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BUILDING. INSPECTOR RECORO
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNET BUIT-DEX DEl'AR-^TION
<br />I hocby ltfm u ja Fulr, oaFjury lhn I m dd non rlE Coturcldt Li..B t$ lor llE tollowos len (Sd 7011 5
<br />B6in63 ald P.otBi,n Cod.) a.y Cily or Courny whrch rcquG , Fsn ro .oi!rucl, tld. in9.oe.. damlih or r4.n &v
<br />rM@ Fs lo it! i!M.. &o r.qur6llE irpli@l ro. tu.n Fnn lo fiL r 3isllt<l ndffil 'hd
<br />lE or $. i lica!.d pu!!rr'l
<br />to ih. FolilioB ol dE ConEsld ! Li*ncd t w ((l!pls 9. Co@cing s nh Scihn 7000 of Di$6n I of tlE BEiB Dd
<br />Pmfdionr Co&) or lh.l h. or rh. i, .rcnpt $ac6om od 6. b.ri. f.r llE dkscd .ronFion Ary riolxbn of S.dnn 70.! I 5 by Ey
<br />lpplrst for . Frn $tj6r. tlE lppli.or ro . .iril Ftully of nol morc lhd 6vc hun&.d dolles (15(x)).
<br />-1.
<br />E o$d olrhc plopdrr. or ny dplo,6 wnh s+6 6 llrn $k cdmp.6rion. {dl tL tlE rst rn tl. srErG i! mr
<br />ddrht Mofiard f sL l Sc 704,1. Buir6 &d PiofarioB ( od. Th. (onkrcror'r Lic@ li* dod not lpPly lo e o*H of
<br />rL p.lFty stb hild o. inpmc tlEoa ,n *ho &6 Bn sn hiEll oi lE-lf or ll@uSh h6 - ls orr dployq
<br />Freyid.d lhaI su.h iml,oEnnn! @ rcl inrod.d or ollsd lor sl.. l( hs6. tu hrilt'3 ot ltprDrqEr i] 5U *ili. oE ]d
<br />otot9tr.r! dE orG B{iEa $in lIE ltE hfbr ofFlq,ts lln lE or lbc drd ml h{ild or itrqrr ti. FoFr, tot tlE P,Fr of
<br />l. s o$E of rlE ForEry. D dclBnlly @dding *nh Li..r6.n codr..loB ro cotrrtud th. Foid {56. 7044. 1}8od
<br />and Pt.l!.bn Co&: Th. Co klor'r Lk.E L.w &6 ml4'9lylo Do*Eof F.rd' who blild!or imFord rlEon.
<br />lnd who comreG f8 su.h Fojdlr *irh r coddo(3)licd!.d purMl to th. conlnctol! Lic@ lrw)
<br />I m.tnd un& sdh6 . A & P C tor lha @n
<br />D.l. Otr.6:
<br />$485l8,!:gDltl!sAn0!
<br />DFCT.ARATION
<br />I ha.bt allirE undq lqulty ol rdjud or of rh. follo* hB d(lJ.'ioB:
<br />Ih.r..d*illBrrtrb!Cd'fr.of(oM!roSdf-lNElorwrkn'coml.n$lion,sFovidqjforbySdrionlTuJoarfi.
<br />tibor Cole lor tlF FfrM. of $. *ul fo. *tth ltE Fnn it is.d
<br />-t h.\. ad \ ill midlio *..t6t conFsrior iBu&c.. 6 rcquncd bt sdion 1700 or $. l,bor Cod.. for rh. Psfolruc. ot
<br />llE worl lor *hkh rhi! FEil b isi.d My $dld onFatio! iclJle. (-it -d polt, runtE i.:
<br />-l
<br />cdify rhd in rlE p<fornl4. oillt worl for whih thn Fmn it isu.d. I Jdl hl qnlkry ) Fsn in uy n1,,fr
<br />b B ro bq!m. rubJ<r 16 rh. *0116' coDp<Edion IlB of Cllifonir. d +c rhtl if I snould bEo . tlbjGt to tlE
<br />srt6 oflFMion ForirirB of S.dion 1700 of rh. lltr Cod.. I !h.ll. Lnhsnh o'nply *nh tlrr. Fu trE
<br />\'IARNING Failur.lo suc wrld onposdhn @\q+. L unl$tul ad ,6ll sbj.ri o 4Ploys lo oi6in l FEli6.rd
<br />.nn nn6 up ro on. hlnrtr.d lhoMd.huh (ll m lddnion k1 lh. co, of cooP.Nrion. daM86 d prolidal aor rh.
<br />serio.1076 ofth.llt r Codc inl6.n &d
<br />I halb lrm ui& Dauny of Dqu,y ih, I m lillr.d s(b Fovi3io. of(n.pd 9 (on:lfficins *n,! S..rion ?oo0) of DNGio. 3
<br />ol lh. B6i6.rd ircfBioG Co<L. td D,li.e i b full 6re tn.,Ld.
<br />q
<br />"". lg)q n
<br />CLBgAX(JrqUtEdDlNGrgiErlll
<br />I h.aby lmrn untld rqDlly oa p.rlury lhd rha. l! ! toNlrucli,n lddins ,s6.y for lh. Ffontlm. ot $. *orl tu {hicfi lh6 Fna a
<br />isu.d (sc !097. cn c )
<br />ATTIJCANI-IECIJIAIIQ!
<br />I hdd'y rtrm u s pdlhy of pdjury on. oIth. fouowing &.ld.lnns
<br />D.nrnniin Pdnnr-Alb6lor Norili.trNn F.ddrl R.luldionr (Tiil. 40. P6l6)
<br />-RaruEn
<br />krsof Nd'ncdbn
<br />-l
<br />.qri& Oi rtE f.dd.t ErlhbE Es.di4 8b.nor lqhrn e d +ditbL lo $a F.Jd
<br />-l
<br />.dit thr I nrr Ed lha .oglt.liot ,n nd. thr fi. .bov. i,fomdion i! contr I igE to conply v'th lll Ci, od aounlv
<br />ordimG Dd Srrl. L3s Ehilt lo t jldog.odi6nD. .d ha*, ulh.i4 r.+.6<driq of lhn Cny lDd Coumy ro alc l4.n tlE
<br />nbo\. 'ndrk'n.d oordr h1 'Nrd n Durpos. ^
<br />Apprrr,dAsa,srr ,u( / fryVj4
<br />P.mi,r'n.rpr,n,,, / Ylcqr\ Sn,7
<br />-,. iu )q tA
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation I
<br />Roof Sheathing rn /tr/l{,)-^1424
<br />Shear Wall I L
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />t
<br />FINAL il /ot /14 ,.*41
<br />Certificate of Occupancy ' / t L/
<br />Noles, Remarks, Etc
<br />Pool Fence
<br />t)
<br />_Iirpnd:L
<br />,.,., r0Cq B
<br />l,.dn'! Adds.
<br />T-
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