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SITE-WORK DATE ID/SIG.COMMENTS OWNEII BUILDER DELCARATION
<br />I hcohy r,lirn u*ldr n Mxy,,fFrjury rh l an cxcmpl rionr th( Conhclo^ l,i.o\c li* td rh. ,olh*in! Er$n lsc.70rl I
<br />Buri.sr rRl l'.ofcsio, Codc) Any Cily or Coutrty *hi(h rcquirc\ ! F.dir ro $nid.r, rlr.r. inrlmrc. LLmlirh or apun my
<br />nuturc. rn ro ir\ i\!uaN- rl*! cqun r rht lllpl(an! f$, rn.h Ffl ro lik r siEmd !.t.m'nl rhal lI or dE ir l'..nsn p8tunr
<br />ro rhc pRrvision\ ol rhc Conka.nr s l,ic.trscd L{* (Chaprr, 9. Conrmminr u{h scrttn Tftn of Drvnior 3 oflhc BulnE$.trii
<br />PmL*dtr Cod.)orrh h..r\h.iscrcnplrh.r.ronsndrh.hasnrorrh.alLscdcrcn{ni'n.Anyvidri('.oasd.rtutr70ll5iyn.,
<br />apnli(]trr lor ! lrmir $hrccB rhc lllpli.r.r lo a c'ril [,cEll, ol nol mne ll,s lir. htnd(d dolldr (15fl,r
<br />l. d\ owncr olrh. !n,Fny..r nryem!|,'yccs wirn $!Sc\ N rhcir v,lc.onDctr\rri,n, silldo ih( rurk tl] dE sl]!*rrn i\ n'l
<br />u crl.\l or ofi..dl ,.. ek rSB--.?Ol.l- Bu\i't\\ and liltc$(ntr Crxl. t hc (l rr:rkn \ l.i..ne l:,* nm! aor lmly k, rn o*nd ot
<br />lhc nn'|Iny wtu huilds or iq,nn c\ rtELnn, Dd wh, d,s such $r)'t hansclf d hcrslf or rltrlu8h hn or n r o$n cmplilrrcs.
<br />provnbd rhrr {r.h iml'n)hL-nhnr*n intndcd olltNl r,trsL lr, tr)wcvu.lh. huillirA o, nl{,nvcm n v,u eilhih onu y.d
<br />orc.rtlllrbn. rh. owtur Buitl.r w hi'c rlt lurkn rr ,,ovi.8 lh,l tE or {r drl n tlilj or in{rot rhc rnoFny ror rlr iUIFE of
<br />L n\o*mr ol rlf, l,otiy, atn.!lu\n.ly eonrturin8 sirh lacn{d.onr(|,tr\ roinFrur ihc Itu.i lS\.. 7(lr.l.Iluitu$
<br />v.i thn ss$ Cr{. Th. Contrucrrr's Lrcn{ l,as dE\ nol appl! n) nh .r trct of poFn y $hu hilds o, nnprnt\ lltr.on
<br />rn who r otkc k, such nk!(.rs wirh u Anntuck'fl ( r lRutrsd !r \utrnl r' |fu Contr!.roi \ l,ir$\c l !w )
<br />Irn,.r.n, utrJ.rSr.rLrr
<br />Dll. Orr..
<br />rroRdi-Rs. ( onntNsATtoN
<br />DA;IJAA.IIO!
<br />I h.tuhrxfinnrund.rr. rlryorlj.rjryonc.rth.rnrL)trinsdNl a,i,nr\
<br />I lr'!rdl*rll ri' r ! ( crrl'.rrrol(i{scrrr, s.ll l,\trrc lir trortera r n[cn\, ni. Jr
<br />rl-t {rlh't1'.1-'l \t\'),'\r{i-Mr(,{1.'.'.,"nt\N.L{r'rn'r.'{c..tr,r' tlF,l )tr
<br />'",,,' Ana&n Z,no4
<br />,,,,,,,,*,,,,,*, WO!/t&a>n7- orr- 1
<br />F)vlrcrt ntr 6y Scr io. lr(X, of lh.
<br />hbor Gll., ror rhc Ffolmkc or
<br />t-/t,/v
<br />Ir.n'ryrrrr irrhcllrrirnrkcofr,tq,trkinr$hi.hrhnF.nnir \ n\uc,l.l shnllnoi ctr'/uIrtry pc^on rnany rrtrr
<br />s !' h8.d{ shF.rro rh. *nrkr\'corn nsri{n, LN\ orCrl'f{nl'. rnd r!(c rhd rlI \|f,'ulJ t\iorrc $hF-r ro rlI
<br />!Trkc^' .on{i:tr.rrion tnr 'snrnv
<br />n Sccr tr{! lTfll d rlr If,hr Gxlc. l \hr!l. l({nrtr ith con,r,l} s trl th,r Inr ri,)n\
<br />TVAININC l'r'lur. h {.urc sorkcri r. U.n\rriotr. !c rc ir urhrrul. n(l \hrll \un]c.r M ,,rlotar t, lrm nr Fulr*\,trrl
<br />*U,lp7ri-'\:'=*':',ilt:iffiil.{:"+;t,tr;n'r'vrh
<br />TI,IIA&IIIgN
<br />or rh. Bostu* .fit lh,rasrion( c(rc. !d my lkcnr n in tull lora !d clrer
<br />Lryl',,.,,0lro/r_t &tot t1
<br />,,,",*;{%a
<br />cotlsraucrloN Ll'NntNc
<br />^l:FNaYI hcEby .farm mds tEtrully of lE,ju.y rh,l rlrrc k r onrddbn Lndin8 trg.m, rd rh. Frfoms^_. oi dE Nrk for shich lhis Fmil i\
<br />isrkd (Se :l(,rl. Cir. C ,.
<br />t n'lci':{!R
<br />-
<br />t rhr's Addm.
<br />-
<br />dllLlg$i.I[gaaall0ti
<br />I lH$yillloi urLr ltorl!, ol p.,lury onc or Ih. r,ni'qn,S {l..lrrrrnA
<br />Drnx,lir(r l'cnN! A(r{o1 Noril Ndi,)n li crrl RetulirnN r'lirlc 1{). l)J 6r
<br />-RcqulBr
<br />l.rtcr.r M'rirErinr
<br />_1.ldirr rh{ $. rcd.ral deulllions mB.ding rsllslos rcn$rrlm oor applirblc r0 rli\ nmFr
<br />Idriryrh lhJvc rud rhi\ rlprrdi,flntr,]lrarc rl r rhcfirvc irturnHlio n.nrccr lrgrL{r
<br />ordnJ (!{rtrd srd! Las\..lJritrE n, build r ron{ru.rn,tr &l hr$y rurlktrtc 'cltt{nhh c\ ol
<br />nh*t nanrx,tui troll.ny tu insFLri(r llUrFMs
<br />ro/a//rr
<br />o.o
<br />'t)ly
<br />!{[ il]( rrli nL{,rtrtry
<br />rr,n c,1. 'y, u \, ! r 't! ,rr
<br />^q'o/o/
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Rool Sheathinq ltnw >A-,{6-.
<br />Shear Wall
<br />Framino
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Itrlasonry
<br />Pool Fence
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />I I
<br />FINAL 4lu*1l ,1fr\lP
<br />Certif icate ol Occupancy - | I \
<br />Notes, Bemarks, Etc I(lrQ 'u >A-+77
<br />I \
<br />BUILDING. INSPECTOR BECORD
<br />T-Bar
<br />Flood Zone Certif .
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