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ELECTRICAL• SWITCH 0 LIGHT OUTLETS PLUG RECE•P•T'e FIXTURES NO LAMPS REIRIO. OUTLET IRON OUTLET RANG[ OUTLET RANG[ CONN. WATER NEATER W. MEAT. CONN. SPACE HEATER STRIP N TOTAL CONTR. IST LIST CHECK ENT. SW. DIST. CAS. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 141 MP NEON TRANS. RADIO TOTAL CONTR. IST LIST CHECK MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No3. 6 Application is hereby made for the approval of the detailed statement of the plane and specifications herewith submitted for the building of other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fiu:ida, 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 1 /+" Owner's Name and Address i ,..).... 1 � x , Y \1...( j fl No 33 Registered Architect and /or ;;:111 E2pl7 g E tricjas6I�,ame - '`'.G .1...' .f.�r Y1.C.c..No �) C I // l cation and egal Description Lot. ^^ ,,Block E. Street and Number where work is to be performed—No... ..p!.V....( L. Street. .S / State work to be performed and purpose of building (By Floors). l Y Yl CC. ` ? ?. New Building Remodeling Addition '7L/ Repairs No. of Stories 1 Amount of Permit $ STATE OP FLORIDA, COUNTY OP DADE. I U. (Signed). (Signed).. Date Subdivision Street. .f...51 I Street_. c 1 // TU � �= „L./ AMP ) aq -t- Service Overhead Site Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation -- Conduit Tubing... ... B.X.L .Metal Moulding Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands a accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act. being Sestion 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspectio n the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub•contrac rs on ork to be performed under this permit, as are licensed by Miami Shores Village. Muter Electric Before me, the undersigned authority, a notary public, duly authorised 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, and he has carefully read the foregoing application, and that he did sign the same, and that all fact therein by him 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. ELECTRICAL INSPECTION DEPARTMENT -7 APPLICATION FOR ELECTRICAL PERMIT i 112 / `6 � Permit No .a7 g / / Date. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building oI other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fiu:ida, and all provisions of the Laws of the State of Florida, all ordinance 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 progreu of work. n - /� Owner's Name and Addres (.!!!44» ...K .. bl. • V77a442/./A-- No ✓ 3 /) £ 9-51. x'14 Registered Architect and /or Engineer Amount of Permit $ Do Employing JL a6'��me.. !. 1 r uo an eecEigion Lot �' G e s MIAMI SHORES VILLAGE Street and Number where work is to be performed —No 5357.. .... State work to be performed and purpose of building (By Floors)... New Building Remodeling Addition Service Overhead Sine Feeders Conduit Main Sw Amps .Main Fuses Amps Underground Type of Installation — Conduit Tubing B.X.L .Metal Moulding (Signed) M` No... // ..... .. Street Block i f . Subdivision��.7 9.3.. Repairs No. of Stories. (Signed Street n Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations u an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has complied 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•contra ,,s, on work to be performed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. I U. Before me, the undersigned authority, a notary public, duly authorised 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, and he 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 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. SWITCH OUTLETS LIGHT 0 PLUO RECE'P'T'S FIXTURES NO. LAMPS REPAID. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER NEATER W. NEAT. CONN. SPACE NEATER STRIP NEATER TOTAL CONTR. Lis? CHECK ENT. SW. DIST. CAS. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1.5 HP NEON TRANS. RADIO TOTAL CONTR. LIST CHECK ELECTRICAL INSPECTION DEPARTMENT -7 APPLICATION FOR ELECTRICAL PERMIT i 112 / `6 � Permit No .a7 g / / Date. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building oI other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fiu:ida, and all provisions of the Laws of the State of Florida, all ordinance 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 progreu of work. n - /� Owner's Name and Addres (.!!!44» ...K .. bl. • V77a442/./A-- No ✓ 3 /) £ 9-51. x'14 Registered Architect and /or Engineer Amount of Permit $ Do Employing JL a6'��me.. !. 1 r uo an eecEigion Lot �' G e s MIAMI SHORES VILLAGE Street and Number where work is to be performed —No 5357.. .... State work to be performed and purpose of building (By Floors)... New Building Remodeling Addition Service Overhead Sine Feeders Conduit Main Sw Amps .Main Fuses Amps Underground Type of Installation — Conduit Tubing B.X.L .Metal Moulding (Signed) M` No... // ..... .. Street Block i f . Subdivision��.7 9.3.. Repairs No. of Stories. (Signed Street n Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations u an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has complied 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•contra ,,s, on work to be performed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. I U. Before me, the undersigned authority, a notary public, duly authorised 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, and he 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 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. Permit No %1164 Employing Electrician's Name._. Gtki IS 1 KR Amount of Permit $ MIAMI SHORES VILLAGE 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, Fiu:ida, 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 progreu of wor , t Owner's Name and Address. / r���a /•. � ..No... i s �, — Street.41 f �t .... 9.3 S js. Registered Architect and /or Engineer n . U°. 7.�.d�. 1..6h d- - -S DCl *i t: 6 E n ,5 CY..1 No . Gar a Street Location and Legal Description Lot Block Subdivision ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT (Signed).. Date. Street. `-' (Signed) Street and Number where work is to be performed—No . 3 .� State work to be performed and purpose of building (By Floors) New Building Remodeling t/ Addition Repairs No. of Stories. 41 Service Overhe Site Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation — Conduit Tubing B.X.L .Metal Moulding Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors 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 contra oti 'op work to be performed under this permit, as are licensed by Miami Shores Village. 974.4fite4-2 Muter Electrician. STATE OF FLORIDA, COUNTY OF DADE. f u 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, and he 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 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. SWITCH OUTLETS LIONT OUTLETS PLUG RECE•P•T•S FIXTURES NO. LAMPS REFRIO. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP NEATER T Co. NTR LIST — / / — A /-- ' , � '4''1 � / // CHECK ENT. Sw. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1.8 HP NEON TRANS. RADIO TOTAL CONTR. LIST CHECK Permit No %1164 Employing Electrician's Name._. Gtki IS 1 KR Amount of Permit $ MIAMI SHORES VILLAGE 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, Fiu:ida, 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 progreu of wor , t Owner's Name and Address. / r���a /•. � ..No... i s �, — Street.41 f �t .... 9.3 S js. Registered Architect and /or Engineer n . U°. 7.�.d�. 1..6h d- - -S DCl *i t: 6 E n ,5 CY..1 No . Gar a Street Location and Legal Description Lot Block Subdivision ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT (Signed).. Date. Street. `-' (Signed) Street and Number where work is to be performed—No . 3 .� State work to be performed and purpose of building (By Floors) New Building Remodeling t/ Addition Repairs No. of Stories. 41 Service Overhe Site Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation — Conduit Tubing B.X.L .Metal Moulding Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors 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 contra oti 'op work to be performed under this permit, as are licensed by Miami Shores Village. 974.4fite4-2 Muter Electrician. STATE OF FLORIDA, COUNTY OF DADE. f u 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, and he 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 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. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No 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 a 4 .1 .-f 6-6,. No Street Registered Architect and /or Engineer 'z � G� e No. - .Y4.7' s "; Street Employing Electrician's Name.. ev Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No 5 . u 2 "J rc v ..s`� ' Street � -' � State work to be performed and purpose of building (By Floors) New Building 2, Remodeling Addition Repairs. No. of Stories Service Overhead Size Feeders Conduit ...4 Main Sw ° ° A mps M a i n F uses d !7 d Amps Underground Type of Installation -- Conduit Tubing B.X.L .Metal Moulding Amount of Permit $ / � o' 1 (Signed) STATE OF FLORIDA, } COUNTY OF DADE. aa. (Signed) • r Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts hi obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors 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 subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. • R ter Electrician. 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, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by hirn stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re•inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. SWITCH OUTLETS LIONT OUTLETS PLUO RLCE'P'7's FIXTURES NO. LAMPS RLPRIO. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER H EATER W. HEAT. CONN. RACK HEATER STRIP HEATER TOTAL CONTR. it p (2-1 -4 _I— 1 -, .. ... / v CHECK ENT. SW. DIST. CAS. SERVICE TEMP. SERVICE PERM. MOTORS MOTORS 0.1 HP HP NEON TRANS. RADIO TOTAL C LIST R. 5)",„9,09 pp I.0 r2 - �s1w L$ (lip/ 0.i <> ( ,q� .c 47/ i CHECK MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No 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 a 4 .1 .-f 6-6,. No Street Registered Architect and /or Engineer 'z � G� e No. - .Y4.7' s "; Street Employing Electrician's Name.. ev Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No 5 . u 2 "J rc v ..s`� ' Street � -' � State work to be performed and purpose of building (By Floors) New Building 2, Remodeling Addition Repairs. No. of Stories Service Overhead Size Feeders Conduit ...4 Main Sw ° ° A mps M a i n F uses d !7 d Amps Underground Type of Installation -- Conduit Tubing B.X.L .Metal Moulding Amount of Permit $ / � o' 1 (Signed) STATE OF FLORIDA, } COUNTY OF DADE. aa. (Signed) • r Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts hi obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors 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 subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. • R ter Electrician. 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, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by hirn 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. Permit No 97 MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT 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 Z7e../. 0., Gl . No Street Registered Architect and /or Engineer p Employing Electrician's Name... ' e AP '. cp �j > ��C e" No. �� ! . V e-e• Street Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed—No 3 . .. J ,;.. .. , �` ' ` � �r Street State work to be performed and purpose of building (By Floors) fa?a? F 9 ; New Building Remodeling Addition Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation — Conduit Tubing B.X.L .Metal Moulding (Signed) Amount of Permit $ Electrical I1ispector. The undersigned applicant for this building permit does hereby certify that he understands and accepts hi{ •.ligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of FlgiiJJ. Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or subp ntractors 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 subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. 65. (Signed) .!— a..,..1!.. 41 - : / :ti:,: %',' � '1 Master Electrician. STATE OF FLORIDA, 1 COUNTY OF DADE. 1l 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, and he 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 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. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES NO. LAMPS REFRIO. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. H EAT. CONN. SPACE HEATER STRIP HEATER TOTAL CONTR. LIST CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1.5 HP N EON TRANS. RADIO TOTAL CONTR. LIST CHECK Permit No 97 MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT 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 Z7e../. 0., Gl . No Street Registered Architect and /or Engineer p Employing Electrician's Name... ' e AP '. cp �j > ��C e" No. �� ! . V e-e• Street Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed—No 3 . .. J ,;.. .. , �` ' ` � �r Street State work to be performed and purpose of building (By Floors) fa?a? F 9 ; New Building Remodeling Addition Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation — Conduit Tubing B.X.L .Metal Moulding (Signed) Amount of Permit $ Electrical I1ispector. The undersigned applicant for this building permit does hereby certify that he understands and accepts hi{ •.ligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of FlgiiJJ. Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or subp ntractors 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 subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. 65. (Signed) .!— a..,..1!.. 41 - : / :ti:,: %',' � '1 Master Electrician. STATE OF FLORIDA, 1 COUNTY OF DADE. 1l 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, and he 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 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. Permit No g a � Amount of Permit $.. STATE OF FLORIDA, 1 COUNTY OF DADE. I 6S. MIAIy VILLAGE did ELECT q INSPECTION DEPARTMENT ELECT AL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT No Date fie. 7 80 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... Street 4 /3l Registered Architect and /or ineer Employing Electrician's Name ' -2--`I' (. `'41 ; No , Street J _ Location and Legal Description Lot Block Subdivision 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 Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation — Conduit Tubing B.X.L Met11 Moulding (Signed) Electrical Inspe or. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has complied 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. (Signed) j Master Electrician. 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, and he 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 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. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES NO. LAMPS REFRIG. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. H EAT. CONN. SPACE HEATER STRIP HEATER TOTAL CONTR. LIST CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. � ,� l4 11144441,. - MOTORS O.1 HP MOTORS 1•S HP N EON TRANS. RADIO TOTAL CONTR. LIST CHECK Permit No g a � Amount of Permit $.. STATE OF FLORIDA, 1 COUNTY OF DADE. I 6S. MIAIy VILLAGE did ELECT q INSPECTION DEPARTMENT ELECT AL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT No Date fie. 7 80 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... Street 4 /3l Registered Architect and /or ineer Employing Electrician's Name ' -2--`I' (. `'41 ; No , Street J _ Location and Legal Description Lot Block Subdivision 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 Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation — Conduit Tubing B.X.L Met11 Moulding (Signed) Electrical Inspe or. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has complied 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. (Signed) j Master Electrician. 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, and he 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 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. UILDING LECTRICAL LUMBING OOFING iwner of uilding rchitect ontractor Builder �ga1 escription ddress of uilding Lot CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE. FLORIDA PERMIT N° 5902 Work to be performed under this Permi Bl. Subdi- vision Value of 1 Amount of Project $ 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 application =refor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans awings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any =le 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 anted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations -rtaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he as responsibility for work me by his agents, servants or employees. Signed r , BY INSPECTOR DATE 195 Contractor's License No. 1 1 In consideration of the issuance to me of this permit I agree to perform the work covered here der in compliance with all ordinances and regulations crtaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Villaag . In ac• ,pting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY BUILDING ELECTRICAL PLUMBING ROOFING CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE. FLORIDA PERMIT N? 6075 Owner of Building Architect Contractor or Builder Legal Lot Description — Bl. Address of Building Work to be performed under this Perini Value of Project Subdi- vision $ DATE 195 Contractor's License No. Amount of 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 application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any 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 hereby whether shown on the plans or drawings cr in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. • Signed. .. BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY SECTION BY DATE Zoning - .;;;/ F-- Electrical 6AlovK Mechanical Plumbing Fire Public Works Structural Building Official iii Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund $ State DCA (Radon) Code Enforcement Fine Zoning Review ❑ PROOF OF OWNERSHIP (Attach) ❑ FIRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $ $ 6 2- (sq.ft. = x/1000 x 0.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) ❑ CONDO ASSOCIATION APPROVAL (Attach) TOTAL $ ISSUING OFFICIAL CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com INSTRUCTIONS: Please indicate the type of work being performed a d quantity(ies) in the space provided below. ELECTRICAL TYPE QTY. TYPE Minimum Fee Dryer QTY. 'TYPE. Outlet, Appl ance QTY. TYPE Service Repair QTY. ■ A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton y ONE Fire Pump Outlet, Switch Signs A/C Central 8 -15 Ton - cc v, ne C Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot fights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/St ip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Rang Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Te p Service Demolition Low -volt, Intercom/Teleph. Repair Circ its Dishwasher Low -volt, Television Service, Nu ber of Amps MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE QTY. Generator TYPE Refrigeration, Tons QTY. A/C Central, Tons Cooling Tower Heating Stri s, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flam able Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pres ure Piping Bath Fan - Vented, # Fireplaces, Number of Pressure Ves el PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof Q'I'1'. 'TYPE. Miscellaneo . Fixture QTY. 'TYPE Soakage Pit Q'I'Y. Bath Tub Drinking Fountain Miscellaneo . Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain - Pump and A andon Sprinkler System Cap - Water Gas - Appliance - Pump, Dome.tic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire and Temporary Toilet Catch Basin Gas - Propane Pump, Re -ci culate Temporary Water Closet Clothes Washer Gas Piping Pump, Repia e - Pool Urinal Dental Chair Grease Tra I Pump, Sprin ler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repai Vacuum Pump Disposal Interceptor - Roof Inlet Water Closet Domestic Well Laundry Tray - Septic Conn tion Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Conn • tion Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION RECEIVED AND REVIEWED BY: DATE: ITEM BATH TUB UNIT FEE ITEM ' • SWITCH OUTLETS UNIT .FEE • ITEM _ SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIN)) 0I5r0SAL SERVICE TEWT URY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN A6PS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION . GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUH3 TANKS . LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER 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 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES . SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEhPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 FP VIOLATION INDIRECT WASTES • A/C WINDOW REINSPECTION WATER SIPPLY TO: AIR CONDITIONERS rC coo neCl t-ilo A,'/f - A/C UNIT STRIP HEATER ce -Conn ecl IOKk GENERATORS TRANSFORMERS GENERATORS TRANSFORMERS A //f FIRE SPRINKLER HEATER -NEW INST. HEATER- REPLACE l GENERATORS TRANSFORMERS • - I LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIIfIING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SIGN TRANSFORMERS SIGN TIME CLOCK ;EWER CONNECTIONS • ITILITY -SEWER AILITY -WATER FIXTURES :EPTIC TANK ANTENNA FLAY TELEVISION OUTLETS :RAINFIELD, 4' TILE/RES. VIOLATION UMP & ABANDON SEPTIC TANK RE INSPECTION OAKAGE PIT CU. FT. _ ATCH BASIN ISCHARGE WELL OMESTIC WELL REA DRAIN DOF INLET OLAR WATER HEATER IRE STANDPIPE 7OL PIPING • _ AWN SPRINKLER SYSTEM ..S RANGE :TER SET (GAS) LS PIPING PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION 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.) ELECTRICAL MECHANICAL - - 8 10 20 - 22 24 - - 26 - - 28 _ 30 34 38 _ - 30 - _42 — AIR CONDITIONING CO. P.O. BOX 681330 - MIAMI, FL 33168 -1330 PHONE: (305) 685 -6394 PAY TO THE \ ORDER OF �tJC. $ 1 .�.o i2 WhSt-ti A; Ced • MEMO QGL,L 2 L � U . BANK OF AMERICA FLORIDA 63- 243/670 I ■ '•�� w AUTHO SIGNATURE 000456311' I:06700 2436i: 401309 10 6011' 4563 83 O f6 V DOLLARS 8 1 2 Miami Shores Village 10050 NE 2nd Avenue 0 Phone: 305-795-2204 Printed: 5/3/2002 Page 1 of 1 Applicant: DEBORAH MADSEN Owner: MADSEN DEBORAH � I JOB ADDRESS: 335 , NE 93 ST ( 1 (� Contractor C & R AIR CONDITIONING CO Contractor's Address: 2121 NW 139 ST #10 ,.�— Local Phone: 305 - 685 -6394 v Parcel # 1132060136260 Permit Status: Approved Permit Expiration: 10/30/2002 Work: RECONNECT4 TON NH Signed* Signed: (Contractor, or.Builder) Electrical Permit Permit Number: EL2002 -142 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 21 & 22 ¢LK 46 LOT SIZE 100.000 -4 6 00 Construction Value: If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. 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 application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any 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 hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. ECTOR) BY: In consi era on of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity :with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work clone by either myself, my agent, servants or employes. BY: $100.00 60. 0 0 Total Fees: $6:00 - Total Receipts: $0.00 CONTRACTOR J Name . f- R I , ' C, v. d , Co License No. C �T e C 004 c. ) 14 Address P.O .box 6(Y(3 O M ;a 0,; FI .3/6S Telephone33 68S639y Fax 3 QS „( ).. 4 . - 6 09 , 3- - Qualifier Name l2 0 b f l J C (, t TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'I Detachment Other 0111 INSTRUCTIONS - The following steps must be taken to obtain a permit from the Nlianti Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Apt. City State Zip Folio Number Description of Work e 4 Z� A11 Address Lot Block Subdivision PB PG Zoning Linear Feet Current Use of Property Square Feet Units Proposed Use of Property Value of Work /00 ' °C Bldg Value Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax PROPERTY OWNER Name Address Home Telephone Business Telephone Fax Tax Assessed/Appraised Value PERMIT APPLICATION Master Permit No. Subsidiary Permit No. , 00 • / a, Floors Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax AFFIDAVIT - Please read carefully. IMPS RTANT NOTICES of a FL R � I� Con er i Page 2 1. 2. 3. 4. 5. 6. 7. 8. 9. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDA the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monda to 5:00 p.m. No inspections will be conducted on weekends or holidays. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DI SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT 0 required for work in or near the street/sidewalk. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDE which requires a separate permit. PORTABLE TOILETS for a construction site require a separate permit. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge Department of Health and Rehabilitative Services (HRS) approval is required for appl Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) a Application is hereby made to obtain a permit to do work and installation work will be performed to meet the standards of all laws regulating constru are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DO ROOFING and SIGNS and there may be additional permits required from I, the OWNER of the property, have disclosed all information related to months to the Building Official. Further, I am fully aware that if the cumu any other permit equals or exceeds fifty percent (50 %) of the fair market present federal flood criteria for finished floor elevation. I am also fully a under this and any other permit exceeds fifty percent (50 %) of the replac conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF C•I MENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or 'ntend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement 22 N.W..Est Street, 1s' Floor, (305) 679 -1078. Once recorded, the Notice of accordance with Section 713 -35 of Florida Statutes. Review the bro Choosing a Contractor. TE OF FLORIDA, COUNTY OF MIAMI -DADE f 6JA ta Signature of Owner lelopiaA alioker) Print Name �j Sworn to and subscribed before me this ` day of O Signat f SEAL: tary Public - State of Mori Joyce Kranz MY COMMISSION # CC808950 EXPIRES February 14, 2003 BONDED THRU TROY FAIN INSURANCE, INC Personally known OR, Produced Identification Personably known Type of Identification Produced: Signa PERMIT APPLICATION D PERMIT AND PERMIT CARD. Applying for a permit does not grant through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. Signat SEAL: ND SANITARY CONDITION free from construction debris. T AND DEBRIS. VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is TIAL CONSTRUCTION SITES. Other construction may have a trailer ithout approval from the Building, Planning and Zoning Department. f pavement. ations involving septic tanks. Department of Environmental Resources proval is required for applications involving sewers. s indicated. I, the OWNER of the property, certify that all tion in this jurisdiction. I understand that separate permits R, MECHANICAL, WINDOW, FENCE, DRIVEWAY, other governmental agencies. any work at the property performed in the prior twelve ative cost of work to my home or business under this and value of the structure, the entire structure must meet the are that if the total cost of work to my home or business ent cost of the structure, then the entire structure must The Notice of Commencement must be recorded at: ommencement must be POSTED AT THE JOB SITE in hure at Village Hall on Construction Lien Law and otary Public - State of Type of identification Produced: TY OF MIAMI -DADE Print me q Sworn o and subscribed before me this .2. ` day of A;4N Joyce Kranz ___ ;.: MY COMMISSION # CC808950 EXPIRES Fn,d . February 14, 2003 o F BONDED THRU TROY FAIN INSURANCE, INC OR, Produced Identification MIA SHORES VILLAGE, FLA. ADDRESS INSPECTION 7t - TIME READY /? REMARKS. INSPECTOR # 4 45:17,--e7; N° 6427 JOB - a . DATE ?-!2,>"-":05.7 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 22. O Time Type Insp'n Permit No. G. ' 00 ) Company Phone # Approved Correction Re- Insp'n Fee Name Address 3S 7 )") . � • 9 1 3 d C3 i f For Inspector: ) 23 l b Name & Date