lld! I 1500) l. $ ovns of ln. FoFriv. or ny mpl.yG qith w!36 6 lh.n sE con{an lrcn. sill 6 lh. so e'd lrE nnx1G ! n rdarl d or ofh.n aor sr. (S( 7or4, aBit$ od Pt fdn,E C.d. 1L (..Inrrto lI.c tiq do6 m! agpl\ 'o u orE oa rh. FnrElv trlF tril& o.,r{m\6 ihson. dd trho d.6 tu.h MiI him.lf or hds.lfor rhmoSh nis or h6 o*n mplor6. provd.drhi tuch mForlEii e inon d.r ofiftd i! !h lt lntr6a. iE h!'LlrB or iI{r.rffi ! sU *ilhm oE lr .f co'r{ .rrn. rll {n\F Builb *ill h!v. rlE tul6 of Folin* fid hc or shc nid dn toild or m,rer. fic Impdy f.r rlE I|IIrE of l. a osnd of rh. FoFay, d .rclulir.ly..rlcr ms * t l,ca*d..nii&roB r..oMl. ih. rmld (s( 7Grj, B!16 i,n h'ki{ Co&: Th. (.o.lrrkn r Lk6* l.$ &E mt qt\ t. ri orn6 ofp.opdit $fio hoil4r or inrmvB th66., ind sh. o Edr ror.u.h rn'jd3 wnh , C.ir6(o(3) Iicard purer ro rh. Conrr.rs s I r.@ te) I m $.mpl,ndd s(rhn tarf,[8l:coulldsAr!]! DECIIEAI]A! I h6d, lmrm!.dd n n!h, of Fqury oR ofth. folhvrns d.(le.r6tri I h.v. dtl *rll miinrain , ('.n 6cd. of (i\dkm ro S.ll lNUr. for tr 0116' comFldrn, 6 Fo\ *H for t^ Sd i)i :r 7(x) .f rh. l..bor Cd.. for rh. Ffotu.. o f ih. *!d for tr{lkh tfi. ,sEir i nsu.! I hA. and tr ill nxnllin * 0116' .omp.$aln'n irq6m.. G ..qun.d t1 Sd ion u00 ol th. l,tarr Cod.. ror ' h. pFronMnc. or rh. $ork itrrh'chlhNpdn r $u.d My tr 0116 .onFsalNn rNure c crF {il ri,lr) numb6 rc l.di! rhll 'n rh. Ffomrc.of rh. *orl lor which lhis pcrFir ,s i3su.d, I lhallnor nploy d, tds. i. ih, mmn6 s N to bcLom slbrct 'o ifi. Noit6 oqxrdion l.*J ofc.lifomi!, .!n laR rh. il I shuld tEom $bdl to ilE tron6'$n'FrElionp(\'isioNorSdirnlT00ofth.l,tor(-or!..lslEll.fonhwithcomrlywilhlho-rolGrB WARNINC: f.ilur. 'o cu. mrld comD.Mbn cor<.s. ii lnh$rul Md !h l 3ubFd d dpL)6 ro ainiEl rEEhir -dcni fi.6 up lo oE fiun&cd lhound &llG (tloo.Oool. in lddili.o h lh. (ost nfcomD.Mlnrn, &m4d 6 p.ovid.d ro' lh. lzolzo '*11*^,tr$--rl l1' I I ucrtrs-riFoii{riroli' lrEcl araa rfuN I Hy lflm !nd6 F.hy ol FJUi] rhr I m lk.r&l un - F.\ tFr of Oqis o lonmtr'is *ith S.clnn ?0.-$l .f Dtr irk]n :1 ol rh. BBirc rd Phf6hN Cod.. nd my lk6! i! in full tn c et.ITdr bLall 0l ? tt [zo I I hGby amm unds poi.hy dl Drjury rhn rhdc i! ! Ndrrucri,n kndbs lrcy aor rti rEfonljft. .f lhc s$rt f.r $hkh rhi! Fmi ii ,e.d (s( !097. ('iv C ) A.EIII(ANfDISJAAI]AI lh66'lrm un.Lr n.nllly oinsiurv on. oflh. folh*inx dalffdi.ns Dcnolit i.n Pdnia-Ast<ros Norificdion fti.ril R.lul reN (I lc .10. Pd6l Rcqur.d Ldrd ol rdrifi (dnn I c.lifylhll th. fcdqal rqulalioN Egedrng 6lEna.drolal{c h! I 'lrc.bl.lo rhK pr.].d I(di!rharIh,\.r..drhtsrtlir.ridndiiar.rharrh.ahr\.,nri)mrhonB.or(rI4rci...fr!l!$dhrllCir!a.d(onnrl o.drn.m6 $d shr.lr{snlr'ntro tri!.Ins ..dtu.r ,rl h6.l') rurh'rn. r.FMidr\d of rhi.Cit sd ( o!nr) lo 6t6 upn th. ihi\.,n.nrr..J lr()tdr for Nfd .\prll(. r or^r0l sk rlnr. N UffD II lN l^t-t Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loor/VenUlnsulation Roof Sheathing Shear Wall F ramrng I n s ulation/E nerg y D rpvall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report FINAL Li,/iK E-i*t \l zru k: Certificate of Occu pancy Notes Remarks, Etc BUILDING- INSPECTOR RECORD I I Flood Zone Certrf.