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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 loor/VenUl nsulation
<br />Roof Sheathinq
<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 />Enqineer Final Report
<br />Flood Zone Certif ./r>,Wubl+ Sr{-r+h t-3-t1 o.-->l-3-1"t x,
<br />9,> )FTNAL -----------/
<br />Certificate of Occupancy U
<br />Notes, Remarks, Etc
<br />owNfr alILDr-t DEtrcaR noN
<br />I h6.by !,Im ui& Frlt, of Fjlry tb. I D a.tupl liom lh. (odrddt Uc.M r^' for llE follo*ina ,6]. tSG 70!1 5
<br />adiK !n Profd6tr Cod.l: Aly Cny or C@ny *h.h rcquc . Fnr ro @dtul. .ts. rqr.ve &blitl or rqn ry
<br />rru.r@ Fir ro tu isll4q .ho r.quic th. qdiol for *h Fnn lo fiE.3istd nioFf lnr lE or tlE i li.€!.d F@d
<br />ro rh. Forisb6 of 0E Conr,rE! Leir.d L.v ((lEF6 9. CoMirS wnb Seliotr ?040 ot OiYnb, I oa tlE BGil6 .rd
<br />Prcf*rG Co&) or th, ll drE a ddl!( thd.6oe !n 0t bds lor th..lkS.d qd!triJn. &y riobbn otsclbn 7011.5 by ey
<br />.pplicd tor . Fnn objctt rlE ipplidl lo . civil Fmhy or ml hoE lh& fivc hu.dt d doll6 (ltoo)
<br />-1.
<br />6 oErB otlh€ pNFnr, o. my mplorE wnh wt86 a rh.n Dt onFsrion. willd, ttE sst a'd llE dtEl@ ii nor
<br />inrod.d or ood.d aor sl. (58.704.1, Bsine sd PEaBioB Cd.: Tt. ( onl,!.loat Lkd. L.w do6 nol @ly lo u owa of
<br />th. FFty who lnil& Dr dlFo!6 Eoc ed who (l)6 sch qr* hiE.clror h.*laot thoosh hit ot hs om dplor.6,
<br />p.ovid.d rh.l iuch mFlvEEd e mr i d!.Ld d otu ft,r t ]. lt, ho*66, lrE hrildiltg or hIF.vcEr ir $U *irrtii d. td
<br />of conpkiro tn. o.*E Builda will hlt tlt hnri ofFotfu $r lE d JE dil ml hitd or r+.ow dE FDFrt 6r tlE F,por of
<br />l, 6 ouE of rlE FDFry. n odBildr .odi.S qnh lM!.n corrr*hR ro @'8tu.t 0E FDF (Sc 7044. &68
<br />.d PDkim Cod. Th. ( orrr.cld . Li.@ tr* {,6 @r .99ly ro x osE of FoFr} *ho toillr or impror€ E@..
<br />ud who @'rrrl! fd r*6 Fnjiht witn ! Conffo(!) li!!.d Fl6un io rh. Conlnclr: Ltc L.*J
<br />I m.lmd sda sdr6. . B e P C tur rhu @n
<br />D.t.: Ornd:
<br />Mabl8l:CAU[}iNrArlQx
<br />DECI.A8AIIII!
<br />I hftby arm unda Fully of Fjuryo..of rh. aollo*in! d.Ll&!li'N:
<br />I hr. rn vill di,r.h . Cdif.n. of Co@r lo S.la-lBuG lor wr6r @dp.nerio[ 3 Forid.d f.r bt SGlb! ]700 otlh.
<br />t bor Codc lor rlE Ff trft.of th.rqt for *nth llE Fin a i6!.d
<br />-l
<br />h!r. lrd ull roitrl.in s.ddt .omFMion iffie G (qumd b+ s.db.17m olrlE l,lB. (td., n r rh. Ffffi. of
<br />ktnt,
<br />re. cMir nl polky numb.r r.
<br />fL LfilL
<br />-,
<br />c.nify rh.t in lh. rEformr. of lh. wort for whichthirprnit n Lruql.l lhillnot dplo, s, p6$n in..y n'ffi
<br />s s b b...m. ruu.d ro rh. wrtd'smp6tsaion laq of (.thfomi4 xd .sr thn if I 3huld t!.om. llbier to tlE
<br />wrtd' conF!.Iion FDvnio6 of sdir. 1700 of thc lrh, (-.aa I rldl, fonh*nh codpl, wnh
<br />'ho- FovnhB
<br />WARNI|iC: Fnlurc lo h(c *0.16' onparnion mrd{. a unL$ful &d tull subj.{ x dPloF lo otnii,l p6.ii! r.d
<br />cnil 6n6 !p lo oE hund.id llrut€td &UE (tlm.mo)'Z)/*^ ,-'*6 6'FDri'd r'r r
<br />Sdron 1076 ofrh.libor(
<br />C
<br />I Hy !,Im ur& F!X, of Fjury fi, I u li@e.d u,r& Ftrlirio. or Ch.Fd 9 (offiins wilh Seln. 70m) of DivisioD l
<br />oa rh. BciIB Md Prcr*bN Cbd.. dd my lic.M n in full fore a'd.,I*1.
<br />{i7375 6
<br />ra7=
<br />(.ONATIU(-TI(1 LTTDIIiC GFII'Y
<br />I nolty rliin ula Frty ot FJury lhi thdt b . oirN.lbi lctd,8 t8dy tu llE Ff6,!t.N 6lllE wt tu *ni(t! rn! Foi b
<br />ascd (sa 1097. cir c)
<br />ATIIICAdLITICBSAIIA!
<br />I hddt,frTn udd pd.h) oap€juryonc oflh. follof,ins &(ls Nnr:
<br />l}mliriof, Pmnr.Albcro! Norilicarion F.d€.1 R.8oLlioN ( I nk 40. Pdr6)
<br />-R.quEd
<br />lnl6 orklilfriirn
<br />-l
<br />cdi6 thd E LiLr.l r.suhlFc i.g,,n6S 6tdr6 rm\i rG mr q!,lr!bL to rha FnF
<br />_l col't rhd I hrr. @r rhir .Fplr.ri). ,n dd. thn rlr !ho!. inford{.I rsE lo orpty e nh .ll city .d coutn,
<br />ordimc6 ed sur.Ir*s Elrrry ro hoildiq co'ErucrioG ud fis(r{ir'6 ofthB ( i) .ntl ( ounlyro olq uIDn rt
<br />atnlc molion.d prc!.ny lor
<br />/\DDli.{nl or Ascnl sktrtrh,rc
<br />n$nile nrme{prinl): /
<br />a trk p t?,
<br />EI
<br />UEI/4:.,
<br />II
<br />a?4
<br />BUILDING. INSPECTOR RECORD
<br />,rnrr"*@r,or*, 'I il
<br />,,.*,,,* . C+l 1.-"1,";
<br />D.. lo!-,t/tf k"ii(>fr/4{
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