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SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Rool Sheathinq
<br />Shear Wall
<br />Framino
<br />lnsu lation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />ofiry*J,FINAL 4lzslut 1\,)
<br />Cerlilicate ol Occupancy vl
<br />Notes Remarks t
<br />|.2.,-t2-L Al d^t J 1
<br />1 : Flle
<br />zo
<br />-t
<br />2-
<br />)
<br />e.l
<br />:F \L
<br />ltaft
<br />Fte r galvaul F*6
<br />32n S2-ol I^.ba,t^T 4t
<br />d,t PL'4J
<br />t*z bL CdLt'at'4 L4<
<br />OWNER BUILDEN !}ELC RATloN
<br />I h*.by rmnn und.r ,(nnhy (n lsjry rhal I m cicnDl lionr ihs Cont{tti l-icc.s tis lor lic aollowin8 r.dhn (scc 70311s
<br />Busincss d Proa.ssion Codc): Any Cry or Coumy *hich rcquncs r Pcrmir ro co.encr. rhd. improvc, dcnDlhh or irn !try
<br />srtucrurc,,rtr ro irs ii\u.n .. ako rcquircs rhc .pplic0nl r'or suchncrmir tr rilc n siSncd rdc'mnl lhol hcorshc is licc.scd Nnulnr
<br />to th. provisions of rhc Conrracxtr s t.iccns.d bw (Ch{r$ 9, C.nrmcrcius wilh Sc.rn,n 70(x) of Divkion I ol rh. Busiics ud _
<br />ProfcsionsCodc)orrhorheorshc i\.x.mpl rhcrcriomdnd th. h,r( rbr lhc rllcgddcxc'n,rn'n. A.t violarionolSccri.nT0.rl5 byan,
<br />rpplicanr tur u pcnnir sLbje.s rhc ilflicatrr to,civiltcnallyolnor n{rcrhM fivc hundrd dollcs lS50)
<br />l. as .wnfi of rhc potEny. or nry cmpk,tccs wirh s,E.s u\ I hcn v'b .onrPcnslion, $ill do rh. s.,k arn rh strrw i nor
<br />inEndcd or olitrcd l'or slc ( S( 71144, ausincss ,nd PmL$ions Cnlc Thc Conrretr'\ t-kciy tj* docs Rn {I,ly ro 3n own.r ol
<br />rhd pot'cny whohuildsnr improusrhcmn-ud slD dms such k)rl hinr.lf or htrc,t ot thmuAh hir or h.r o*n cDployccs.
<br />lovidcd rhrr sich i'nptul$tunrs ae ({ iDrcrxk or ofic({ tur $b li howcvcr. dt hu ildiu or imlmrcmnr h 5ll] wirhin ,
<br />'nc rr
<br />oicomphnnr, rtEOwncr Buildq *illh,v. ih. hurd.nolproving rhd tr or shc did mr builr or itr{,n,h ihc Pmpcny for rhc l)lrPsol
<br />-1.
<br />as owmr of rhc pn,Fdy. ,m cxclusilcly conrrrr in8 wirh liccn*d conlracb^ n' .on(rucr rhc pmicl (56.' rtl4rr, sdsin$
<br />aM Pmf$ion Codc:1hc Conlrenn \ Liccn\c Lr* dm\ nor +tly ro,n owner ofptopcrry qh,r bxildr.r imflolcs lhc,con-
<br />nnd who onrh.k rrr su.h pruj.rB w h o ContBdor( s) liccn{d purunr t, rhc Conk.cror's Liccn* lj$)
<br />_l ncxcnfl xndfi S.crion-. B & P.C. fo!rhh rcason
<br />D6r. Oerer
<br />1!ABf,!&i].(OIIPENSA.IION
<br />DEII,ASAI'AN
<br />I hc.cb)_xlfn'nu cr pcnalrtorlcrjur!.trc orrhc rolloEirs dcclftirions
<br />I hrverd trilltrli'nrindCcnill..rc.fCorscnrr, Sclfl n{rc ,nr slrkr^ .otrl|xn\{ior. is providcd lar byS(ri(rlTlDolrhc
<br />lnhn ant. ftr rlr r.rronuncc ol r rr work ntr which rhc t^*nnir is i\s'd
<br />-lh!!c
<br />dwilltrri nin workcrc'conDcnsntion i.surancc. n\ rcqrire.tb!SNrionl70l)olrhcLlborCodc.lnrthtPcrlorMnccoI
<br />rhc Norl firshichrhi\ p.nnir is ksuct. My$orkcf conr!.nsrlion i,xuraftrotricr md Policy Narhcr uc
<br />R)li.J_ Ntri$cr
<br />-lixntc\:
<br />v, ask, h..o \c \ubic.l rorhc sorkcis'conl,[n{rri{nr hs\oiCalilnntir. r d reec rhd il l\ln,ukl hccomc sthjc.r rorhc
<br />srrk.^..rtf,'ari( pr.vktun\olSc.rn'nl7(XJolrhcl.alxtrCodc,lshrll.lonhLYirhuonrPlywirhrx)*!n)vi!i r{
<br />WARNINC l'iinnc ro ecurc \lrkcr\ .onpc \rto . rtri8c rs trnh*lnl. rnd \hrll \ohjc.r arr cn{loycr ro.ri'ni',rl [rirh*\ ind
<br />civil in$ !p ro on. hrndrd rh.utdnd dollas {Sloo.ou)r. in nndiiotr k, rhc .os c.mncnsrlion. drtuser rl rrovidcd aot lhc
<br />Sc.tnr.10T6olrlr tf,txrC{xic. in.rci d iuoarcyi,,,., 4/z{
<br />trt( L,\R,\ItoN
<br />IhcEbyaflirdundcrp..allyofrcrjuiyrh l am lic.n{rr u.dcr [ovkion ol Ch{rct I (commlcing sirh Serion r0]0) ol Divhio. .l
<br />of rhc AxsiNrs and Piofcsions Codc. ajd my liccnrc n in tull lorcc a,rl cffd.
<br />,-,.,*.K
<br />rh. eork foi wh{h lhis FIn h
<br />(l]lSl!tllx llrrl2ll!i:!!iE\-(J
<br />rha h.rc h a connructbn ,cndin8 lsency a., rh. l,.rfonuftc ol
<br />AIILIIAITLIIECIAEAIIA!
<br />dnnnuDdcrpctrrlryoipcrru.,otrcotrh.folloqing ..lrrJhoi\:
<br />_l ccnityrhrr I hnv. ft".I rhn npllEdion 0d sdc lhdr thc trtr)nndion is.oner. I ure roomply wirh Nll Cirydd Counly
<br />ordinancc\ rtrd Srrrc lj*\rbritr8 h tui[nrr .on(ruc1ion. il rorhorizc rcprc{trlrrivcs o{thh Ciry
<br />Jh"c,* hrc,| n-n iy h" .'r\y',m
<br />non,n*, *n**, "**.* L
<br />^iz;:-
<br />I
<br />,I
<br />BUILDING. INSPECTOR RECORD
<br />a
<br />issucd (se. l09l. civ. c ).
<br />l.ndc, \N8fr
<br />-
<br />,^J:trc\.
<br />-
<br />D€mlirion P6nnr Asb.slos Notiicalion Fcdeal Rcsuloriotrs (IirL 40. Pd6)
<br />_Rcquted Lrrl.r of Ndilf,srbn
<br />-l
<br />eniiylhal rhe fedcBl rcsu lai io ns rcs,rdins asb.slos Bmvularc not aptli.lbh lo rhk Pmi.l.
<br />UFER Ground
<br />Sublloor/Vent/l nsulation
<br />T-Bar
<br />il
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