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ELECTRICALPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date/ 8° 'a 9' Job Address o0 -- 1 - e.RkTax FolioD/ P/ ,#,1' , .I,egel Description Owner / Lessee / Tenant \S O r °LZ , Owner's Address / #rte 1 24J Contracting Co. 14 t^ 0 c_cN, I J c o Address 1 17 C 991 S l'QiCk- Qualifier V r OS` SS# " `` Phone : Yr " State # l Municipal # Competency # 17Z67 Ins.Co. G-1.-1 Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING �ECTRICAL 'LUMBING MECHANICAL ROOFING PAVING FENCE SIGN 1 � WORK DESCRIPTION l-t.. 0"0) �l V D � ©L l ® c v„,w ,5 A itS Signature of owner and /or Condo President Date: Notary as to Owner and /or Condo President Icy Commission Expires: Zoning l 1' tar; as to I \ * v. My Commission Master Per it #3Y7 / Phone Square Ft. Estimated Cost (value) WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOT X CE OF COMMENCEMENT). . Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, 1 authorize the above -named contractor to do the work state Date://0 j, or Owner °Builde Si natur f Contractor )pF?HINE E;;iv FEES: PERMIT l °, /, RADON C.C.F. NOTARY L42e TOTAL DUE APPROVED: Fire Other Building - Electricier ** Mechanical Plumbing Engineering ITEM BATH TUB UNIT FEE, ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT ' FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES 6 A/C (WIND) DIS CGAL SERVICE TEMPORARY A/C (CENTRAL) 9 DRINKING FOUNTAIN SERVICE SIZE IN MPS 1 DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP INTERCEPTOR f APPLI ANCE OUTLETS RANGE TOP PROCESS AND PRESS PIPING UNDERGROUND TANKS LAVATORY OVEN >q 15r7, ABOVE GRCUND TANKS LAUNDRY TRAY WATER HEATER U" U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0— 1 HP STEAM BOILERS SHOWER MOTORS OVER 1— 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3— 5 If MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP • TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8— 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10— 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP I VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS -.P1 'N "- •Ig. A/C UNIT STRIP HEATER 6 ° FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER —NEW INST. GENERATORS TRANSFORMERS HEATER— REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER —WELL SPECIAL PURPOSE SWIMMING POOL I OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY —SEWER SIGN TIME CLOCK UTILITY —WATER FIXTURES SEPTIC TANK ANTENNA • RELAY TELEVISION OUTLETS 4' TILE/RES. VIOLATION PUP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET ! _, SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM e K GAS RANGE METER SET (GAS) GAS PIPING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL f 6 MECHANICAL PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date ?� I / Job Address / / / I hi L Tax Folio . / 2 Legal Description L-1 `� L� r 5.— vV< g Loot'' -4 r -e. Owner / Lessee / Tenant 25J '6 6P/1722"g Owner's Address 0,14i,oF 9/ 7' i' Phone Contracting Co. 2 ,if ' .C — , ,r i i a 4ddress /ACM A* / Z, Qualifier f m L— SSO/0 - - � Phone State OR, 00301 Municipal # Competency #4�90/r' % Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION 112 (,0y 65,4S f 4-719R- Yi% t MT Square Ft. Estimated Cost(value) 2S0 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT). Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. 444.444e Signature of owner and /or Condo President Signature of Contractor or Owner- Builder Date: Date : 3 �� `I Notary as to Owner and /or Condo President My Commission Expires: Notary as to My Commissio Master Permit 4i 3-5 /bL i+Y' CF-RI&L 1T,;/ ntrac no A� OEF1/4+ @:.'P OSO :ON NUM i - ` ` ,e iv COMM/;,SOON EXP. ** i * * * * * * * * * * FEES: PERMIT l F RADON C.C.F. NOTARY "Of TOTAL DUE �` APPROVED: Fire Other ZZoning Building Electrical Pr t 1 Mechanical Plumbing Engineering *