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SITE.WORK DATE ID/SIG.COMMENTS ()*a,B{'1,.r D..hr.rsn
<br />I hd.t' rm.m unds FMhy of rdlurr rh l.nd.m form rh. Codfido L'en* Lr* for rh. fotlowrs.en (c ?o] t j AuIB
<br />trd Pmfdsion Cod.): Any CiryorCou y whi.h r.{!t6 . p.mn lo codrucr. .h6, inprolc, d.@tbh or Ep.i. &y nrudR. For to ir,
<br />ntunct. rlso r.quic ihc .pplicinl for ruct p6nit to lil. I lisrcd nffil $.t h. o. fi. ir liccdcd puEut to lh. pmlisios of rh.
<br />Cont..ror'! L'e^ed trw (Cll.pts 9, Comm.ncrs edh sftr6n 7mo orD'vtron, oarh. Bcrnas..d P,oa.rt'oN cod.) or rrrl h. or
<br />th. t.r.mpr tho.tom.nd rh. bei! for lh. dr.s.d .r.nplion .A., viol hi ofs.nio.70ll 5 b, ur.ppti..m for r p6nn rubj.ct! ltE
<br />tprli.&r to . cilil Fqh, oa nor rcrc the fiv. huldr.rl dolltr (t500)
<br />l. ! 6w ollll FoFdr. or hy.mDk'r6 snh *.s6 { rlrir $h corp.Nrhn. rill do rlE *o* .!!d rh.IMu. ir tut iddi.d
<br />or olfi.d for ek ( se 7or,r. BunE, rnd Prof4r6nr c.& TIE codr.doar l.rc@ 1., d6 d .pply ro d ow of dE goFry
<br />IIB buil.h or imprcvg llrr6n. .ti wh. dc lrh *oft hirelror hdrlf or rluoun hn or h.r wn mphy6, ,ro!rd.d $1tclr
<br />imprcv.nmrr e d inr.ftH or onald fo, nb la h.w.ra. rh.b{ildiq or inp6ro..i ! sld snnD oe yd of.onpldion. rh.
<br />own.rBtrildd s iU Mv. li. bud.n of prcvi.3
<br />'h,l
<br />h. o. rh. .ot build o. improv. for lh. purpG. of sl.)
<br />l, u o*M ofrh. prop.ny, .n .r.luri!.ly conrdclbs uith liccN.d conkdoErocosrrud th. proj<r { s< 7(x4. B6i,6r&d
<br />PrcfBion Cort T1l. Conr.dori L'c.n* trw d6 Nt rpply ro u ow of pro0dy who bu'ld! or 'n!rov6 ihdNn,..d *ho
<br />conhdr for su.h FoJ.dr wdh r Conhdo(, lE6rd pusunr ro rh. Conr.d., ,. l-&ns ll* )
<br />I m.!dF{ ond6 sd$n .lj &PC lor rhit rce.
<br />WORI(FRS ('OMPf, NSA'NON DF(-T ARATION
<br />I h.rcb, affid und6p.nrlly olFrjuryon.ofrh. rolh*'.x dclratioc:
<br />I h.!..rd rill uinlrin. Ccnific.l. of CoMnr ro !i.ll-I6!r for mrka! conp.Eircn. u p,ovd.d lor t't Sdbn l7m of fi.
<br />trbor Co{t., for rh. Ffome of rh. f,dt aor $hirh rlE larmd i! $u<d
<br />I bv. rn wnl mrtur *orlnr' onp.ri5n rtur.E. ! ..qu..d by Sd.. l7@ o, rh. t b., Co<t. for rh. FfolBftG of tll
<br />eoll for whah th! p.rhi tr 'r.u.d My srldr' .onp.n-r6n Gffi. .ui, .r!d Dolky tuola c:
<br />loli(y Nunbd: Ii\pir.3
<br />I Ih's3.crion n.cd mr b.conDld.d iarh.Frn !hr(h.hund,.ddolllEltl(r(rlorlBs)
<br />I .diry ln] in rh. Ffodr. olrlE $ort fd uhrh rhs p.rnt n i!u.d. I {.ll @t .rloby !r} F-! h.!y mm6 h B ro
<br />b.crc ebr6r b ill Erl6 @mFNt.n L6 of C.[ao.u .ri rgra rtrr 'f I rhouL bcor rubrd ro tlE *ql6'
<br />;:l::---'*-":Ifi JdH_"..,:Hffi
<br />*_*_,..,WARNINC Fr'lur.ro GUr.work.E conp.Nlton covi
<br />6nd up to o.. hu,rlErl lhou.nd dolh6 (1100.000).i..ddnio. ro rh..o! or.onpcurioi! d@sd B prord.n aor rlE S.dion 3076 of
<br />rlEl,borCod., r a6r md rnor.y i 16
<br />UCEIIEDI;qNEASqAIOICIJEAIA!
<br />I hdlbt .If@ u'dd ,.dly of pcrrry $r I m li.!d.rl uda FDvili,n orct.Fi 9 (@n1,tjfui!s * nt Sccl6. ?0r) of DirLFn I of
<br />lL EuilB lnd PmfoioB Co&,."d ny lk.4 L in tuU aor. &d.frcr.
<br />I l..nse Ntr rhrr
<br />,.",^.,,,, K UJ.r4 v4l4'-,g
<br />(ONSIAUCTION Lf, NDTNG CENCY
<br />I t ruy .rm urld Frlry oaFi'ry th.t tlE i, . @BlrBlion Lldils .s*y 6r tlE Ffotm.. ol E ydr for *hih tnir pGnit n
<br />i$lctl (Sc 1097, Civ. C.).
<br />AITUIAtsI:jLDTCIAAAUq{
<br />t).mlnbn Pdnr'Alh.rror Norili.rir Fc.tor R.8rlrlbN {Tirh,O. P.n 6)
<br />R.quir.d Ldt6 ot Nolifdion
<br />I .drify rh.r fi. r.dsrl GsulniB E3rdi.t sbcrot rmrd & er r@ti..bl. to lhn For.t
<br />I ccn'O th.r lh.v. r..d rhR rppliclrion md sr.r. rh rh. !bo\r i.rom rco trcotr.cr I isr(roco'nplys h ill Ciry rndCoumv
<br />ord'h!n.6indSr.lrw!(
<br />ilhv. n.mio*d prop.n, for
<br />h.r.byrurhorn Epr6.nl'riv.3 orrns Ciry ind ( ouory ro dr.r uD.. rh.l,xns ro buildinB corBttucri.n '(ud
<br />"",,O/>zlq
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SubfloorA/enVlnsul.
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<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 />FINAL /t'1"rrlLlt<-ffi katrv{.d )I I Cl-rCertificate of Occupancy
<br />M \WP51\P.mrt-lnsp€ction Fcro\Elr(d.9]Bpetion Rlcod do. 03.31.06
<br />BUILDING. INSPECTOR RECORD
<br />Flood Zone Certif.
<br />Notes, Remarks, Etc.
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