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SITE-WORK DATE ID/SIG.COMMENTS OIVNER BtIII,DER DEI,(ARATION
<br />I hd.b .fiim uhd6 Fuhy or p.rjury rhar I m dcmfl Eom th. (-oarelou' Lid lru liJr rh. fi'llo\inr rdrn (sc rol l 5
<br />B8in6s .,n Profeii,n cod.) Any ( irt or ('.nrnrt $hi(h r?qun6 . p6nil li1 c.Blrucl. 1116. inp.ore ddmlBh o, ErFtr in)
<br />ntuduqFrtrroirr isu,nc., ibo rdNt6 rh. rprli.anr for su(h p.m ro rik , srsn n {no6! rhd lr.r nk i! lr.G.tl po,tuid
<br />ro rh. I'ovBroB of
<br />'lE
<br />('onrdo.s Licds.d l-ds (('h.rrd e. (irmmocinr s'irh Serion 7(xlo ol Dntnn :r of rh. Itush6s ,nd
<br />Prcf6m.s ( odc)or thar h. or sh. s dcmfl !nd.6om dd rh. b.rB loi lhc.llq.d cropli,n A.) \hlslnnolsdnn Torl 1i} an)
<br />dppl'canl ror ! Fnh subjds rh. appli(anl n, a ci\ il psBll t of nor Bnc lhan 6\ ( hun&.J &llel (t5m)
<br />l. nr o* n6 of rh. ,n,flny. .. mt mrn,tG lnh wis6 ar rh.n $l. coma.nu i,n. tril d, rhc *qt a]d rlE rdut R ftn
<br />fl<dol oroltF.i forsl.(Sc 7(!1,1, B$nsdd ProtdrtuN ( od. IhrC..do.tl.td<lr\r,lBmrq'd\nrMorid I
<br />th.I'nFr,- sh) htrlJs or mqro\6 rlEBrn. bd sho d{B ru.h $!{ hif,s.lf o. h.Mlf or tlloo3h hir or hd o$n 6pn )6.
<br />Fo\ i{t d rh6r sfth mF,vdffik e mr ido&J or olld.d tu sl. lL h.s6a. th. trildi.r or inp.trmt b sld tr rhr.rc \6
<br />.aco'r{,Llrn. $. (x€ BuLjs v h.r.lhchr&nofrm\hslhdhcorslEdd 'l ttrikjordFo\.th.F\Er n 'lrF,FR!l
<br />l. a\ ouF oarh. F,IEr\. d.rllusrcl) codndrn$ \lrh lirds.d .ofiadoB h .ons DC! rhc I'oldl (S( 70rl. tnliBr
<br />a,t hrisi$(id. lh.Cd.rdo.r t.icmr L!\ do6 mr.pplrro hnow.6oipror.ny\rho bu'ld!or imph.rrhdon.
<br />and rho $ 6ll fnr \uch Fnj.d! r'nh r (nnEdo(t lic(i.n puBud ro rhc ( ontddois l-icd* t-h$ ,
<br />I n.\an undd sdri'n
<br />Drl. ()i!d
<br />rvoRxiRs a(inrPF.\sATror
<br />DISdSAIIAT
<br />I hd.b, lmm undq FElrl otFluD orolrh. aolld$,iit &clr ha
<br />t hlr. sd \! ll mlinrlm . Cdnfi.ar. o[CoEcnr ro s.lt-lNur. ti{sor\.i (ohpddirn, a rh\iLd nv b, sdrnrn r]Ll(lol rh.
<br />lntFr ( od(, tn
<br />'hc
<br />pqfomdc. orrh. *ort n! s,h
<br />'ch
<br />r hc p€rmn ir Gu.rl
<br />I h.1..nds'll mrmrdin \o as' .omFns.ton 'curanc.. ns r.qu trcd b! sdion r 7(xJ oar h. I it{r ( otL. tor I h. rErollrwrc or
<br />rh. {orl fo.!hih'hi.Fnn 6 Kd [!t sorkd'mnp.neton inlrMc..Mr6 od Flicv ntrmtE {.
<br />I c.n,ry rn r in th. Ftumffi.ofrh. trort tu trhrh rt'r p6F( E Fsud. I sl8ll nor opi') .ny pde,n r.nt ranM
<br />$ dq (' trdm. !'hi.{r h rh. \oir6 (onFnsri.. ls\ 3 o I ( al'fom'r. od isN ihar rf I shiuld hc(on. srbr(l l" lh.
<br />norld mrnp.trsri(r 16r ni'B ofs(1i].17rl06arh.l.hy ( di.,l sh.ll. aonh$nh omplr \nh rhis prollrions
<br />WARNINC hilu..lo KW n.rld'
<br />.n'l fin.! u, b oru hundr.d tlNusnd
<br />sdron 1076.Irh.lrlrr ( od. inrdd
<br />r",|1e1e.4-
<br />omrEnr.iir (\d4. t unl!\ful.enpl.y. b mm'nal Frlt6.nll
<br />nnr ddnar6 I tnlvid.d for rh.
<br />I hn.tt .mrm lnda tdftl ol Frjury rhd I dm li.6sdl fnld l,rvn6n of( hrrt6 e (omE(ina trnh SElion 700{)) otl)'vn'on l
<br />ol rh. $('n* Md ProrB:ioa Cod.. erl hy li(@ h in full lo(! nd .It<
<br />,,.,"r.r,"' B' I ?Lo/
<br />I h-rhv.llt und.r lbilrt.rfrrun rlnr
<br />r\u.drsfr (n7 (,v (. I
<br />a. kirlins !ra() ror rh.Fnrmaflc. otrt.\ork rorrhrhrhs Fin u
<br />arSll(alll.E llLasallal
<br />I hd.b lmm uRld rEnrh \ o, Fdjury .n( o I
<br />'h.
<br />nnh$ in8 dftl.r.r io.s
<br />Drmlikrn Pdn('A3i*ros Ndifird$n F.d6.l R.*ul!rionsl r l..l0, Pd6l
<br />tcqutr.rl I .lrr of M{if(ni)n
<br />I rdia!rhd rh. f.&r.lr.*ulntoB r$adinr.rb.io. r. olal.r. nor.r'plcali. ro thr pn'rNt
<br />h.vcrc lhn q,t lril[a nn n rcotrR1 I asrch.orllh tr,rh ill ('ir\ iid( rtrnr\
<br />. u*a Eldin! r, hill]'na c,.rn6ondtr6 olrhis ('irr and ( ounr ro dn( ul\r lh(
<br />i C,t 4 ,<.2 /4/./C 4-< Z
<br />/a- 10. / 7
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />Subfloor/VenUlnsulation I tl -
<br />Roof Sheathing lolrllP.Tfr'.ll+1
<br />Shear Wall ll
<br />Framing
<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 />Flood Zone Certif
<br />FINAL lol znlt7 5lh v.a14
<br />Certificate of Occu pancy
<br />Notes, Remarks Etc
<br />BUILDING. INSPECTOR RECORD
<br />I
<br />I
<br />I
<br />SLAB Floor
<br />-tllCulelion/qnefSI l
<br />I
<br />I
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