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SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DUI-CARATION
<br />I tErcby ifr,m ufrid Fn!l!, or F4rry rha! I m .r.nfl fnnn thc (hnrEct,N l.er{ Lw lnr rlE a.ll,*itr8 ,cr5n {.'( 70ll 5
<br />BuriEs. s'n Pri,r6k'. cnt ) An, Ciy or Counly f,hrh Equirc\ ! Fmi, k, .$mML {ll.i nq'rovc- .Ltulith rFn rny
<br />qMur, Fir k, ir( rssffi!. .lso Ertuircr tlE .rT'lica ntr \uch Fmir ro lih, .r8nd st.l.mnl rhxr lt or rrE i l{.ntn purunt
<br />ro llE rFviimr or 0r cl'rtdd r Litn*d t w lchtPrf, 9. ConrmNins wirh s..!on 7(xI) of Division I or rh. auriru( rnd
<br />Pn,f.<si,n( (lxi.| or rh{ h.n rlE ir.rcnv'l llErctrot !d lri lt!\ ft, th. rlkS.i.rcmltlion Any vnn,lhnofscdhnT0ll5 hy!.y
<br />+t'li.d ntr . Fmir rubj.rr! rlE rr?li.rnr ro r.'v,l p.Mh, or ftn m)rc thr. tit hundftd durtah l35txr,
<br />-1,
<br />{r ower or E ,,D,Erry. or my crlPlora! *irh *asca r rlEi. sk dnitEndi'.. will &, r,t qnt 1d lrE nulE i! n
<br />mt.d.d or oiYcicd ror sL {SE 7lx,l. B8irs rnd PmLrsi,nr CflL Tlx c.dd 'i litr t * d(- d {rlv ro rn otrftr ol
<br />ih. pniFny wh, hi&t m irp'oB rhtdtr 8rl wh. &q uh Htt hiN.lr ur hmlf o.llmu3h his tr lE own.iplrya.
<br />FovBGnrhlr fth iqmmnB c mt iil.id oronird rd eb lf. h*w. llE hihin! or ittEtcnr ir $E rrhh m Fa
<br />or otrpErion. tlE OrEr Build.r *ill h.t lL hndcn dr FDvin8 rhd lr or nt€ dn d l{i! or rlPma dr FDFIy ror dE !o.F- ol
<br />-
<br />l. x\ o*rur ol rlr F'p.d y. !n cr.lusntly .o rdins rirh li..n\.i .onrrxlo^ to con{ru.r rtr F+il ( Sd 7lr1l. Bu\irF$
<br />ud Pnf$sirn (i . Thc Cont.!.ktr \ l-ictr\c Lr* di{r n lltlyro anu*ncr.lt()p(nv$h, hoild! ur imaoYcl ri.rNn-
<br />ind uh' (nrrrd\nn rurhln)Fr\wfhr (.('nrru(!'nt lrcn{d nlru'r hrhccontrf,ttr !L.cnt li*r
<br />llaa$iB5_1;rDlf[lilAlrQx
<br />T'I'CLARATION
<br />I h.r.h, irnilnun,ld F,ralry ol p.UUrl onr or rtu n,l[,*in8 dc.]:trrrtr11\
<br />I hrt! rrl prtl minr.i. . Cffifr{. of Consr ro sclr ln\oE fd *,rk$' co,q,cnqri'tr. as F.vA.d for hy Sdion l7({l .f lh.
<br />l,ru Cd.. for ilr Frfolffi ol rtr rdl titr {hah
<br />'lE IEnn i nllcd.
<br />-l
<br />hrvc and *
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<br />ll tuinr.r *od.B comrxn\ri 'n n,su..Ec. n\ nq!ftJ ht SNI x!. .17llr ot rlE lrxY AxL. tu rhc Fionum. ol
<br />rhc *ort r,r *hi.hrhN Fmil $ h\ud Mywork.6 cotr{xnsri,n i.rurarc cMir urIr litnor ., dt
<br />-lccnify
<br />rhlr in rh. F rorNB. of lh. work lif, rhih rhir !.nnil n n\kl, I snil mr.tr{'h, oy Fr$. ih rnr rBn,rr
<br />r, as k lr(,nE {hj.rt k, th. *orlc6 .Tn{Ensin,n hs\ urcrlihmh. .rrl4N lhd irI {buld ttrnm suqtl n'lrr
<br />*0*6 d,nlEnqrnrn ,mvtio.s ol SNrioi :l7lx) ol r h. tjh, Grlc, I <rsll. fonhvirh o'npl, q irh rt ttn,vilhn\
<br />WAnNNG l'lrluE lo sut lort.^ NrmFn\dn'n cdrcms.^ rh\hrl.r n lnrl,r(r r rtr,Ilotlr t, diniml Ftulrir o.rl
<br />cieil iift3 up ro oE hodRd rlbn{d dollr^ l3lln.(tx)). i. lddir h! th. co{ oi conrrrsri,,n, dr I.t $ omvd.! n, rhc
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<br />ITSJAAIIIIB
<br />I hcEhy.ftrm uflL. Fuhr.f Frr!.y rh'r I rm lr€n<rt und.! F,vGion.rCtaprs 9(onmminS wirh SBri,.7(lr, orr,irii.!. 1
<br />ot rlE BuiiF\ .d P,Dr6sion! Cod.. !n my li{ue n ii lull rod dnl .,Lcr
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<br />I h.rchy um,m undc. Fuxy or Flru.y rhd rh.E n s Nn(Mrio. L'dhs +dy fot rrE FrlrEN or llt Mlt ror \ hth thtr Fn ir
<br />AITLICANLIIEI;I.ABAIIIIB
<br />I 'r*rq lllm, onk ltnrhyor Frrury oft nl'hc nnbuins dc{[r8hon\
<br />Dcml i'. Pcrnnh A\trnor t{n,tkdnr f{ds rl Rc8ullr nn\ ( l rlL l(,. ttrnh r
<br />-R.quircd
<br />Irtrcr of Nr,fidbn
<br />I(.n',yrh r,tl.dcrrln!ulrri,tr\Nlrkl'trgr\ti!.\ro n\ rl r t hi rr,ll{J$k r, rhn P(),..r
<br />-.1!un'r!rh. lru.,.ilrh\rFpl^rrtn'rn! rrh,trherlr']a tk{.!tkInr,tr.!r lrEkr r,.on'alr_ qirhrllCi\.nr](irtr\
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<br />;::,-:;:::;::":N.',-*" #r ^," ofofs
<br />".;,,*".-.,,".,; /loar," y'ft,'l
<br />Sel Backs
<br />Formsi Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall /o/n,/* ,fznor>-/d2
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Beport
<br />Engineer Final Report
<br />FINAL tr/z/t{ c vlto14-/ o>-
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />BUILDING. INSPECTOR RECORD
<br />lrdN r'1.,..,* tofu/rg
<br />i$t.d (s( .1097. ci!. c )
<br />tr.d.r'3 Nrft:
<br />-
<br />T-Bar
<br />Flood Zone Certil.
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