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15 NE 95 St (11)PERMIT APPLICATION FOR MIAMI[ SHORES VILLAGE Job Address / S N• C. 9 S 4 Tax Folio Date Legal Description (� Owner/Lessee / Tenant y� (C �- r �,_ (\, (` C� Owner's Address / ! N • E Contracting Co. Al/ EN f r c� N U't't l 0 N i N, Historically Designated: Yes No Master Permit # Phone 1 L i 9 7.? t - E- Address 9063 Qualifier A ( b E R-40 4-(' SS# Phone (OS) -) 1 )j State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING ECHANICAL OFING PAVING FENCE SIGN WORK DESCRIPTION Th/' V (AAA "d v () R l e vN i'r- Luz tie or.? � . S +0N tr s- 6.,,= -6,'> ta- a Piet lc V-VAVre Square Ft. Estimated Cost (value) Signature of owner and/or Condo President '-J') -5S-327- o 1 l a z, -Qs My Commission Exp e Pav PUB ,( Zoning A ■ - , rOwner : R . . • - (‘ 0 7 d ✓ FEES: PERMIT ) / , RADON Z f dd APPROVED: - y - e: 26 _ , Mechanical (4 .16 « Plumbing Da ate C.C.F. 'r a () NOTARY °.-4 a► `c Qu - 0(7 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 perfonned 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 wort: 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. P ay P OFFHCiAL NOTARY SEAL ANGELA M BECKER )ri IX)M 4S'SION HUMBER • • ¢ CC7d6697 <C' cis, RAY COMMISSION EXPIRES of fro NOV. 1 5,2002 TOTAL DUE 1 -/ —S-0/ Contractor or Owner- Builder Date ( i)/Dr otary as "o Contractor' or Owner Builder Date My Commission Expires: Building Electrical 4‘ Structural Engineer ITEM BATH TL6 UNIT FEE ITEM SWITCH CUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIN)) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) 2. +y in L DRINKING FOUNTAIN SERVICE SIZE IN AFS DUCT WORK % • IM∎y 10 FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE CUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TCP UNDERGROUND TANKS LAVATORY OVEN ABOVE (MOUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTCRS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 FP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 FP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 FP TRANSPORTING ASSEMBLIES SINK, SLOP MOTCRS OVER 8- 10 FP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTCRS OVER 10- 25 NP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP C0OLING TOWERS EATER CLOSET MOTORS OVER 100 FP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS ' A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIWING POOL CUTLETS CC 4I RCIAL WATER SERVICE SIGN TUBES ;EWER CONNECTIONS SIGN TRANSFORMERS JTILITY -SEWER SIGN TIME CLOCK 1TILITY -WATER FIXTURES ;EPTIC TANK ANTENNA ' IELAY TELEVISION OUTLETS RAINFIELD, 4 TILE/RES. VIOLATION UM? & ABANDON SEPTIC TANK 'WAGE REINSPECTION PIT CU. FT. :ATCH BASIN DISCHARGE WELL OMESTIC WELL REA DRAIN OOF INLET OLAR WATER HEATER IRE STANDPIPE 001 PIPING AWN SPRINKLER SYSTEM AS RANGE _TER SET (GAS) AS PIPING PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) ELECTRICAL MECHANICAL Sec. 6 -3 Air Conditioning Regulations. Miami Shores Village (a) All individual air conditioning units installed in walls or windows shall be securely anchored to the walls by approved methods. Units installed over public property, paths of egress or more than ten (10) feet above grade shall be secured to the structure by bolts or screws to resist horizontal wind loads. Such units cantilevering more than eight (8) inches on the exterior of a building shall be supported by steel angle brackets secured by bolting. Bolts to masonry shall be set in lead shields or similarly rot - resistant fastenings. (b) The following special requirements shall apply to the control and regulation of noise nuisance from air conditioning machinery. (1) All equipment, existing or hereafter installed, regardless of location, shall be maintained in good worlcing order. Equipment so located that normal operating noises create a nuisance to adjacent owners or occupants shall be provided with soundproofing, or sound- absorbing baffels, or enclosures, as approved to insure maintenance of a reasonable noise level. (2) All equipment on outer walls, on roofs, or in the other exposed locations, which are unduly noisy, and which causes valid complaints from adjoining property owners or occupants may be required to be relocated, redesigned and/or enclosed in noise- retarding materials when, in the opinion of the building official, such enclosure is necessary or would be effective. (3) Special consideration shall be given to the planning of all future installations to minimize the noise nuisance to adjoining property owners or occupants and the building official shall have authority to reject or require the redesign of any system which, in his opinion, would cause such a no:ise nuisance. (c) Violation of this section shall be punished as is now or may hereafter be provided by law (Ord. No. 299, Sec. 1 -3, 2- 21 -61). I have read the above ordinance and will comply with the regulations thereof. owner /signature Contractor Signature I have read the above ordinance and will comply with the regulations thereof. • Project Address City State /Zip Owner Builder HVAC Contr SUBTOTAL L DUCT LOSS TOTAL LOSS MECHANICAL VENT.- 50 CFM MINIMUM EQUIPMENT LOSS 20% OVERSIZE LOSS EQUIPMENT LOSS MAXIMUM EQUIPMENT LOSS HEATING FACTOR (BTUH /CFM) HEATING CFM EQT. MANUF CU MOD # AHU MOD # HEATING INPUT HEATING OUTPUT HEATING CFM AFUE /HSPF * ResmanuJ(c) Version 3 * RESIDENTIAL HEAT GAIN / HEAT LOSS CALCULATION (BASED ON A.C.C.A. MANUAL J - SEVENTH EDITION (c) 1986 by A.C.C.A.) RENOVATION FOR BERNARD 15 NE 95 ST MIAMI FL NULL SCOTT BERNARD & KIMBERLY FOSTE NULL N/A Cond Floor Area = 868 ITotal Glass Area = 157 Conditioned Floor Area to Total Glass Area Ratio = 18.1% * USA Climatic Conditions & Design Conditions * Geographical Location North Latitude / Elevation Outdoor Winter Dry Bulb Indoor Winter Dry Bulb Winter Temperature Diff. (wTd) Outdoor Summer Dry Bulb Outdoor Summer Wet Bulb Outdoor Summer Hum. Ratio Gr /Lb Indoor Summer Relaltive Hum. Indoor Summer Design Gr /Lb. Indoor Summer Dry Bulb Summer Temperature Diff.(sTd) Summer Daily Range * HEATING SUMMARY * AACBEFO. 19459.4 973.0 20432.4 1210.0 21642.4 4328.5 21642.4 25970.9 * AIR FLOW FACTORS * * EQUIPMENT SELECTION * (BTUH) (BTUH) (BTUH) Prepared by: GUERRERO /GONZALEZ ENG.INC. 4300 SW 73 AVE MIAMI, FL. 33155 TEL:1- 305 -262 3944 FAX:1- 305 -262 8211 email:GGENG @ACCESSPRO.NET Maimi AP, Florida 25 9Ft. Above Sea Level 48 70 22 89 77 0 49 50% 56 74 15 15 (Low Deviation) ENB * COOLING SUMMARY * STRUCTURE SENSIBLE OCCUPANTS APPLIANCES SUBTOTAL SENSIBLE DUCT GAIN TOTAL SENSIBLE MECHANICAL VENT.- 50 CFM TEMP.SWING 3.0 ° @ 95 MINIMUM EQUIPMENT SENSIBLE 20% OVERSIZE SENSIBLE EQUIPMENT SENSIBLE MAXIMUM EQUIPMENT SENSIBLE TOTAL LATENT EQUIPMENT SENSIBLE EQT.SENSIBLE + LATENT 20.0 1 COOLING FACTOR (BTUH /CFM) 1082.1 1 COOLING CFM SENSIBLE CLG LATENT CLG TOTAL CLG TONAGE (S)EER COOLING CFM TYPE 13921.6 1800.0 1200.0 16921.6 1692.2 18613.8 825.0 1.0 19438.8 3887.8 19438.8 / 23326.6 7258.3 19438.8 26697.1 13.6 1425.5 (BTUH) (BTUH) (BTUH) Procedure A Winter Infiltration HTM 2. Winter Infiltration Btuh 1.1 x 287 CFM x 22 Degrees Winter TD Calculation Procedures A,B,C,D 1. Winter Infiltration CFM Envelope Evaluation #2 (Good /Average) 2.2 Air Changes per hour x 7812 Cubic ft. x .0167 3. Winter Infiltration HTM 6945.7 Btuh / 157 Sq.Ft of total Glass & Door areas 2. Summer Infiltration Btuh 1.1 x 104.4 CFM x 15 Degrees Summer TD 1. Sensible Sizing Load 2. Latent Sizing Load Procedure B Summer Infiltration HTM 1. Summer Infiltration CFM Envelope Evaluation #2 (Good /Average) .8 Air Changes per hour x 7812 Cubic ft. x .0167 3. Summer Infiltration HTM 1722.1 Btuh / 157 Sq.Ft of total Glass & Door areas Procedure C Latent Infiltration 0.68 x 56 grains difference @ 50 RH x 104.4 CFM Procedure D Equipment Sizing 287.0 CFM 6945.7 BTUH = 44.2 HTM 104.4 CFM = 1722.1 BTUH 11.0 HTM = 3974.3 BTUH Sensible Ventilation Load 1.1 x 50 VENT CFM x 15 Degrees Summer TD = 825.0 BTUH Sensible Load for Structure + 18613.8 BTUH Sum of Ventilation & Structure Loads = 19438.8 BTUH Rating & Temperature Swing Multiplier (3.0 ° @ 95 ° ) x 1.0 RSM Equipment Sizing Load - Sensible = 19438.8 BTUH Latent Ventilation Load 0.68 x 50 VENT CFM x 56 differance = 1904.0 BTUH Internal Loads = 230 Btuh x 6 people + 1380.0 BTUH Infiltration Load from Procedure C + 3975.6 BTUH Equipment Sizing Load - Latent = 7258.3 BTUH Abbreveations * Glass /Windows * S.C.= Single Clear 1 S.T. = Single Tint 1 S.R. = Single Reflective D.C.= Double Clear 1 D.T. = Qouble Tint 1 D.R. = Double Reflective T.C.= Triple Clear 1 T.T. = Triple Tint 1 T.R. = Triple Reflective Shdg= Shading 1 Ovhg = Overhang 1 Btm = Bottom 1 Hgt = Height 1 Sc = Shading Coefficient * Inside Shading * N.S.= No shades 1 D/B = Drapes or Blinds 1 R.S. = Roller Shades * Other * Whtm = Winter Heat Transfer Multiplier 1 Shtm = Summer Heat Transfer Multiplier Infiltration #'s: 1..Sub Standard /Poor 1 2..Standa.rd 1 3..Better 1 4..Excellent Dir. Ext.Shdg Type Shdg OvHg Botm Hgt Sc Area W'atm Loss /Btuh Shtm Gain /Btuh E - Shaded Area S.C. N.S. E -Solar Area S.C. N.S. E -Total Area S.C. N.S. E - Shaded Area S.C. N.S. E -Solar Area S.C. N.S. E -Total Area S.C. N.S. E - Shaded Area S.C. N.S. E -Solar Area S.C. N.S. E -Total Area S.C. N.S. N -No Shdg Fctr S.C. N.S. S -All Shaded S.C. N.S. S -All Shaded S.C. N.S. W - Shaded Area S.C. N.S. W -Solar Area S.C. N.S. W -Total Area S.C. N.S. Componet Type Building Componet Heat Loss & Gain Calculations 4.0 4.0 4.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 3.0 6.0 6.0 6.0 5.1 5.1 5.1 5.0 5.0 5.0 5.0 5.0 5.0 n/a 5.0 2.0 5.0 5.0 5.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 W -All Shaded S.C. N.S. 10.0 8.0 7.3 1.0 48.0 25.4 Glass Infiltration: 157.0 39.2 Glass Sub Totals: 157.0 Exposure R -Value Area N/W C.B. - Int Insul Exterior 4.2 Solid Core /Wood Exterior n/a Door Infiltration: Slab on Grade 0 Under Attic 19.0 13.6 12.4 26.0 25.4 0.3 8.7 9.0 25.4 0.3 8.7 9.0 25.4 9.0 25.4 36.0 25.4 2.0 25.4 0.6 17.4 18.0 25.4 1135.0 4.0 20.0 12.3 20.0 39.2 152.0 17.8 868.0 :L.2 660.4 228.6 228.6 228.6 914.4 50.8 457.2 1219.2 6154.4 10142.2 4540.0 246.0 784.0 2705.6 1041.6 27.0 367.2 85.0 1054.0 27.0 8.1 85.0 739.5 27.0 85.0 27.0 27.0 27.0 27.0 85.0 27.0 9.7 2.7 12.7 9.7 8.1 739.5 243.0 972.0 54.0 16.2 1479.0 1296.0 1522.9 8499.5 Whtm Loss /Btuh Shtm Gain /Btuh 3064.5 254.0 194.0 0 0 2.2 1909.6 Project Address City State /Zip Owner Builder HVAC Contr SUBTOTAL DUCT LOSS TOTAL LOSS MECHANICAL VENT.- 50 CFM MINIMUM EQUIPMENT LOSS 20% OVERSIZE LOSS EQUIPMENT LOSS MAXIMUM EQUIPMENT LOSS HEATING FACTOR (BTUH /CFM) HEATING CFM EQT. MANUF CU MOD # AHU MOD # HEATING INPUT HEATING OUTPUT HEATING CFM AFUE /HSPF * ResmanuJ(c) Version 3 * RESIDENTIAL HEAT GAIN / HEAT LOSS CALCULATION (BASED ON A.C.C.A. MANUAL J - SEVENTH EDITION (c) 1986 by A.C.C.A.) RENOVATION FOR BERNARD-FOSTER' . 15 NE 95 ST . MIAMI FL NULL SCOTT BERNARD & KIMBERLY FOSTE NULL . N/A Cond Floor Area = 868 'Total Glass Area = 157 Conditioned Floor Area to Total Glass Area Ratio = 18.1% * USA Climatic Conditions & Design Conditions * Geographical Location North Latitude / Elevation Outdoor Winter Dry Bulb Indoor Winter Dry Bulb Winter Temperature Diff. (wTd) Outdoor Summer Dry Bulb Outdoor Summer Wet Bulb Outdoor Summer Hum. Ratio Gr /Lb Indoor Summer Relaltive Hum. Indoor Summer Design Gr /Lb. Indoor Summer Dry Bulb Summer Temperature Diff.(sTd) Summer Daily Range * HEATING SUMMARY * AACBEFO. 19459.4 973.0 20432.4 1210.0 21642.4 4328.5 21642.4 25970.9 * AIR FLOW FACTORS * * EQUIPMENT SELECTION * (BTUH) (BTUH) (BTUH) Prepared by: GUERRERO /GONZALEZ ENG.INC. 4300 SW 73 AVE MIAMI, FL. 33155 TEL:1- 305 -262 3944 FAX:1- 305 -262 8211 email:GGENG @ACCESSPRO.NET Maimi AP, Florida 25 9Ft. Above Sea Level 48 70 22 89 77 49 50% 56 74 15 15 (Low Deviation) ENB * COOLING SUMMARY * STRUCTURE SENSIBLE OCCUPANTS APPLIANCES SUBTOTAL SENSIBLE DUCT GAIN TOTAL SENSIBLE MECHANICAL VENT.- 50 CFM TEMP.SWINC 3.0 ° @ 95 MINIMUM EQUIPMENT SENSIBLE 20% OVERSIZE SENSIBLE EQUIPMENT SENSIBLE MAXIMUM EQUIPMENT SENSIBLE TOTAL LATENT EQUIPMENT SENSIBLE EQT.SENSIBLE + LATENT 20.0 1 COOLING FACTOR (BTUH /CFM) 1082.1 1 COOLING CFM SENSIBLE CLG LATENT CLG TOTAL CLG TONAGE (S) EER COOLING CE'M TYPE 13921.6 1800.0 1200.0 16921.6 1692.2 18613.8 825.0 1.0 19438.8 3887.8 19438.8 23326.6 7258.3 19438.8 26697.1 13.6 1425.5 (BTUH) (BTUH) (BTUH) Calculation Procedures A,B,C,.D Procedure , A Winter Infiltration HTM 1. Winter Infiltration CFM Envelope Evaluation #2 (Good /Average) 2.2 Air Changes per hour x 7812 Cubic ft. x .0167 2. Winter Infiltration Btuh 1.1 x 287 CFM x 22 Degrees Winter TD 3. Winter Infiltration HTM 6945.7 Btuh / 157 Sq.Ft of total Glass & Door areas 1. Summer Infiltration CFM Envelope Evaluation #2 (Good /Average) .8 Air Changes per hour x 7812 Cubic ft. x .0167 2. Summer Infiltration Btuh 1.1 x 104.4 CFM x 15 Degrees Summer TD 3. Summer Infiltration HTM 1722.1 Btuh / 157 Sq.Ft of total Glass & Door areas 1. Sensible Sizing Load 2. Latent Sizing Load Procedure B Summer Infiltration HTM Procedure C Latent Infiltration 0.68 x 56 grains difference @ 50 RH x 104.4 CFM Procedure D Equipment Sizing 287.0 CFM 6945.7 BTUH = 44.2 HTM 104.4 CFM 1722.1 BTUH 11.0 HTM 3974.3 BTUH Sensible Ventilation Load 1.1 x 50 VENT CFM x 15 Degrees Summer TD = 825.0 BTUH Sensible Load for Structure + 18613.8 BTUH Sum of Ventilation & Structure Loads = 19438.8 BTUH Rating & Temperature Swing Multiplier (3.0 ° @ 95 ° ) x 1.0 RSM Equipment Sizing Load - Sensible = 19438.8 BTUH Latent Ventilation Load 0.68 x 50 VENT CFM x 56 differance = 1904.0 BTUH Internal Loads = 230 Btuh x 6 people + 1380.0 BTUH Infiltration Load from Procedure C + 3975.6 BTUH Equipment Sizing Load - Latent = 7258.3 BTUH Abbreveations * Glass /Windows * S.C.= Single Clear 1 S.T. = Single Tint 1 S.R. = Single Reflective D.C.= Double Clear 1 D.T.,= Double Tint 1 D.R. = Double Reflective T.C.= Triple Clear 1 T.T. = Triple Tint 1 T.R. = Triple Reflective Shdg= Shading 1 Ovhg = Overhang 1 Btm = Bottom 1 Hgt = Height 1 Sc = Shading Coefficient * Inside Shading * N.S.= No shades 1 D/B = Drapes or Blinds 1 R.S. = Roller Shades * Other * Whtm = Winter Heat Transfer Multiplier 1 Shtm = Summer Heat Transfer Multiplier Infiltration #'s: 1..Sub Standard /Poor 1 2..Standard 1 3..Better 1 4..Excellent E - Shaded Area S.C. N.S. E -Solar Area S.C. N.S. E -Total Area S.C. N.S. E - Shaded Area S.C. N.S. E -Solar Area S.C. N.S. E -Total Area S.C. N.S. E - Shaded Area S.C. N.S. E -Solar Area S.C. N.S. E -Total Area S.C. N.S. N -No Shdg Fctr S.C. N.S. S -All Shaded S.C. N.S. S -All Shaded S.C. N.S. W - Shaded Area S.C. N.S. W -Solar Area S.C. N.S. W -Total Area S.C. N.S. Componet Type Building Componet Heat Loss & Gain Calculations Dir. Ext.Shdg Type Shdg OvHg Botm Hgt Sc Area Whtm Loss /Btuh Shtm Gain /Btuh 4.0 4.0 4.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 3.0 6.0 6.0 6.0 5.1 5.1 5.1 5.0 5.0 5.0 5.0 5.0 5.0 n/a 5.0 2.0 5.0 5.0 5.0 N/W C.B. - Int Insul Exterior 4.2 Solid Core /Wood Exterior n/a Door Infiltration: Slab on Grade 0 Under Attic 19.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 Exposure R -Value Area 13.6 12.4 26.0 25.4 0.3 8.7 9.0 25.4 0.3 8.7 9.0 25.4 9.0 25.4 36.0 25.4 2.0 25.4 0.6 17.4 18.0 25.4 W -All Shaded S.C. N.S. 10.0 8.0 7.3 1.0 48.0 25,4 Glass Infiltration: 157.0 39.2 Glass Sub Totals: 157.0 1135.0 4.0 20.0 12.3 20.0 39.2 152.0 17.8 868.0 1.2 660.4 228.6 228.6 228.6 914.4 50.8 457.2 1219.2 6154.4 10142.2 4540.0 246.0 784.0 2705.6 1041.6 27.0 367.2 85.0 1054.0 27.0 8.1 85.0 739.5 27.0 85.0 27.0 27.0 27.0 27.0 85.0 27.0 9.7 2.7 12.7 9.7 8.1 739.5 243.0 972.0 54.0 16.2 1479.0 1296.0 1522.9 8499.5 Whtm Loss /Btuh Shtm Gain /Btuh 3064.5 254.0 194.0 0 0 2.2 1909.6 i Date / - 10 2101 Job Address PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Legal Description /6 4/4 f5 5 7— Tax Folio Owner/Lessee / Tenant /! /72!,.Q /t'JE 95' Owner's Address //� Contracting Co. i� %LAC Qualifier / \7 — e4t /4/ State # C22 /9 9_ Municipal # Competency # 7 z Ins. Co. /Z- Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): WORK DESCRIPTION Square Ft. Notary as to APPROVED: Zoning Mechanical Address 1/1 Address Address BUILDING ELECTRICAL PLUMBIN MECHANI /0eiA ) /1 %‘,4¢Q 1 .UCCo • -e Signature of owner and/or Condo President e My Commission E F °Y CCMPPSSION EXPIRES Date President Date okay p OFFICIAL NOTARY SEAL � MARY P BRIGGS Z � t `^ ( 0 COMMISSION NUMBER . 1'• Q CC741860 c "�,.•�1 i . tn0 FEES: PERMIT ‘‘;' RADON Building Historically Designated: Yes No k Address 5 F9/r / 37 I ss# p hone 66 ?Ales s>— t Notary as to Clntract My Commissi n Exp Master Permit # Phone 7a Estimated Cost (value) 4 a75 •O WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all 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 contracts ►s o the work stated. i Signature of Contractor or Owner - Builder U Date Electrical '(/4 OFFICIAL NOTARY SEAL U4� MARY P BRIGGS (1 C1* COMMISSION NUMBER < 'L. Q CC741860 8 7,4 zt(v' 1 C P.S•' COMMISSION EXPIRES 0 _ , • C.C.F. I (9 a NOTARY BOND TOTAL DUE W gggpb - 308 ��33 ROOFING PAVING FENCES N 0/ Date Plumbing Structural Engineer ITEM BATH TDB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN MPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/NETER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TCP UNDERGROUND 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 FP HOT WATER BOILERS SINK, POT /3 COMP. MOTCRS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 FP ELEVATORS /ESCALATORS TEMPORARY WATER CLOSET MOTCRS OVER 10- 25 FP FIRE SPRINKLER SYSTEMS URIC MOTORS OVER 25-100 FP COOLING TOWERS WATER CLOSET MOTORS OVER 100 FP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS 0 2 Y . fot) j A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS • HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS GRAINFIELD, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE 'OOL PIPING _AWN SPRINKLER SYSTEM ;AS RANGE DETER SET (GAS) ?AS PIPING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE :PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL