PLUMBING PERMITr- • •
Owner's Name and Address
Registered Architect and /or Engineer_
Employing Plumber's Name
Location and Legal Description Lot
Feet of Drain Tile
Amount of Permit $
STATE OF FLORIDA,'
COUNTY OF DADE.
/ CP
Nature of Water Supply: City -Well
• • • • ••_• cu�� c_c_
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No 7 7 ii
1
I Date_ - - 9'"''` . i �-- /- -
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith mitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of 'Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, iwhether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work. -
v — No
Street
Street and Number where work is to be performed -No Street
State work to be performed and purpose of building (By Floors
New Building Remodeling
Addition
Size Septic Tank Type of Tank f1' 0-•
Block Subdivision
Dist. Feet of Tank or Drain Field from Well
•
No -/A - Street_/Y_E 92r_2. ( .
Repairs
Size of Soakage Pit
(Signed)
(Signed)
Capacity Gals 6s7 __
No. of Stories
Plumbing Inspector.
-The undersigned applicant for this building permit does hereby certify that he u frstands and accepts his obligais as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gen -ral Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that h has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
Notary Public, State of Florida
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
I SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
F FIXTURES
CONTR.
LIST
I
CHECK
-
-
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
• PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CHECK
l
r- • •
Owner's Name and Address
Registered Architect and /or Engineer_
Employing Plumber's Name
Location and Legal Description Lot
Feet of Drain Tile
Amount of Permit $
STATE OF FLORIDA,'
COUNTY OF DADE.
/ CP
Nature of Water Supply: City -Well
• • • • ••_• cu�� c_c_
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No 7 7 ii
1
I Date_ - - 9'"''` . i �-- /- -
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith mitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of 'Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, iwhether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work. -
v — No
Street
Street and Number where work is to be performed -No Street
State work to be performed and purpose of building (By Floors
New Building Remodeling
Addition
Size Septic Tank Type of Tank f1' 0-•
Block Subdivision
Dist. Feet of Tank or Drain Field from Well
•
No -/A - Street_/Y_E 92r_2. ( .
Repairs
Size of Soakage Pit
(Signed)
(Signed)
Capacity Gals 6s7 __
No. of Stories
Plumbing Inspector.
-The undersigned applicant for this building permit does hereby certify that he u frstands and accepts his obligais as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gen -ral Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that h has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
Notary Public, State of Florida
BUILDING
ELECTRICAL
PLUMBING v I
Work to be performed under
Owner of
Building
Architect
Contractor
or Builder
N.4.,
Legal Lot II BI.
Description
Address dng / ,�� r� ;� .��..•G
This permit is granted to the contractor or builder nammed ab
cation herefor in strict compliance with all ordinances pertainibg °g
plans, drawings, statements or specifications that may have be
at any time if the work is not done in compliance with such ordi
permit is granted is the understanding that the contractor or buil
regulations pertaining to the work covered hereby whether shown
sibiiity for work done by his agents, servants or employees.
In consideration of the issuance to me of this permit 1
mining thereto and in strict conformity with the plans,
is p nit I assume r-'aonsibilit for all work on
MIAMI SHDIRE VILLAGE, FLORIDA
DA .
PERMIT go ,
87G5
Permit
Subdi-
vision
•
i94 3
C #actor's
ehse No.
Value of II Amt. of O 4}�
Project Permit
0 construct the building or to install the 'equipment or device described in the appli-
e and with the understanding that the work will be performed in compliance with any
> tted to and approved by the proper municipal authorities. This Permit may be revoked
ces or if the plans are changed without authorization. A,further condition upon which this
arced above assumes the re onsibility for .a thorough knowledge of the ordinances and
n the plans or drawin: or in •, a statemen or specifications and that he assumes reopen-
Signed.
R
perform « rk covered hereunder in compliance with all o now and
s,; statenen speolf ications submitted to the proper authorities of Miami Shot
either myself, my agent, servant or employee.
BY
By ) '
IAN'
0 erl0
ray ag ei, s
BUILDING
ELECTRICAL
- PLUMBING
Owner of
Building
CO
PERM!
Work to Be perform
Architect
Contractor
or Builder
Legal
Description
Address of
Building
This permit is granted to the contractor or
cation herefor in strict compliance with all ordln
plans, drawings statements or specifications that
at any time if the work is not done in compliance
permit is granted is the understanding that the
regulations pertaining to the work covered hereb
sibility for work done by his agents, servants or eatplo,
In consideration of the issuance to me a
pertaining thereto and in strict ity wi
In aece ljng this p nit I . ss e r onsibili
SmokES VILLAGE, FLORIDA
N? 8782 •
u der this Per
Subdi-
vision
Value of
"eat
uddiag or to ins
eking that die
pr
DATE .v '9
Cot actor's
Li arse No
er in compliance
bsnitted to the proper authorities
tnt or employee.
BY AUTHORITY
•
Permit 7
or device described in the apph-
be performed in compliance with any
authorities. This Permit may be revoked
on. A. further condition upon which this
route knowledge of the ordinances and
cations and that he assumes capon-
BUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA
Date_ 77'.. / t 19
ELECTRICAL ❑
PLUMBING 1 16 PERMIT Np 8930 Contractor's , -
d
ROOFING ❑ License No.
Owner of
Building
❑ Work to be performed under this Permit
H OC, Co 7, c 4, • Dow P4 • Ni 1 242
Architect
or Builder 210 c c. 1" g rit-,
Legal Lox r Subdi-
Description 131 v 1 $ 101
SgFt 3
Address of j �' ....CI Value of Amount of
Building � Project $ I I Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with an
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered her by wheth shown on the •tans or drawAs or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants.
Signed`'•� ' • �1 CT R) BY
In consideration of the issuance to me of this permit I agree
pertaining thereto and in strict conformity with the plans, drawing
In accepting this permit I assume responsibility for all work done
CONTRACTOR or BUILDER
erform the work covered hereunder in compliance with all ordinances and regulations
ements or specifications submitted to the proper authorities of Miami Shores Village.
either, myself, my agent, servant or employee.
BY AUTHORITY
MIA.* SHORES VILLAGE, FLA. No
JOB e-V E
ADDRESS i - 1 'Z-
INSPECTION G
TIME READY 4 -1-i - L
REMARKS: ads., f 4 e L—_ L ��...�, _
INSPECTOR
0-fk,
044 4,
2044
DATE — ____
Cd o
7,L MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
UMB NG RM IT
' Permit No
Location and Legal Description Lot -- Biorh� -- on
State work to be performed and purpose of building (By Floors
New Building __ _ -- Remodeling
Amount of Permit $
3.00
( Signed) _
( Signed
Date___.__._____ /11/fi7
Application is Hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address___ 0_12A t COi___ ___ -__ N 8130 Street Bisc. Blvd.
Registered Architect and /or Engineer _____
____�_______�_______— _�__._
Employing Plumber's Name RQ$Q Septic Tank CO. N
Street_ ` Ave .
Street and Number where work is to be performed— ' • ._J1__________ st N. E. 92 St .
Addition________ Repairs No. of Stories
Size Septic Tank ___ - -- Type of Tank_ Capacity Gals
Feet of Drain Tile._ .O t (Relay.). __Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City— Well ._______ _ — ____Size of Soakage Pit
Plu . '.. ing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent Sup :I - ent, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, 1
COUNTY OF DADE. I
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the - --
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by hire stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and/or workmanship.
CLOSETS
BATH
T UBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
URINALS
INALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
-�_
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
CONTR.
LIST
CHECK
Cd o
7,L MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
UMB NG RM IT
' Permit No
Location and Legal Description Lot -- Biorh� -- on
State work to be performed and purpose of building (By Floors
New Building __ _ -- Remodeling
Amount of Permit $
3.00
( Signed) _
( Signed
Date___.__._____ /11/fi7
Application is Hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address___ 0_12A t COi___ ___ -__ N 8130 Street Bisc. Blvd.
Registered Architect and /or Engineer _____
____�_______�_______— _�__._
Employing Plumber's Name RQ$Q Septic Tank CO. N
Street_ ` Ave .
Street and Number where work is to be performed— ' • ._J1__________ st N. E. 92 St .
Addition________ Repairs No. of Stories
Size Septic Tank ___ - -- Type of Tank_ Capacity Gals
Feet of Drain Tile._ .O t (Relay.). __Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City— Well ._______ _ — ____Size of Soakage Pit
Plu . '.. ing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennanent Sup :I - ent, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, 1
COUNTY OF DADE. I
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the - --
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by hire stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and/or workmanship.
t .1
4
PemiLNo 1(7
Date__... ",'
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or . other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address ............
Registered Architect and /or Engineer_.__ _.___ ___— ____ _____._— ___
Employing Plumber's Name ' 4 I d'? P " / ?
Location and Legal Description Lot ___S 4._4' r. -
Street and Number where work is to be performed —No 1
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
t u
Street f
State work to be performed and purpose of building (By Floors )________ ...... ___________
__
New Building __ —._._. Remodeling - Addition_ -•_ -�
// /
No. ___� / J _----- - - -___ Street ' E 9') 5`'
Nol ° y _ -- - - - - -- Street. / ` (3/i Q /7
ff ,
Block 3 _.... Subdivision._ `__! '
Repairs No. of Stories.
Size Septic Tank ...... Type of Tank Capacity Gals.
Feet of Drain Tile ____ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well.__ — ___________ ______— _____- ____________Size of Soakage Pit
Amount of Permit $
My Commission Expires
( Signed)_
( Signed) ____,
Plumb g Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his .. ii'ations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Per , , . ent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by tlie Act. The undersigned agrees to employ only such sub- contractors, on work , tp performed under this permit, as are
licensed by Miami Shores Village.
4
Master Plumber.
STATE OF FLORIDA, I
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the_
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•neeessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA
TORIES
SINKS
SLOP
SINKS
LAUNDRY
rues
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LI
/
/
/
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CHECK
t .1
4
PemiLNo 1(7
Date__... ",'
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or . other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address ............
Registered Architect and /or Engineer_.__ _.___ ___— ____ _____._— ___
Employing Plumber's Name ' 4 I d'? P " / ?
Location and Legal Description Lot ___S 4._4' r. -
Street and Number where work is to be performed —No 1
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
t u
Street f
State work to be performed and purpose of building (By Floors )________ ...... ___________
__
New Building __ —._._. Remodeling - Addition_ -•_ -�
// /
No. ___� / J _----- - - -___ Street ' E 9') 5`'
Nol ° y _ -- - - - - -- Street. / ` (3/i Q /7
ff ,
Block 3 _.... Subdivision._ `__! '
Repairs No. of Stories.
Size Septic Tank ...... Type of Tank Capacity Gals.
Feet of Drain Tile ____ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well.__ — ___________ ______— _____- ____________Size of Soakage Pit
Amount of Permit $
My Commission Expires
( Signed)_
( Signed) ____,
Plumb g Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his .. ii'ations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Per , , . ent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by tlie Act. The undersigned agrees to employ only such sub- contractors, on work , tp performed under this permit, as are
licensed by Miami Shores Village.
4
Master Plumber.
STATE OF FLORIDA, I
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the_
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•neeessary by improper notice for inspection, or faulty
materials and /or workmanship.
• PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date I. /5 i6 Job Address 1/6 8 N ST�C.C,? Tax Folio
Legal Description Historically Designated: Yes No
( 1 4 L /Ori
Owner/Lessee / Tenant t�VWl>Q.� UYt,' TA3 l44-1 Master Permit #
Owner's Address 1 15 N E, 9 3a. . 5! ez,z.7, M - S Ho u5, / l 5/31 Phone (3(6) 75 ) - CA )
C o n t r a c t i n g Co. A W 1 T 3 3 Ft wYX . Address I 1Z-66 Su 5a Tea. \-13-Arm , f� L 35165
Qualifier S( . .E4 SS# , -
State # 0/F L D L I 14,2) Municipal # Competency #
Address
Address
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL LUMBIN MECHANICAL ROOFING PAVING FENCE SIGN
t ��N ti,w TO g rO'vL 1/1/4st) �7,4s 740 cr-ce,p ao
WORK DESCRIPTION
Square Ft. Estimated Cost (value) /, 50. O!)
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 la < regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING d MECHANICAL WORK.
constructio
autho e abo
Signature of owner and/or Condo President Date
No : . t. er : or C. .
ft
My Commission Expires:
FEES: PERMIT
AVIT: I certify that a
d zoning. urthermor
RADON
03
APPROVED:
Zoning
' �nical Plumbing
Building
foreg g info ation is accurate and that all work will be done in compliance with all applicable laws regulating
erd
MAYUN M. FEU00
My Ceram 6p. 184104
Ns. CC 906363
Mom 11011r1.0.
named contractor to do the work stated.
o3//sl6d
ntractor or Owner - Builder
No : " as to ontract• (or •
My Commission Exp 'e
C.C.F. / • (2 0 NOTARY D -- BOND
Electrical
er- Builder
Phone D5) z79- 23210
Ins. Co.
MAYUN M. FE000
My Corm Exp. vases
/ Na 0C 901363
firomdki Y Mum 1 IOW LA
�d
TOTAL DUE 9/
Date
00/610
Date
Structural Engineer
ITEM
BATH TUB
UNIT
1
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR GRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS ANO PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
1
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSLRE 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 HP
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
1
MOTORS OVER 100 FP
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER-WELL
SPECIAL PURPOSE
SWI4MING POOL
-
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTLRES
SEPTIC TANK
ANTENNA '
RELAY
TELEVISION OUTLETS
GRAINFIELD, 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
REINSPECTION
- i
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
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 B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL