ELECTRICALHigh Velocity Hurricane Zone Uniform Roofing Permit Application Form
MIAMI -DADE COUNTY BUILDING DEPARTMENT ELECTRONIC APPLICATION
Illustrate Components Noted and Details as Applicable:
Woodblocking, Gutter, Edge Terminations /Stripping /Flashing, Continuous Cleat, Cant Strip, Base
Flashing,Counterflashing, Coping, Etc.
Indicate: Mean Roof Height, Parapet Height, Height of Base Flashing, Component Material, Material
Thickness, Fastener Type, Fastener Spacing
Or: Submit Manufacturers Details that Comply with RAS -111 and Chapter 16.
Page 3a
http: / /www.miamidade.gov/bldg/roofmg permiting/section_c_4_2.html
Parapet Wall Height 4f3 Ft.
MeanRoofHeight )/' Ft.
1 of 1 7/8/2005 1:13 PM
http:// www. miamidade. gov/ bldg /roofing_permiting/section_c 4°/x20...
High Velocity Hurricane Zone Uniform Roofing Permit Application Form
MIAMI -DADE COUNTY BUILDING DEPARTMENT ELECTRONIC APPLICATION < font>
Section C (Low Sloped Roof System)
Fill in the specific roof assembly components. If a component is not required, insert not applicable (N/A) in the text
box.
Roof System Manufacturer:
IGAF Materials Corp.
NOA No: 03- 0501.05 System Type: Built -Up
Wind Uplift Pressures, From RAS 128 or Sealed Calculations:
(P1) Field: 9.2 psf (P2) Perimeters: FgEpsf
(P3) Comers: 124.5 psf
Maximum Design Pressure, From the Specific
NOA System: 1-52.5 psf
Deck type: 1" x 6" T & G
• These decks require a fastener pull test by
an approved test laboratory
Other Deck Type:
I N /A
Deck Support Spacing:
I N /A
Slope: l /2" :12
Fire or Vapor Barrier:
I N /A
Anchor /Base Sheet & No. of Ply(s):
I N /A
Anchor/Base Sheet Fastener/Bonding Material:
I N /A
Insulation Base Layer Size & Thickness:
I /A
Insulation Base Layer Fastener /Bonding Material:
I N /A
Insulation Top Layer Size & Thickness:
I N /A
Insulation Top Layer Fastener /Bonding Material:
IN /A
Wood Nailer:
I / A
Wood Nailer Fastener Type and Spacing:
IN /A
Base Sheet(s) & No. of Ply(s):
I#75 Gla Base sheet
Base Sheet Fastener /Bonding Material:
11 1/4" R/S Nails
Ply Sheet(s) & No. of Ply(s):
IGaf Glas Ply 4
Ply Sheet Fastener /Bonding Material:
(Type III mopping asphalt
Top Ply:
IGafglas Mineral Cap sheet
Top PIy Fastening /Bonding Material:
'Type III mopping asphalt
Surfacing:
I N /A
Single Ply membrane:
I N /A
Single Ply Sheet Width: N/A 1/2 sheet width: N/A
No. of Single Ply 1/2 sheets: N/A
Single PIy Membrane Fastening /Bonding Material:
I N /A
Drip /GS Edge Metal Size & Gauge or weight: 3" face 26 ga.
Drip /GS Material Type: Galvinized Metal , ;I
Drip /GS Hook Strip /Cleat Metal gauge or weight: N/A
Parapet Coping Metal Size & Gauge or weight: N/A
Coping Material Type: N/A
Parapet Hook Strip /Cleat Metal gauge or weight: N/A
FASTENER SPACING FOR BASESHEET ATTACHMENT
1. Field:
2. Perimeter:
3. Comers:
9 " o/c @ laps &
6 " o/c @laps&
6" o/c @ laps &
rows @
rows @
rows @
NUMBER OF FASTENERS PER INSULATION BOARD
Field: N/A Perimeter: N/A Comer: N/A
Fastener Type :
1 1 %" R.S. Nails
Altemate Fastener: IN /A
Page 3
9 " o/c
6 " o/c
6 " o/c
1 of 1 6/8/2005 2:12 PM
M I A M EDADE
BUILDING CODE COMPLIANCE OFFICE (BCCO)
PRODUCT CONTROL DIVISION
NOTICE OF ACCEPTANCE (NOA)
GAF Material Corporation
1361 Alps Road
Wayne, NJ 07470
MIAMI -DADE COUNTY, FLORIDA
METRO -DADE FLAGLER BUILDING
140 WEST FLAGLER STREET, SUITE 1603
MIAMI, FLORIDA 33130 -1563
(305) 375 -2901 FAX (305) 375 -2908
SCOPE:
This NOA is being issued under the applicable rules and regulations.governing the use of construction materials.
The documentation submitted has been reviewed by the BCCO and accepted by the Building Code and Product
Review Committee to be used in Miami Dade County and other areas where allowed by the Authority Having
Jurisdiction (AHJ).
This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Control
Division (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) reserve the right to
have this product or material tested for quality assurance purposes. If this product or material fails to perform in
the accepted manner, the manufacturer will incur the • expense of such testing and the AHJ may immediately
revoke, modify, or suspend the use of such product or material within their jurisdiction. *BORA reserves the right
to revoke this acceptance, if it is determined by Miami -Dade County Product Control Division that this product or
material fails to meet the requirements of the applicable building code.
This product is approved as described herein, and has been designed to comply with the High Velocity Hurricane
Zone of the Florida Building Code.
DESCRIPTION: GAF Conventional Built -Up Roof System for Wood Deck.
LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and
following statement: "Miami -Dade County Product Control Approved ", unless otherwise noted herein.
RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no
change in the applicable building code negatively affecting the performance of this product.
TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the
materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any
product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply
with any section of this NOA shall be cause for termination and removal of NOA.
ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by
the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall
be done in its entirety.
INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors
and shall be available for inspection at the job site at the request of the Building Official.
This NOA renews NOA #02-0408.09 and consists of pages 1 through 21.
The submitted documentation was reviewed by Frank Zuloaga, RRC
NOA No: 03- 0501.05
Expiration Date: 11/04/08
Approval Date:10/23 /03
Page 1 of 21
Deck Type 1: Wood, Non - insulated
Deck Description: 19 / 32 " or greater plywood or wood plank decks
System Type E (1): Base sheet mechanically fastened.
All General and System Limitations shall apply.
Base sheet:
Fastening Options:
Ply Sheet:
Cap Sheet:
GAFGLAS #80 UltimaTM Base Sheet, STRATAVENT® Eliminator Perforated
Nailable, RUBEROID Modified Base Sheet, RUBEROID® 20, RUBEROID
SBS Heat- WeldTM Smooth or RUBEROID SBS Heat -Weld 25 base sheet
mechanically fastened to deck as described below;
GAFGLAS® Ply 4 ®, GAFGLAS Flex P1yTM 6, GAFGLAS #75 Base Sheet or
any of above Base sheets attached to deck with approved annular ring shank
nails and tin caps at a fastener spacing of 9" o.c. at the lap staggered and in two
rows 12" o.c. in the field.
(Maximum Design Pressure —45 psf, See General Limitation #7)
GAFGLAS® Ply 4 ®, GAFGLAS Flex PlyTM 6, GAFGLAS #75 Base Sheet or
any of above Base sheets attached to deck with Drill-Tec (GAFTITE) #12 or
#14 Screws and 3" Plates, 12" o.c. in 3 rows. One row is in the 2" side lap. The
other rows are equally spaced approximately 12" o.c. in the field of the sheet.
(Maximum Design Pressure —45 psf, See General Limitation #7)
GAFGLAS Flex P1yTM 6, GAFGLAS #75 Base Sheet or any of above Base
sheets attached to deck with approved annular ring shank nails and tin caps at a
fastener spacing of 9" o.c. at the 4" lap staggered and in two rows 9" o.c. in the
field. (Maximum Design Pressure —52.5 psf, See General Limitation #7)
GAFGLAS #75 Base Sheet or any of above Base sheets attached to deck with
Drill-Tec (GAFTITE) #12 or #14 Screws and 3" Plates, 12" o.c. in 4 rows. One
row is in the 2" side lap. The other rows are equally spaced approximately 9"
o.c. in the field of the sheet.
(Maximum Design Pressure —60 psf, See General limitation #7)
Any of above Base sheets attached to deck approved annular ring shank nails
and 3" inverted Drill-Tec (GAFfJTE) insulation plates at a fastener spacing of
9" o.c. at the 4" lap staggered in two rows 9" in the field.
(Maximum Design Pressure —60 psf, See General Limitation #7)
GAFGLAS #75 Base Sheet Or any of above Base sheets attached to deck with
Drill -Tec (GAFTITE) #12 or #14 Screws and 3" Plates, 8" o.c. in 4 rows. One
row is in the 2" side lap. The other rows are equally spaced approximately 9"
o.c. in the field of the sheet.
(Maximum Design Pressure —75 psf, See General Limitation #7)
One or more plies of GAFGLAS® PLY 4 ®, GAFGLAS® PLY 6® ply sheet,
#80 Ultima, RUBEROID MOP Smooth or RUBEROID 20 adhered in a full
mopping of approved asphalt applied within the EVT range and at a rate of 20-
40 lbs. /sq.
(Optional) One ply of GAFGLAS® Mineral Surfaced Cap Sheet adhered in a
full mopping of approved asphalt applied within the EVT range and at a rate of
20-40 lbs./sq.
NOA No: 03- 0501.05
Expiration Date: 11/04/08
Approval Date:10/23 /03
Page 18of21
Surfacing:
Maximum Design
Pressure: See Fastening Above
(Required if no cap sheet is used) Install one of the following:
1. GAF Special Roofing Bitumen with an application rate of 20 lbs.sq with an
application rate of 1.5 galJsq.; or GAF WEATHER COAT® Emulsion
(Matrix 305 Fibered Emulsion) with an application rate of 3 galJsq.; or GAF
Premium•Fibered Aluminum Roof Coating (Matrix System Pro Aluminum
Roof Coating Fibered 301) with an application rate of 1.5 galJsq.
2. Asphalt flood coat at an application rate of 60 lbs./sq. t 20%; plus gravel or
slag with an application rate of 400 lbsJsq. & 300 lbs. /sq., respectively.
3. Top Coat Surface Seal SB (Matrix 602 SB Coating), Top Coat MB Plus
(Matrix 715 MB Coating), GAF WeatherCote or WeatherCote LOW -VOC
applied at rate of 1 -1.5 gal/sq.
NOA No: 03- 0501.05
Expiration Date: 11/04/08
Approval Date:10/23/03
Page 19 of 21
WOOD DECK SYSTEM LIMITATIONS:
1 A slip sheet is required with Ply 4 and Flex Ply 6 when used as a mechanically fastened base or
anchor sheet.
2. Minimum 1 /a" Dens Deck or 2 Type X gypsum board is acceptable to be installed directly over the
wood deck.
GENERAL LIMITATIONS:
1. Fire classification is not part of this acceptance, refer to a current Approved Roofing Materials
Directory for fire ratings of this product.
2. Insulation may be installed in multiple layers. The first layer shall be attached in compliance with
Product Control Approval guidelines. All other layers shall be adhered in a full mopping of
approved asphalt applied within the EVT range and at a rate of 20-40 lbs./sq., or mechanically
attached using the fastening pattern of the top layer
3. All standard panel sizes are acceptable for mechanical attachment. When applied in approved
asphalt, panel size shall be 4' x 4' maximum.
4. An overlay and/or recovery board insulation panel is required on all applications over closed cell
foam insulations when the base sheet is fully mopped. If no recovery board is used the base sheet
shall be applied using spot mopping with approved asphalt, 12" diameter circles, 24" o.c.; or strip
mopped 8" ribbons in three rows, one at each sidelap and one down the center of the sheet allowing
a continuous area of ventilation. Encircling of the strips is not acceptable. A 6" break shall be
placed every 12' in each ribbon to allow cross ventilation. Asphalt application of either system shall
be at a minimum rate of 12 lbs. /sq. Note: Spot attached systems shall be limited to a maximum
design pressure of -45 psf.
5. Fastener spacing for insulation attachment is based on a Minunum Characteristic Force (F') value of
275 lbf., as tested in compliance with Testing Application Standard TAS 105. If the fastener value,
as field- tested, are below 275 lbf. insulation attachment shall not be acceptable.
6. Fastener spacing for mechanical attachment of anchor /base sheet or membrane attachment is based
on a minimum fastener resistance value in conjunction with the maximum design value listed within
a specific system. Should the fastener resistance be less than that required, as determined by the
Building Official, a revised fastener spacing, prepared, signed and sealed by a Florida Registered
Engineer, Architect, or Registered Roof Consultant may be submitted. Said revised fastener spacing
shall utilize the withdrawal resistance value taken from Testing Application Standards TAS 105 and
calculations in compliance with Roofing Application Standard RAS 117.
7. Perimeter and corner areas shall comply with the enhanced uplift pressure requirements of these
areas. Fastener densities shall be increased fqr .both insulation and base sheet as calculated in
compliance with Roofmg Application'Staudard RAS 117. (When this limitation is specifically
referred within this NOA, General Limitation #9 will not be applicable.)
8. All attachment and sizing of perimeter nailers, metal profile, and/or flashing termination designs
shall conform with Roofing Application Standard RAS 111 and applicable wind load requirements.
9. The maximum designed pressure limitation listed shall be applicable to all roof pressure zones (i.e.
field, perimeters, and corners). Neither rational analysis, nor extrapolation shall be permitted for
enhanced fastening at enhanced pressure zones (i.e. perimeters, extended corners and corners).
(When this limitation is specifically referred within this NOA, General Limitation #7 will not
be applicable.)
10. A.11 products listed herein shall have a quality assurance audit in accorthuice with the Florida
Building Code and Rule 9B -72 of the Florida Administrative Code.
END OF THIS ACCEPTANCE
NOA No: 03- 0501.05
Expiration Date: 11/04/08
Approval Date:10/23 /03
Page 21 of 21
1
ROOF COVERING MATERIALS (TEVT)
Roofing Systems (TGFU) — Continued
GAFCLAS 1080 Premium Base Sheet may be used in•any of the following
>ys terns.
"GAFglas Flex Ply 6" is a suitable alternate to "CAFglas Ply 6 ".
"CAFTEMP Permalite Recover Board" may be used in lieu of any - perlite
Insulation in any of the following NC Classifications. :>
Class A,B and C
Hot roofing asphalt, for use with organic and glass felts or Modified bitumen
membranes.
"Ruberoid Heat Weld" SBS roofing membraner may be used in lieu of
• Ruberoid Mop" SBS products in any applicable Classification.
Class A
!. Deck: C -15/32 Incline: 3
Insulation (Optional): One or more layers perlite, wood fiber, glass
fiber, isocyanurate, urethane, perlite /isocyanurate composite, perlite/
urethane composite, wood fiber/isocyanurate composite, phenolic, any
thickness.
Ply Sheet: Three or more layers Type G1 "GAFCLAS PIy 4" or
"GAFCLAS Ply 6 ", hot mopped.
Surfacing: Gravel.
2. Deck: C -15/32 Incline: 2
Insulation (Optional): One or more layers perlite, wood fiber, glass
fiber, isocyanurate, urethane, perlite/isocyanurate composite, perlite/
urethane composite, wood fiber/isocyanurate composite, phenolic, any
thickness.
Ply Sheet: Three or more layers Type G1 "GAFGLAS Ply 4" or
"GAFCLAS Ply 6 ".
Cap Sheet: One layer Type G3 "GAFCLAS Mineral Surfaced Cap
Sheet ".
3. Deck: NC Incline: 2
Insulation (Optional): One or more layers perlite, wood fiber, glass
fiber, isocyanurate, urethane, perlite/isocyanurate composite, perlite/
urethane composite, wood fiber/isocyanurate composite, phenolic, 2 in.
max.
Ply Sheet: Two or more layers Type GI "GAFGLAS Ply 4" or "GAF-
CLAS Ply 6 ".
Cap Sheet: One layer Type C3 "GAFGLAS Mineral Surfaced Cap
Sheet ".
4. Deck: NC Incline: 1/2
Insulation: One or two layers "Isotherm R ", 4 in. max, hot mopped.
Ply Sheet: Any UL Classified gravel surfaced Class A asphalt glass fiber
mat system.
�. Deck: C -15/32 Incline: 1
Slip Sheet (Optional): Red rosin paper, nailed to deck.
Base Sheet: One layer of Type C2 "CAFCLAS 1175 Base Sheet" (may be
nailed)•
PIy Sheet: One
GAFGLAS PIy 6 ".
Cap Sheet: One
Sheet ".
'3. Deck: NC
Base Sheet: One
Ply Sheet: One
CAFGLAS Ply 6 ".
Cap Sheet: One
Sheet "•
G
�'zsLS "•-
or more layers of Type G1 "GAFCLAS PIy 4" or
layer of Type G -3 "CAFGLAS Mineral Surfaced Cap
Incline: 3
layer of Type G2 "CAFGLAS 1175 Base Sheet".
or more layers of Type GI "CAFGLAS PIy 4" or
layer of Type C -3 "CAFGLAS Mineral Surfaced Cap
Deck: C -15/32 Incline: 2
Insulation: One or more layers perlite, glass fiber, isocyanurate, ure-
thane, perlite/isocyanurate composite, perlite /urethane composite, phe-
nolic, 1.0 in. min (offset from plywood joints 6 in.).
Base Sheet: One or more layers of Type Gl, C2 or C3.
Membrane: One or more layers of "Ruberoid Torch" (smooth or
granule), "Ruberoid Torch Plus" (granule), "Ruberoid Mop" (smooth or
granule) or "Ruberoid Mop Plus" (granule):
Cap Sheet: "CAFGLAS Mineral Surfaced Cap Sheet ", hot mopped.
Deck: C -15/32 Incline: 2
Insulation (Optional): One or more layers perlite, wood fiber, glass
fiber, isocyanurate, urethane, perlite/isocyanurate composite, perlite/
urethane composite, wood fiber/isocyanurate composite, phenolic, any
thickness.
Base Sheet: Two or more layers of Type G2 or C3.
Ply Sheet (Optional): One or more layers of Type Cl.
Membrane: One or more layers of "Ruberoid Torch" (smooth or
granule), "Ruberoid Torch Plus" (granule), "Ruberoid Mop" (smooth or
granule) or "Ruberoid Mop Plus "'(granule),
-` • •" "• •••`∎ 1• ' ^I L.d UUt\LQ #%$ L) I UHY
•
t
5.
LOOK FOR THE UL MARK ON PRODUCT
ROOF COVERING MATERIALS (TEVT)
Roofing Systems (TGFU) Continued
Cap Sheet: "GAFCLAS Mineral Su ?faced Cap Sheet", hot mopped.
Class 13
1. Deck: C -15/32 Incline: 3-1/2
Insulation (Optional): One or more layers perlite, wood fiber, glass
fiber, isocyanurate, urethane, perlite /isocyanurate composite, perlite/
urethane composite, wood fiber/isocyanurate composite, phenolic, any
thickness.
Ply Sheet: Twu or more layers of Type GI "GAFCLAS Ply 4" or
"GAFGLAS PIy 6"
Cap Sheet: Tvpe G3 "GAFGLAS Mineral Surfaced Cap Sheet ", hot
mopped.
2. Deck: C -15/32 Incline: 3 -1/2
Insulation (Optional): One or more layers perlite, wood fiber, glass
fiber, isocyanurate, urethane, perlite /isocyanurate composite, perlite/
urethane composite, wood fiber /isocyanurate composite, phenolic, any
thickness.
Base Sheet: Two or more layers of Type Cl, G2 or G3.
Membrane: One or more layers of "Ruberoid Torch" (smooth or
granule), "Ruberoid Torch Plus" (granule), "Ruberoid Mop" (smooth or
granule) or "Ruberoid Mop Plus" (granule).
Cap Sheet: "CAFGLAS Mineral Surfaced Cap Sheet ", hot mopped.
Class C
1. Deck: C -15/32 Incline: 1/2
Insulation (Optional): One or more layers perlite, wood fiber, glass
fiber, isocyanurate, urethane, perlite/isocyanurate composite, pe.Iite/
urethane composite, wood fiber /isocyanurate composite, phenolic, any
thickness.
Ply Sheet: Three or more lavers of Type GI "GAFCLAS Ply 4" or
"CAFGLAS Ply 6 ".
Surfacing: "Special Roofing Bitumen" 20 Ibs /sq.
COAL TAR FELT SYSTEMS WITH HOT ROOFING COAL TAR
Class A
1. Deck: C -15/32 Incline: 1/2
Insulation (Optional): One or more layers perlite, wood fiber, glass
fiber, isocyanurate, urethane, perlite /isocyanurate composite, perlite/
urethane composite, wood fiber /isocyanurate composite, phenolic, any
thickness.
PIy Sheet: Three or more layers of Type GI "GAFCLAS Ply 4" or
"CAFGLAS PIy 6 ", hot mopped with coal tar bitumen.
Surfacing: Gravel.
COMBINATION HOT AND COLD SYSTEMS
Class A
1. Deck: NC Incline: 2
Insulation (Optional): One or more layers perlite, wood fiber or glass
fiber, 2 in. max.
Ply Sheet: Three or more layers of Type GI "GAFCLAS PIy 4" or
"CAFCLAS Ply 6 ".
Surfacing: Grundy Industries "al MB Aluminum Roof Coating" at
1-1/2 gal /sq.
2. Deck: NC Incline: 1
Insulation (Optional): One or more layers perlite, wood fiber, glass
fiber, isocyanurate, urethane, perlite/isocyanurate composite, perlite/
urethane composite, wood fiber /isocyanurate composite; phenolic, any
thickness.
Ply Sheet: Three or more layers of Type G1 "GAFGLAS Ply 4" or
"CAFCLAS Ply 6".
Surfacing: "Weather Coat Emulsion" at 3 gal /sq. •
3. Deck: NC Incline: 1/2
Insulation: One or two layers "Isotherm R ", 4 in., hot mopped.
Ply Sheet: Any UL Classified gravel surfaced Class A asphalt glass fiber
mat system.
4. Deck: NC Incline: 2
Insulation (Optional): isocyanurate, perlite, isocyanurate /composite
wood fiber and glass fiber, any thickness, mechanically fastened.
Base Sheet: One ply Type Gl "or C2, mechanically fastened or hot
mopped.
Ply Sheet: One or more plies Type G1 or G2, adhered with hot roofing
asphalt.
Surfacing: "GAF Premium Fibered Aluminum Roof Coating ", 1 -1/2
gal /sq or "GAF Weather Coat Emulsion ", 3 gal /sq.
Deck: NC Incline: 1
Insulation (Optional): Perlite, glass fiber, polyisocyanurate, wood fiber,
mechanically fastened, any thickness.
173
Legal Description .
Owner's Address
Qualifier
Nc'ary as to Owner and/or Condo President
My Commission Expires:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ( 9 D 0 Job Address / / (1.-- 16 - 5 7 Tax Folio //- 3 - ®/ Oo Sz O
O w n e r / L e s s e e / Tenant U� /�cJ J 0 A - 1/4 l v / e /2. , .f o /) Master Permit # C, 44-5
1060 4/. E'. pis s 7
Contracting Co. I/ E46 /G .4Z» �.
Signature of owner and/or Condo President Date
Historically Designated: Yes No
SS#
Phone
Address
Date Notary : to Contractor or
My Commission Expires:
Electrical
/ 7 261 / /VW 7 S -r.
. Phone 3v -s -- -66 S6 7-C-‘714
State # E/2 - Gb /3bc 9 Municipal # V/ Competency # 357 37 p» J Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): 1: UILDING 4,ECTRICAL)PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIIPTION / L it C.._ 5 t72vi c-E (c>r7/c G LI.i// ), 79i606Z
,a: .i i
Square Ft. Estimated Cost (value) 7, ; SOQ a a
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.
G -g -o
ignatirre o ontractpr d or 9 Owner-Builder
7.e -
GLADYS I VOLT AR Dat=
NOTARY P'UBUC STATE Or FLOP.1DA
COMMISSION NO. �CC7tt �P
MY COMMISSION EXi . MAR. Ir ? c
ES: PERMIT ®P RADON C.C.F. NOTARY J BOND
APPROVED:
Zoning Building
Mechanical Plumbing Structural Engineer
TOTAL DUE
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‘...d Expires May 13, 2002
14 012 P.SON . 1060 x, 1= .95 . _ M On I ,5K0A- p
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SUBJECT TO COMPLIANCE WITH ALL
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RUIIS AND
MIAMI SHORES VILLAGE ASSUME
FROM PO E POS ES FOR ACCI!R' . `
OF OR RESULTS
COMPLIANCE WiT19
THE SOUTH FLORIDA BUILDING CODE AS ADOP '7
MIAMI SHORES VILLAGE IS WITH THE KNOWLEDGE O�U�+� ;f t Bun:
CONTRACTORS ARE
REGULATIONS WHETHER OR HOT SPECIFICALLY INDICATED ',ERF't�•
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D Mittares
*' _9 *My Commission CI: "
' Expires May 13.. •, .:
2 1
.N iopanm 'Rss. 1014 1\1, q5 5 T, 5ROP SA.
•
6Q�9 SHORES VILLAGE
APPROVED
ZONING
STRUCTURAL
ELECTRIC
PLUMBING
MECHANICAL
BLDG. OFFICIAL
BY DA's
SUBJECT TO COMPLIANCE WITH ALL VI
I DERA S STATE AND COUNTY
RULES PAD
F� � ESPONSI"riLltlE3 FOR ACCUrtti•'.'+ 1
MIAMI SHORES VILLAGE
OR RESULTS FROM THESE_ KANS.
AS 1 F ?rC� E�
C0 PUAPICE WITH THE SOUTH FLORIDA BUILDING CODE AS iA F, c.:1:8 i
VILLAGE IS REQUIRED. THE ARCHITECT, Et: r
C0fl ACTORS ^n .,
CONTRACTORS ARE CHARGED ��PEC1ftCAlLY INDICATED t� � i`i'::.'
REMOTIONS WHETHER OR NOT .� _ - — - -- - -
Outlets
Motors
Receptacles
Generators
Stoves
STREET
PART OF LOT
LOT
BL'K
Permit Fee
i i
SUBDIVISION
/!NO{t.
t e ,'✓
ii
PP
. � --.
4''
F 9
4
, .' C.
9
, r
✓
� a ^, g v *..
D
P
F T
!.'' --- 4..�.�(
�...
`•ief/
S
A Le(1�
�,
Outlets
Motors
Receptacles
Generators
Stoves
Water Heaters
Signs
Billboards
Other Apparatus
Permit Fee
i i
d...,A
ELECTRICAL PERMIT
N. B. —This Permit must be on display on the premises during
the construction.
/ 2 , y a ` n
Owner of Building
•ractor or Electrician
Dated , 19
OFFICE OF ELECTRICAL DEPARTMENT
Miami Shores Village, Fla , 19 °�
In consideration of the issuance to me of the foregoing Electrical
the Application and the plans and specifications thereof heretofore by me
State of Florida, all the Electrical Ordinances and Codes of Miami Shores
Shores Village.
aiami FItores
F L 0 R 1 D A
LO CATI 0 N
DESCRIPTION OF WORK
NUMBER OF
This Permit is granted upon the express condition that all facts stated in the Application are true and that the construction complies strictly with
the plans and specifications submitted and are in accordance with the Electrical Laws of the State of Florida and with the Electrical Ordinances and Code
of Miami Shores Village and the rules and regulations of the Electrical Department of Miami Shores Village. This Permit may be revoked at any time
upon the violation of any provisions of said laws, ordinances, or rules and regulations, or upon any change in the Plans and specifications unauthorized by
t ' Department.
N? 731
, Electrical Inspector.
Permit, I hereby agree to do the proposed construction in strict conformity with
submitted, and in compliance with all provisions of all Electrical Laws of the
Village, and all, rules and regulations of the Electrical Department of Miami
p h
d 1 } .r,AW
NO.
Motors
Receptacles
Generators
STREET
Water Heaters
PART OF LOT
LOT
BL'K
SUBDIVISION
If ",,
• t / ,
. "4
s
...
/
•
Ali
I wo:
Outlets
Motors
Receptacles
Generators
Stoves
Water Heaters
Signs
Billboards
Other Apparatus
Permit Fee
Ali
4 "
a
.4.
3 1
t
ELECTRICAL PERMIT
- N. B. —This Permit must be on display on the premises during
the construction.
� a
Owner of Building ;
Dated
-1
Contractor or Electrician_
,19
aiami Jhores9llage
F L 0 A n A
OFFICE OF ELECTRICAL DEPARTMENT
,Miami Shores Village, Fla , s. s ,'
LO CATI 0 N
DESCRIPTION OF WORK
NUMBER OF
0
837
This Permit is granted upon the express condition that all facts stated in the Application are true anc(that the construction complies strictly with
the plans and specifications submitted and are in accordance with the Electrical Laws of the State of Florida and with the Electrical Ordinances and Code
of Miami Shores Village and the rules and regulations of the Electrical Department of Miami Shores Village. This Permit may be revoked at any time
upon the violation of any provisions of said laws, ordinances, or rules and regulations, or upon any change in the plans and specifications unauthorized by
this Department.
, Electrical Inspector.
In consideration of the issuance to me of the foregoing Electrical Permit, I hereby agree to do the proposed construction in strict conformity with
the Application and the plans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all Electrical Laws of the
State of Florida, all the Electrical Ordinances and Codes of Miami Shores Village, and all rules and regulations of the Electrical Department of Miami
Shores Village.
Outlets
Motors
Receptacles
Generators
Stoves
Water Heaters
Signs
Billboards
Other Apparatus
Permit Fee
ELECTRICAL PERMIT
N. B. —This Permit must be on display on the premises during
the construction.
Owner of Building
Contractor or Electrician
NO.
STREET
dd Iiami cShores91llage
F L 0 R 1 D A
OFFICE OF ELECTRICAL DEPARTMENT
Miami Shores Village, Fla , 19
PART OF LOT
NUMBER OF
LO CATI 0 N
LOT
BL'K
DESCRIPTION OF WORK
SUBDIVISION
N9 731
This Permit is granted upon the express condition that all facts stated in the Application are true and that the construction complies strictly with
the plans and specifications submitted and are in accordance with the Electrical Laws of the State of Florida and with the Electrical Ordinances and Code
of Miami Shores Village and the rules and regulations of the Electrical Department of Miami Shores Village. This Permit may be revoked at any time
upon the violation of any provisions of said laws, ordinances, or rules and regulations, or upon any change in the plans and specifications unauthorized by
this Department.
, Electrical Inspector.
In consideration of the issuance to me of the foregoing Electrical Permit, I hereby agree to do the proposed construction in strict conformity with
the Application and the plans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all Electrical Laws of the
State of Florida, all the Electrical Ordinances and Codes of Miami Shores Village, and all rules and regulations of the Electrical Department of Miami
Shores Village.
Dated , 19 (Seal)
NO.
Motors
Receptacles
Generators
Stoves
STREET
Signs
a
9
PART OF LOT
LOT
BL'K
SUBDIVI�
l '
rl
�.Y 1 B. <
l
1
fi Y
le.- l ,f
f '
,;
,.tA' .
•
f A' fit ` '�h.
�
'y [ 3 d
, � r '1/4,... - -
/._�
Outlets
Motors
Receptacles
Generators
Stoves
Water Heaters
Signs
Billboards
Other Apparatus
Permit Fee
disol
0 i
`
ELECTRICAL PERMIT
N. B. —This Permit must be on display on the premises during
the co struc
actor or Electrician
f
Owner of Building
7liami fhoreslillage
F L 0 R 1 D A
OFFICE OF ELECTRICAL DEPARTMENT
ia mi Shores Village, Fla , 19 4
DESCRIPTION OF WORK
NUMBER OF
LO CATI 0 N
This Permit is granted upon the express condition that all facts stated in the Application ar!true ap ' that the construction complies strictly with
the plans and specifications submitted and are in accordance with the Electrical Laws of the. State of Flori a and with the Electrical Ordinances and Code
of Miami Shores Village and the rules and regulations of the Electrical Department of Miami Shores Village. This Permit may 4e revoked at any time
upon the violation of any provisions of said laws, ordinances, or rules and regulations, or upon any change in'the plans and s eeifications unauthorized by
thi Department. !' - ` , e
'' *� , Electrical Inspector.
In consideration of the issuance to me of the foregoing Electrical Permit, I herebi agree to do the proposed construction in strict conformity with
the Application and the plans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all Electrical Laws of the
State of Florida, all the Electrical Ordinances and Codes of Miami Shores Village, and all rules and regulations of the Electrical Department of Miami
Shores Village. o'
o. s-- 4- ; s -Yr s
a d
Dated . f_� , 19 ` . , i;r �'� 9{ ti .fi , Seal)
•
N9 83
Permit No
STATE OF FLORIDA,
COUNTY OF DADE. Ij ss'
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
Ap,ICATION FOR ELECTRICAL PERMIT
Application is hereby made for the approval of the detailed statement of the plans 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 work. /�
Owner's Name and Address Q e 4� a S 0 alt
Registered Architect and /or Engineer J r
Employing Electricia6's Name.. 6„) 4:.. /.Y9\Si.4- r...... ...L-..... ... � ..No e ... !Y Otreet 41 C--
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 Site Feeders Conduit.. Main Sw
Underground
Type of Installation — Conduit Tubing B.X.L
No
(Signed)
l4 d0
Date
KE Street
Amps Main Fuses . Amps
Metal Moulding
Amount of Permit $ .. (Signed)..
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o• ations as an employer of
labor under the Florida Workmen's Compensation Act. being Section 5966, Compiled General Laws of Florida ermanent 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.
lectrical nspector.
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'8
FIXTURES
NO. LAMPS
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIDT
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.8 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
I `()
3 i -P
v
CHECK
Cmet
//aa
-A 'L
. ..
Permit No
STATE OF FLORIDA,
COUNTY OF DADE. Ij ss'
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
Ap,ICATION FOR ELECTRICAL PERMIT
Application is hereby made for the approval of the detailed statement of the plans 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 work. /�
Owner's Name and Address Q e 4� a S 0 alt
Registered Architect and /or Engineer J r
Employing Electricia6's Name.. 6„) 4:.. /.Y9\Si.4- r...... ...L-..... ... � ..No e ... !Y Otreet 41 C--
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 Site Feeders Conduit.. Main Sw
Underground
Type of Installation — Conduit Tubing B.X.L
No
(Signed)
l4 d0
Date
KE Street
Amps Main Fuses . Amps
Metal Moulding
Amount of Permit $ .. (Signed)..
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o• ations as an employer of
labor under the Florida Workmen's Compensation Act. being Section 5966, Compiled General Laws of Florida ermanent 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.
lectrical nspector.
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.
OORB
rIA ruHCFb (ONLY
NUMBER OF
TOTAL
OUTLETS
SIZE OF
SIZE SERVICE
CONDUIT
NO.
CIRCUITS
LIGHTS
CEILING
BRACKETS
MAIN
SUBS
BRANCHES
ENT
3 vq 1
±_y______
f/
D
H
•
A -83
LOT NUMBER
STREET AND NUMa R
OWNER
OCCUPIED As
CEILING
KIND OF INSTALLATION
F
BASEM
FIRST
SECON
THIRD
FOURT
BRACKETS
RECEIVED BY INSPECTOR
PROGRESS
WILL INSPECT AGAIN
LOCATION
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED OR APPLICATION
BUILDING- -NEW OR OLD (UNDERLINE WHICH)
H. P. OF EACH MOTOR VOLTS_ TOTAL AMPS PHASE
RECEPTACLES
(" , ./�-, / „o '
MASTER EkECTRICIAN 1
/
/- 1 ) is (
ROUGH WIRING
FINAL. No.
CORRECTED
TEMPORARY DAYS.
DATE ISSUED
APPLICATION
ELECTIRICAL DEPARTMENT OF THE CITY OF MIAMI
Desiring your certificate of Approval, application is hereby made for an inspection of the
electric installation in the premises stated below, for which undersigned agrees to correct
any infractions of the National Electrical Code and the City Ordinance pointed out by In-
spector.
BL •,` K NUMBER
OPEN OR CONCEALED
SWITCHES
REMARKS
WILL BE RETURNED.
SUBDIVISION » /7 . A1/11-- ?/ > ; %
r
��/ F
SIDE
WORK -- ADDITIONAL, NEW, ALTERATION OR REPAIR
SPECIFICATIONS
STOVES
e
REMARKS
SPACE BELOW FOR INSPECTOR'S USE ONLY
WATER HEATERS
SIGNS
7,
DATE C L 19340
OTHER APPARATUS
KNOB. RX., BX., MLDG., CONDUIT, METALLIC TUBING
INSPECTION WANTED
)
ADDRESS 1
INSPECTED
FEE REMITTED
INSPECTOR
FLOORS
FIXTURES ONLY
NUMBER OF
TOTAL
OUTLETS
SIZE OF
SIZE SERVICE
CONDUIT
NO.
CIRCUITS
LIGHTS
CEILING
BRACKETS
MAIN
SUBS
BRANCHES
BASEMENT
� '�
_-
FIRST
SECOND
-
THIRD
FOURTH
A - 89
OCCUPIED AS
CEILING
REMARKS
BRACKETS
RECEIVED BY INSPECTOR
PROGRESS
WILL INSPECT AGAIN
BUILDING - y -pR OLD (UNDERLINE WHICH)
�. /
ROUGH WIRING
FINAL No
CORRECTED
TEMPORARY DAYS.
DATE ISSUED
APPLICATION NO
DATE
ELECTRICAL DEPARTMENT OF THE CITY OF MIAMI
Desiring your certificate of Approval, application is hereby made for an inspection of the
electric installation in the premises stated below, for which undersigned agrees to correct
any infractions of the National Electrical Code and the City Ordinance pointed out by In-
spector.
LOCATION
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL.
WILL 8E, RETURNED.
LOT NUMBER BLOCK NUMB R UBDI °•
i , ' Z-,
RECEPTACLES
SWITCHES
REMARKS
WORK -- ADDITIONAL. NEW. ALTERATION OR REPAIR
SPECIFICATIONS
H. P. OF EACH MOTOR VOLTS TOTAL AMPS PHASE
STOVES
WATER HEATERS
7/ � , i '%�7 �� ^� INSPECTION WANTED
• R
SIGNS
SPACE BELOW FOR INSPECTOR'S USE ONLY
MUST BE FILLED OR A.CATION
a
I
KIND OF INSTALLATION OPEN OR CONCEALED KNOB. RX.. BX.. MLDG., CONDUIT, METALLIC TUBING
OTHER APPARATUS
193
FEE REMITTED
INSPECTOR
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
1
Owner's Name and Address ___.�- _/__�� L � �'____�__________ No.____ �_ Street__
Registered Architect and /or Engineer
Employing Electrician's Name - > y ! / 4 5 ! 4: YCAS _ ,No.
Location and Legal Description Lot
Street and Number where work is to be performed— No.20.L_ __ l`
State work to be performed and purpose of building (By Floors)
Subdivision__
Street --
New Building Remodeling___________ Addition
Service Overhead Size Feeders Conduit._ Main Sw.
Underground
Type of Installation— Conduit Tubing B.X.L
Amount of Permit $
APPLICATION FOR ELECTRICAL PERMIT
The undersigned applicant for this building permit does hereby ce
under the Florida Workmen's Compensation Act, being Section 5966,
plied with the provisions thereof, and will require similar compliance
performed under this permit; and will post or cause to be posted for
required by the Act. The under signed agrees to employ only such
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly
85.
My Commission Expires
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
Block
(Signed)
Date
Street__ — ___�__ Jam//
Repairs__
Notary Public. State of Florida
No. of Stories
Amps. Main
Metal Moulding
,. fi r)
Electrical Inspector.
rtify that he understands and accepts his obligations as an employer of labor
Compiled General Laws of Florida Permanent Supplement, and has com-
from all contractors or sub - contractors employed by him in the work to be
inspection on the site of the work such public notice or notices as are
sub - contractors, on work to be performed under this permit, as are
,? 4 ,, Master Electrican.
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 him stated are true.
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'8
FIXTUR ES
NO. LAMPS
REFRI O.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
H EATER
STRIP
HEATER
TOTAL
CONTR.
LIST.`
/O
; 1 . _ /
i,
,c�
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1 -5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
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
1
Owner's Name and Address ___.�- _/__�� L � �'____�__________ No.____ �_ Street__
Registered Architect and /or Engineer
Employing Electrician's Name - > y ! / 4 5 ! 4: YCAS _ ,No.
Location and Legal Description Lot
Street and Number where work is to be performed— No.20.L_ __ l`
State work to be performed and purpose of building (By Floors)
Subdivision__
Street --
New Building Remodeling___________ Addition
Service Overhead Size Feeders Conduit._ Main Sw.
Underground
Type of Installation— Conduit Tubing B.X.L
Amount of Permit $
APPLICATION FOR ELECTRICAL PERMIT
The undersigned applicant for this building permit does hereby ce
under the Florida Workmen's Compensation Act, being Section 5966,
plied with the provisions thereof, and will require similar compliance
performed under this permit; and will post or cause to be posted for
required by the Act. The under signed agrees to employ only such
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly
85.
My Commission Expires
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
Block
(Signed)
Date
Street__ — ___�__ Jam//
Repairs__
Notary Public. State of Florida
No. of Stories
Amps. Main
Metal Moulding
,. fi r)
Electrical Inspector.
rtify that he understands and accepts his obligations as an employer of labor
Compiled General Laws of Florida Permanent Supplement, and has com-
from all contractors or sub - contractors employed by him in the work to be
inspection on the site of the work such public notice or notices as are
sub - contractors, on work to be performed under this permit, as are
,? 4 ,, Master Electrican.
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 him stated are true.
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.