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BUILDING- INSPECTOR RECOBD
<br />SITE-WORK ID/SIG.COMMENTS
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />Sublloor/Vent/lnsulation
<br />Goof Sheathing
<br />Framing
<br />ln su lation/E nergy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />+landicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .,.\
<br />-) Z/tthn (c?Lb)T Lt^
<br />FINAL ffi
<br />Certilicate ot Occupancy
<br />Notes, Remarks, Etc.
<br />OWNET AUII-DET DELCARATION
<br />I h.rcby .lltn trnd.. Fnihy (, lxrjry rhlr I m.r.hpr fn,m rt. (i'nkack'6- l-rcn{ Law tur rh. nnhwot Eiq'n 1S.c.7011.5
<br />Bunn.s ul Pnnisim C,{.): Any C y or Counry *hrh Eqorr r lrrn ro ..n(B'. .lrcr. imrroE. &mhh or '!lu uy(Nde, Intr t' ( (r!e.. .l$ r6t!R\ rh. q! rd l,n \rh Fmr tu a. r !'grrl (d.mnr rh.r tr o. {E 6 ll..cJ Frrmr
<br />t, rrx F,vN!'nr of rli cl,nrr rq'! l,r.n{n Lze t Ch.da I, ConmEms *ih S-r.n 700(} ol Drvr.n ! or rh. B$r( lil
<br />Pnnanx,nr ( (,J.) or rh,r h. or tlr i\ .r.hI hftrioo .nl lh.l'.ri! tu. rhc &l!s.d.r.nqrn'n. Atry vd,rx,n orSRr$n 70ll J hy !.y
<br />$pli.ad ntr. p.mt suhjeG rhc .pll,crnrto rciv !.nrlryofrt, m,Rrhrn h!. huhdr.d dolk! (3500).
<br />I
<br />l. rs d*mr orrhc F,Fny, n my.mf'!,F.. *irh s{.t r! rlrr $L $qndrn vI Jo rlE *(lt r l tlE rurE ! rn
<br />d.d.l r oll.Gl n{ eL (Sa.?04.{. Buws r.tl Pnr.(DN CrL TrE (i'rrrnr'l LEac L.w 'lE.,rd rpply ro u owtt ol
<br />rh. nn'Fny wh' hr j! ohn{nrE. tlER).. rnt who du! tuh fr,a hmt.lfu.h.rclfor rhnu3h h( d h.rovn.n li,y.cs,
<br />I't)vrlcd rhd.u.h inln,Erdr ft nn d.,rl.J o.ofiir.J ntr e!. ll, t$EE, rlE huillr8 or ryr'Errn i! $ll wirhin "* yrr
<br />ol orllLri'n. th. O*Er Bud.r cdl h.E rh. hrd.n F'yo! lha tr d \h. drl nt h{ u urFlE lrr totEry lq llE l,rqrs ol
<br />!Ll.A.rmri,lrhcn lFny. tm.(lu!tr.1) (onr&rds * hl(.nGiLonrd "^ r' (,nqruit rrE F,Ft ,Sd rlsa. Bulrq
<br />rd P$li*ri'. C,rlcr 'I h. Contrcr.rs Lrcn( L.w d(rr n arplt b m o*rcr ofptuFdy wh) huildro. improwrlhcron,
<br />rnd wl$ odRr!frrrhFDF6* hICo &ro(i) lEnrn pxrur iork Cinrrdoar tr.ns l,*)
<br />u^. - I J(l 7iaTr-Tl
<br />utrl"!ts.lltl\
<br />I h.rcby rllrm untlci I'.Mlry ol lrrJtlry or olih.li)l[)wu3 dehr.r.nt
<br />I hrv. filw,llrunrrm racn'lirr( rl(on* n) S.ll-ln\urc ntr work.^ ..nl{nlr(,n, a\ tn)v cd lnhySc(rr)n:rr(,(rdlrhc
<br />Ilhtr c(il. l(n rhc lcnrR k.otrh. s,'rl ntr*hrh rh. p.mi r tr{,.J
<br />I h.E ,ui wrll minr.r *orr.rr .oqrcn..lnn arur.Ec, t rcquErl by Scl pn l'7ll) of rh. lrhr CftL. fo. r,. Frfollle. ot
<br />rh. work lo.*h.hlisn m r niEd. My v{t*qr comFnr.lFn inrur.N. c.ftr .,n F)liy nunhcr N:
<br />_l c.nrli rh{ m rh. p.normtu. ofih. work turwhifi rhi IErm tr nsucJ,I ihlll nor .mplo, rny p.ilon rnrnt murcr
<br />$ tr lo tBrrr ruhjdt b rlE *ort6 .r'rqm.dFn Lwi oI cdrtomr. ., {r lhd f I rrFUU lE oE rubF.t io th.
<br />qds d'r{Enlrbn F,vNDn! oa Scrln .l1l(r ol r|r L.htr Cd.l. I drll tudh*rh onply wrh thn4FvlnN
<br />i{ARNING F.duE ro *.. m eft.ri (,ftlEndrr o€r!. n unLwrrL .,rl .r ohjdr r.rrpbFr lo ml FEIB.,n(Nrl liNs u, lo om hunlEd lhous.nd dolls (lloo,fix)), n rti k'. t, rtE on ol .oryEnqrtr,n. drm3.. I ,n]v!.d ntr rh.
<br />Sc.iur.l(,16 dl lhc Ljhn (d.r.{,trtr|,[irmv \ lr(\
<br />trt.( t. \R\ llr,\
<br />I hcrchylltun!undcrpcnally l p.rjury rhal I inr l,{n{dund.r !n)vs!'n.lCh.rl.r9 (.omm rnaw h Se.rr,n TlXl)) ot DNr
<br />.l rhc Burm .nd Pnn.*rn\ Cd., ul my l.cn. r n tuI tuR. !n .ll.rt.
<br />l-(rnsc Ch(:_
<br />lrnJcrr tl'i.*
<br />AI&IIANLDISJAAIIOB
<br />lrn{yrnimunl.r p.nrhy ol Fr,lrt or ol rh. ft,lk)}tr,8 &.hdr)n\
<br />l)Lfr'li!,n I'{nnrFA\lx{o{ Noi'li.ik,n l.cJ.ral Rcrulnrtr)nr (l L.l(,, l,an6)
<br />_R.qum,l Irrrcrot Nd,,trx,n
<br />_l {nnyihr rhc litLfll rluhri,n\ R3dm3 arh.nor nm)y:lr. ftn rpoh.6k r) rhN lroFr
<br />Ic.drlirhd lhrcrc rhrlpFlr tr,n!inar.thrtlhc!h)v.rnt fltur(,n n .or..r. l i8@ lo d,nliy *ith 0ll Ciry ! Coonry
<br />onlh.Rrsa l Str'. rr*s rcLlf3 ro burllh8 con(ruurtrm..rn h.rcby.urhtrrc r.rr.snra[rcs olrhn C(ynd C.onry t'.nr.r ulr,n rrr
<br />lkrc Nnr r nr,l pn,Fny ,!n m\F(rK
<br />Appli.rnr o. Alor SitNru('v^.,/cz.n Jnv/c^7),.
<br />I
<br />,
<br />DATE
<br />CONSTRUCTION LFNlrlNG AGEN(1
<br />I h.rby rlhmrrnlcr lxnrlry ol n rjury rlrar rh.ic n r $ndtu.rr)n knJn8 a3cncy inr rhc Idtulfuk. ol rh. work ntr whf,h rhB F.trl s
<br />a\kJ (Sc. r(D?. Civ C J
<br />1.ftl(r's Nrnr
<br />Forms/Steel/Holdowns
<br />SLAB Floor
<br />Shear Wall
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