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SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs ' AL,l. ^ .D.a\
<br />Forms/Steel/Holdowns u
<br />-t qr\ I ?wt!r&U
<br />UFER Ground -a 'h_AJL(.',vry
<br />SLAB Floor I I UI
<br />SublloorivenVl nsu lation
<br />Roof Sheathing l,t /
<br />Shear Wall )
<br />Framino 7 1
<br />lnsu lation/Enerqy u I '2/^
<br />Drywall I t>/
<br />€ifltnt. Lattr (l I tlv,t\Atr&l 1*)
<br />Birown Coat I 6\)
<br />It/lasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil.
<br />!1IcL+rlA-,l
<br />I (It
<br />FINAL q-.C4a'iarqYrelgl 'w)
<br />Certificate ol Occu pancy U I
<br />Notes Rema rks, Etc.
<br />BUILDING- INSPECTOR RECORD
<br />OlVNI]R IIINLDI]R DI'LCARATIoN
<br />I hcrchy .lftm utrdc, pcNlly oi Frjury (hri I m cxcnrpr {iorn lhc Cont.cft,r I iccn\c If,w ftr rhc rrrlosir8 rc.so. (sc.7031 5
<br />Buli'rcss aid P()Icsi{nr C{d.): Aiy Ciry or Cotrnry $hich rrqutcs n ncrinir t, conifl.t. rlrcr. nnDnvc. dcrFlhh nr mFrn ry
<br />nfl.trtrc. !riorro irs hsunn.c. rlso rcqnircs rhcappli.mr for surhFflnir tu lilc, si8.cd stdcmcnl rnrlhcor shc h liccmcd pusunr I
<br />ro rh. polhions oi rhc Cotrrrrctr s l-iccnscd l,aN ichaflcr 9. Conrnrncins sirh sc.rn'n 70(D or Divistrin I ol lhc Busincs md
<br />Prufc\sn sC'odc) orrhnl hcorshc is crc.{, lh.rulio'n ddihchr\isf.rth.rll.tcdcxcnflion Anyviolalio.otSccrionTO:ll5hyrny
<br />rppli.{nl for . rcnnil subiRs lhc rppli.anllo rciviirctrrIy.rnol nFrc lhrn lirc hundrcdnoUr (5500]
<br />l. r\ .wNr .r rhc rmpcny. or ny cmplott r Birh (r8cs as rhcn r,b ..mNtrsrhon. pill do rhc work ud lhc nMr@ i\ r,
<br />inrc cd oroficrcd ld silc(Scc.?04,4.,]usincslnd ltorisions Cnde:1hc Conraclm s l.iccn\.If,Qdoes..ranplyro osncror
<br />rhc pron y whotariklsoi impro\c!lh.Btrr. ki *ho dcs such v)R Innsc lf or hcrslf.r lhnugh hi\ orhcr owncn,pt,yccc.
<br />pnivnbd rhd su.h inprcvc.r h nc nor i,rctrddd orolTcd lor \rlc Il hoscrci rhc trildirE or inworcrrcf t i\sold sirhinonc )ru
<br />olcon\alclion- rl.( Osncr AuiBcr sill hare rhc bu(lcn ofl]rovin8 rh hcorshcdid nor t ild or i'npruvc ln. pn,Fny lar ltt Nrpo$ or
<br />l- \ own.roflhc prDcny. rmexclu\ivcl)_ conrrJcrirg wih liccnrd..nhcnn n) conntud rhc pR,lc( (Sr..7LrJ4. au.i'rcsr
<br />rtrd I'jdcs\i Codc Thc Conkac(tr ( Li.cn\c Lrs docs norrtplyt1r !trncr ol l}o$rry$ho huildsor im0r.vc\ rhc..on.
<br />rtrd qho conlncb furN.hprojcds!ilha Gtrn.clo(9 li.ctrrcd pus,an r.rhcCo r ci{n\ l.iccn\cln*).
<br />-l
<br />rncxcmll u cr Scd o
<br />I h...by rfi nnun(lo pc hyot|rcrjNtoncof(hc
<br />Dqcr,inarot
<br />I hrtrlnlqill nr{i'rrrinrCcnilicrrc.l(in,{trrh Itr{rc hr *nrkc'r c.Dtf, uri()n.* lrovidcd hr brScction:17(xroirhc
<br />l-ihn Codc. li! lhc Nriornnncc.l rhc s.'( ntr!hi.h I
<br />I hrvc.nd will hnnrir workcra.ortf,trs.riotr imnran.c. as Nluircd hyS.ctidr:17{lroflhc t:rhorCode. ft, rhc f(rrornuncc .f
<br />t,tr sork fd whi.hrha pcnnn,s issucd. My sortcrj- ..nrFnsir i(nr irsumNc.aricrmd policyflumhcr rc.
<br />Poli.yNu lbcr: Erpirc\
<br />-l
<br />ccnily rhrr ir rl[ tcrtunnn.. ofrhc sork ntr N[ich this pcnn]r is i\surlt- I \ltll Dor rndoy riy tcbotr trr {try ntrtrr.r
<br />$ r\n,lr..nic {rbrc.rk,rhcsorkcric.nrpcn\nri{rr hs\ olCnhlnhir. ntrd rgrc rl rifl rhou[l b.cofr suhjcct lolhc
<br />*orkcrico'ntcnsri,)nt(,ri\i.i\orSccriui:1700ofrhcl-rtxtrColc.I\l[ll.f(trrhsirlrcoDln!\iihtlDscDni!kifl,\
<br />ir dtld iotr to rhc .o{ ol ..mt)cnsrrion- &nra.s rs tr.vidcd for rhc
<br />I hcrdhyxlli',nL*tcr pcnrliy.rl)crjry lhai I rD li$n{d und.r lnovhion.iahaprcr 9 (coDnrcncinE rvilh Ssrion ?O0O)orDilision:l
<br />oi rhc Blsircs ond Profcrsiolr C.de. and nyliccnsc n in iulliq.c Mdcli.cr
<br />Licc \cclds: Lrctrsc Nunrbcr
<br />Doler Conlr.clor
<br />C(INSTRT](]TIoN I,ENDIN(; A(;EN(]Y
<br />I hcrcby alfiirn undcr rctrrlryofNrjMy rlr{r lhcrc h. con(ruclion hndins ascncy i{r rhe p.riornancc orrhc s.rk ror w[ich lhis ncrmit is
<br />isucd (Scc 1097. Cir C )
<br />I ccnil_vlhil rhc icdcr rcgul tnsrcgurdin8 ashc(os rcnEulrrc norapplicrhh r, rhis pn,jccr
<br />lcUr li rhrr I hxvc r.ra lhi\i(nr tukl {d. rhnll[ r&)r. i,fonnrridr n.oIc.t lrErG_loc.nuly\ilh rll( nyrndCo!trrt
<br />ildinS connrudnJNkl hctuby.uth.rnc rcDrcscntarivcs ofuhn Cily,nd Cotnry ro cnr.r,
<br />xho\c nni i,nnal |ni,J]ci I y lnr
<br />^pDli(anr
<br />or,{rcnr SEnnru
<br />*,9
<br />AITLICANLDECLAAA.IION
<br />I hcR', al]im u Mcr !.nnlrr.fr.qury.n. olrlr f.llowin! dcclararnrN:
<br />l)c nnirion Pciinirs Ashcdor Norificrti.n Fcd.ral Rc8ulari{nt (Tirld 4l). P.n6)
<br />Rcqun d hncrolNorific.rirr
<br />Erection Pads
<br />"z
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