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SITE.WORK DATE ID/SIG.COMMENTS OWNI:X BUILDEA I'ILCARATION
<br />I lnRby otfirm und€r pcnllry ol Frrury lh l un .Empl f$n lh. (onl!rn'6 l-t.nrc lir lor lhc i('ll{,*ins rca6n ls(.71)ll 5
<br />Burim$ .nd Pnlcsi.n C.d.) An) C[y o, (i{d} shth rLluirc! . Im r. !on{Ml. aXd. iqn,vt. d.m,lilh or E?.n rl,
<br />ddrrur.. prxnro ir\ L$ulh.--., ul$ rcquir.\ rhc trI)pl'(rnr t rtr.h Fmir (' fih d riSmd srrrcmnr rhrr lEor sh. ! licnrtl punu0nr
<br />!o rr. Fovnnn{ of rlE Contr!.tn r t.ncnEri lrs lclunier 9. CoNEE--int wirh S.cri,n 7tm of Divisi.,n :l of rh. Iru{rc* rnd
<br />Pn,ks\i,n\ (ixlc) or rhr li r rh. ir dr.i{ll ihcsarcm all rh. h.rG n)r ihc rlkted q.rqr(k,n Any vFhthn oI S&lhn ?oJ I 5 hy rny
<br />oppli.! n, r rErmil suhj.!'r rh. lnrla0nt lo !.ivilp.tultyolnn flrrcthln fivc hundrcd ollesllnn)
<br />-1.
<br />$ oancr ofrh. p$Fny. {tr my.mt|,ycd wrh sn8cs.\ rh.n q,L omnctrsrti,'n. *illd, rh. wort dftl rlf, (turuE r n,
<br />inr.d.n {r ofi.rn ror sL ( Se 7{lr.l- Buiims\ Md PrnLlsbnl ( od. 'r1lc O,ntEkr'r l,ic. € tr* (l.B n 4,lly n) !n uuE ol
<br />rtF pn,Fn, *t trikl\ r itrlhE\ rh6ar. rl elI, il.E \uh srl* h ifrl.lf ur h.Nll or rhnrgh hn r*, wtrc,q,hycct.
<br />rovilcd ihrr sEh inv'tuNnrnl\ m B, Drcrld.rl o. oll.rrl fo. sL lt hrf,Err. rh. t{rhinA , tr nlmmnr t sU liriin 'r trr
<br />.f!r!rit)Et'n. rhc(bBr Blilt r rIl h.E rh. hrd6 ollNii8 rhd lri,{r rt r{ hotll or irlIre$ rh. I'r,td} fL, rF Fr.f
<br />_ 1. nr os ftr ol r)tr nrcnd ry. anr .rclu\r.iy .onricnn* tr h |..nrn . rrrr(trr t, . n{tu.r rlt ro|(Ir rS( 7Ol-1, B!!k$
<br />lnd lh,rsqn,Cod.: rhr (i).r(rtr \l.l.cn\rI $drr\mrrtrplvr,rno*ncrolf'otf, yull, huikl< or irq'r,Lc\ rhc.uoo
<br />rnd $tx, o k--k ftr rkh rroFdr unh. cl,ntBlo ,litn<d I)u^M nr thc Codrd,ri L&nc lrrr
<br />,8 (,'Q
<br />,ITJ
<br />-lhDve,rlvill
<br />Duinrtrin ! CcnirKdc ir Con{nr l{, scltln\uR.n, worlcn ron{rtr\di{,h, r\ pn'vnted ritr hys.clhn r?(x)orrhc
<br />brrn Codc- for llx FTormNc oll,E * tfor*h.nrlrFlnn 6 i!\$.1
<br />I hN.nd wil! nuinrrn work.rJ co.{Eneri,n inrurlk.. r\ rquftd by Sfrr irn l7lxr ol th. L{h" Codc. for lL FrformN ol
<br />rh. *ork fd *hth lhn F6 6 !i{id ltl, wo 6 .onlnerrrn i.{htu! drd lrl lnliy nun*q Ec
<br />l..nrlirhar ir rh. FrlurnDN.r)frh. work hr whah rhn Nrmir r\ N\u.d.l shalltur cD oy rny |E sotr in rny nunn.r
<br />e b lE$nE ruhFt t' llr *,rt6 .1'nrEns i,n h*(.rcrllnmii. !dl8Eihar ill \rruu tqnft shFr n,rrr
<br />*1r1.^.onlll.ns i]nparvNx,n\orS.cnonlTlx)oflt lihn (ixlc- l shrll. n,nh*iih.ontly *iih rh,* pfl'vi\xnr
<br />$,\R\l\(; I-r,lu'r ri irtrrc q,!krh (otrrfrn\rnon.,tr.r,'r. i. !tr1,,trtu1 .ml\lrll e .'qrhF. tr'.rnnnEl |l,Eltt\ d
<br />n 'dJirrrn h rl! (.( of
<br />L
<br />r)r.onurorirs s h S..rion Tlrx)r ol l),rnntrr t
<br />ol !h. au\ims,rl P,.f.s6n\ (ixtc, rrl n! h.n{ N i tull fok! {n.ife]
<br />qIISIBIJI.fXIUIEdIAG.&GIUIjI
<br />I h.Ehy iffirm u.dd Fnalry of FrJory rhar rh.r. ri. con{ddirn kndins rS.ky for lh( FrntrmRr nfrhc $or* ftr *hth rh$ Fimir iq
<br />isikd (SE* 11097. ( iv C )
<br />tr t r'\ Nrm
<br />Alrull r.uEcLA8allo!
<br />I hdrt'y dnim und.r |].nrlr, of r.Uury om rlth. nrlhwrnS detsrdrioo\
<br />Ocnhlirnn P.rmnrArb.{or Noiifi..riDn Fcd.r6l R.3uLr.nr r'I k.{). Pd6,
<br />-Rcquirc
<br />Lerrcrof M)rituarin
<br />lr.'r,l!rhdrl(r(l('i 'cgtr,n(r\'n: rl 'rr\hlr!\rr rn,,lrrnLirlit,'trhl.r'!rhi\t,,.rc.r
<br />-l.cnityrhar I h.E rcoi rhBlpr $rnrtr drl {ar. rhrrrhatnr infttrnurtr,n^ror(r Irgrdh$nrd!$ihall('rtrftl(-"udy
<br />o innxc\ xt Sl c lrsr rhr iu l,) huild ina c.n!fl.r i,nr
<br />rtbr. 'r.rk'flal nn,Fntf,{ d\tXrn,n furF*\
<br />^"rr-r"r^*"rrdr"4 - Y -
<br />P.nrt.r Nrkryn r /7
<br />Cc :,',"":;B/d'-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Roof Sheathinq SlEte ('*ao$ Lr )
<br />Shear Wall xlqlK ('flUrrt I r-1
<br />Framing *rlv 6vts,.-a--I a\-'
<br />lnsu lation/Energy 7"Jrt GfuaA4-m,.,
<br />Drywall th',1 n h4E d LA.
<br />Ext./lnt. Lath r{.."' h r Arra*-t tL---/fu1/c A/r,/t ntu
<br />Brown Coat r
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />En gineer Final Report
<br />Flood Zone Certif
<br />FINAL Z-lt,tlu w.,hArr*;17 ,r)
<br />Certilicate ot Occupancy A -T ---
<br />Notes, Remarks , Etc. _
<br />dl/ CG7
<br />7
<br />BUILDING. INSPECTOR RECORD
<br />lx alklttt* /i,
<br />".
<br />/.
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