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540 NE 96 St (7)MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No ' 0 c;.._1 Date..._..._ . /... 5' 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 �, specified or not. A copy of approved plans and specifications must be kept at building during f k progress o work. Owner's Name and Address ' No Registered Architect and /or Engineer ;Triply g Plumber's- / Nam I / / Locatlon and Legal Descri tion Lot_ A Street and Number where work L to be performed —No %C State work to be performed and purpose of building (By Floors) New Building- - - - - -_ _ _.._....... - -•_ -. Remodeling Addition My Commission Expires 5 ye) Bloom S Subdivision (Signed) �treet_. Amount of Permit $ ( Signed )- _- .� -. -. -- street. C _.. :' _ 7 Repairs No. of Stories ............. Size Septic Tank_- Type of Tank __ __._ Feet of Drain Tile rte- Feet of Tank or Drain Field from Well .. ._.__._ —__ -_- Nature of Water Supply: City—WeIL Size of Soakage Pit_ P Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and a s his obligation as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of orida Permanent Sup lement, and Ilan mm- plied with the provisions thereof, and will require similar compliance from all contractors or su • . tractors em . 'yed b him in ,'won' to be performed under this permit; and will post or cause to be posted' far inspection on the site of th6 wor l�t, u� public ce noti err required by the Act. The undersigned agrees to employ ody such sub - contractors, • . won to 7/ ormed tits are licensed by Miami Shores Village. Master Plumber. — to me well known, and who, being by me first duly sworn, upon oath deposes and says that be is the .._ _.._ - -_ - •.- •--- -. - -.. _ _ ...�. of the above described construction, that he has carefully read the foregoing application, and that be did sign the same, and that all facts therein by him stated are true. STATE OF FLORIDA, 1 COUNTY OF DADE. j Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made whom molt sriaspeotion le soada.oeoeaeary by improper notice fur impaction, or faulty materials and/or worlaaenahip. CCLOSETS BATH TOSS SHOWERS LAVA• TORIES SINK* BLOT eINK[ LANDR TU /• U URINALS CA OA /IN FLOOR DRAIN DRINKING FOUNT•NS TOTAL FIXTURES CONTR. LIST CHICK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT G TRAP SOLAR MUTER DEEP WILL SPRKLR. SYSTEM SWIM•0 POOL CONTR. LIST ��-- I l CHECK MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No ' 0 c;.._1 Date..._..._ . /... 5' 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 �, specified or not. A copy of approved plans and specifications must be kept at building during f k progress o work. Owner's Name and Address ' No Registered Architect and /or Engineer ;Triply g Plumber's- / Nam I / / Locatlon and Legal Descri tion Lot_ A Street and Number where work L to be performed —No %C State work to be performed and purpose of building (By Floors) New Building- - - - - -_ _ _.._....... - -•_ -. Remodeling Addition My Commission Expires 5 ye) Bloom S Subdivision (Signed) �treet_. Amount of Permit $ ( Signed )- _- .� -. -. -- street. C _.. :' _ 7 Repairs No. of Stories ............. Size Septic Tank_- Type of Tank __ __._ Feet of Drain Tile rte- Feet of Tank or Drain Field from Well .. ._.__._ —__ -_- Nature of Water Supply: City—WeIL Size of Soakage Pit_ P Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and a s his obligation as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of orida Permanent Sup lement, and Ilan mm- plied with the provisions thereof, and will require similar compliance from all contractors or su • . tractors em . 'yed b him in ,'won' to be performed under this permit; and will post or cause to be posted' far inspection on the site of th6 wor l�t, u� public ce noti err required by the Act. The undersigned agrees to employ ody such sub - contractors, • . won to 7/ ormed tits are licensed by Miami Shores Village. Master Plumber. — to me well known, and who, being by me first duly sworn, upon oath deposes and says that be is the .._ _.._ - -_ - •.- •--- -. - -.. _ _ ...�. of the above described construction, that he has carefully read the foregoing application, and that be did sign the same, and that all facts therein by him stated are true. STATE OF FLORIDA, 1 COUNTY OF DADE. j Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made whom molt sriaspeotion le soada.oeoeaeary by improper notice fur impaction, or faulty materials and/or worlaaenahip. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT `` � It APPLICATION FOR PLUMBING PERMIT 4f Xi J I {t� LJJ � Permit No i�� � � ... . . ....._ - — — Application is hereby made for the approval of the detailed statement of the plans and specifications herewith subratt:..rI for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Mi : -.7i. Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatic . of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and spec.'fications must be kept at building during progress of wor Owners Name and Address T D i ( .L.. t .__._ _ e_ ..__.._. No Street. - -- �`` ..::egistared Architect and /or Engineer _..... __... :mploying Plumber's Name �+ ti"43 a' 'L r.9 f • NO 6 z3 e.. . �..,,.... street: ? S/ ° 1411`411A- STATE OF FLORIDA, 1 as. COUNTY OF DADE. Size Septic of Tank.__ Bloc) Subdivlaion..__ -•_- - Location and Legal Description Lot. Street and Number where work is to be performed —No +.5 () . / . Street 9 S7 State work to be performeil and purpose of building (By Floors)__ _.____._.. New Building Remodeling Addition Feet of Drain Tile._.___ ____ _- -Dist. Feet of Tank or Drain Field from Well. Repairs Nature of Water Supply: City — Well. __________._____. __._____ _ .._Size of Soakage Pit Amount of Permit $ -1 4 05 -0 (Signed )_°v (Signed) 4 ; 4 1 Capacity Frans. - No. of Stones . My Commission Expires Notary Public, State of Florida Plum • inq Inspector The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an endioyci of i ho under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent ;upi lement, and ilav Ferri• plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed ly him in • e wcrk o b� performed under this permit; and will post or cause to be posted' for inspection on the site of the wor,k such publi notice„ is no icer required by the Act. The undersigned agrees to employ only such sub - contractors, on work to ed licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, peraor.. L ppearec. 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 be has carefully read the foregoing application, and that be did sign the same, and that all acts therein by him stated are true. NOTE: A re- inspection fee of 0.00 will be made when such re- inspection is made•neoessary by improper notice for inspection, tlr faulty materials and/cc workmanship. CLOSETS BATH TUBS r.6. � M 4 LAVA- LAVA- TORIES SIN SINK[ LAUNDRY "rues 1 �. 114,L- ' �+ CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS ( tr:J 6,,„- 1 i. ' S 44 , 11,,, TOT1.L P IXTL R[• CONTR. C LI T r I Y / r 1 / . / e) CHECK 1 !�Lj V3 ` SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM '0 P001. CONTR. LIST CHECK MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT `` � It APPLICATION FOR PLUMBING PERMIT 4f Xi J I {t� LJJ � Permit No i�� � � ... . . ....._ - — — Application is hereby made for the approval of the detailed statement of the plans and specifications herewith subratt:..rI for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Mi : -.7i. Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatic . of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and spec.'fications must be kept at building during progress of wor Owners Name and Address T D i ( .L.. t .__._ _ e_ ..__.._. No Street. - -- �`` ..::egistared Architect and /or Engineer _..... __... :mploying Plumber's Name �+ ti"43 a' 'L r.9 f • NO 6 z3 e.. . �..,,.... street: ? S/ ° 1411`411A- STATE OF FLORIDA, 1 as. COUNTY OF DADE. Size Septic of Tank.__ Bloc) Subdivlaion..__ -•_- - Location and Legal Description Lot. Street and Number where work is to be performed —No +.5 () . / . Street 9 S7 State work to be performeil and purpose of building (By Floors)__ _.____._.. New Building Remodeling Addition Feet of Drain Tile._.___ ____ _- -Dist. Feet of Tank or Drain Field from Well. Repairs Nature of Water Supply: City — Well. __________._____. __._____ _ .._Size of Soakage Pit Amount of Permit $ -1 4 05 -0 (Signed )_°v (Signed) 4 ; 4 1 Capacity Frans. - No. of Stones . My Commission Expires Notary Public, State of Florida Plum • inq Inspector The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an endioyci of i ho under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent ;upi lement, and ilav Ferri• plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed ly him in • e wcrk o b� performed under this permit; and will post or cause to be posted' for inspection on the site of the wor,k such publi notice„ is no icer required by the Act. The undersigned agrees to employ only such sub - contractors, on work to ed licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, peraor.. L ppearec. 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 be has carefully read the foregoing application, and that be did sign the same, and that all acts therein by him stated are true. NOTE: A re- inspection fee of 0.00 will be made when such re- inspection is made•neoessary by improper notice for inspection, tlr faulty materials and/cc workmanship. Permit No. -- 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. r ` //i�. Owner's Name and Address Registered Architect and /or Engineer Employing Plumber's Name A _t s ...== - Amount of Permit $ STATE OF FLORIDA, I COUNTY OF DADE. t MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Size Septic Tank _-- •- _- ._______ ____ - - - -- ---Type of Tads - - - — — -- - Feet of Drain Tile._-_- —.___ _Dist. Feet of Tank or Drain Field from Well ... Nature of Water Supply: City — Well.- _-- ___----- ..- ...-__._. _-__--____Size of Soakage Pit (Signed)_ Capacity Gals 1 .0 street. ._ !. ..4. Location and Legal Description Lot. Block _ �� � Subdivhdon..-...— ....__..�....— Street and Number where work is to be performed —No Street . - -- • -- - - -- .. _...... 4' .;.. ..... _ /.. State work to be performed and purpose of building (By Floors)-- .--- - .... - -A�. --_' _ . � _ -. �• - _ r4 • -, . . L( '..L� Y....). f ?..L ;_�. New Building ....... _.- _._ .......... ...._.. Remodeling—.__ _ .- Addition... -._ Repairs E...r! No. of Stories 5 s c 7. Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatios as an employer of labor under the Florida Workmen's Compensation Act, being Section 5888, Compiled General Laws of Florida Perinanen upplement, and Ilan com- p lied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors •toyed by him in the work to be performed under this permit; and will post or cause to be posted for inspection a site of the wor c public notice or notices as are required by the Act. The undersigned agrees to employ only such su tractors, work to fprm;• nder this permit, as are licensed by Miami Shores Village. F ` Before me, the undersigned authority, a notary public, duly authorized to admirter oaths and take aclmowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the . - • - _ - .... ........ .. .••_ --• -- -- .._ _.. of the above described construction, that be 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 as•iospoctiou Is mads by improper notice for inspection, or faulty material and /or workmanship. CLOSETS BATH Tue. SHOWERS LAVA- TORIES S SLOP LAUNDRY Tuns U RINAL/ CATCH B ASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIxyuec. CONTR. — LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WILL SPRKLR. SYSTEM SWING POOL COHTR. '- -- LIST CHECK Permit No. -- 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. r ` //i�. Owner's Name and Address Registered Architect and /or Engineer Employing Plumber's Name A _t s ...== - Amount of Permit $ STATE OF FLORIDA, I COUNTY OF DADE. t MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Size Septic Tank _-- •- _- ._______ ____ - - - -- ---Type of Tads - - - — — -- - Feet of Drain Tile._-_- —.___ _Dist. Feet of Tank or Drain Field from Well ... Nature of Water Supply: City — Well.- _-- ___----- ..- ...-__._. _-__--____Size of Soakage Pit (Signed)_ Capacity Gals 1 .0 street. ._ !. ..4. Location and Legal Description Lot. Block _ �� � Subdivhdon..-...— ....__..�....— Street and Number where work is to be performed —No Street . - -- • -- - - -- .. _...... 4' .;.. ..... _ /.. State work to be performed and purpose of building (By Floors)-- .--- - .... - -A�. --_' _ . � _ -. �• - _ r4 • -, . . L( '..L� Y....). f ?..L ;_�. New Building ....... _.- _._ .......... ...._.. Remodeling—.__ _ .- Addition... -._ Repairs E...r! No. of Stories 5 s c 7. Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatios as an employer of labor under the Florida Workmen's Compensation Act, being Section 5888, Compiled General Laws of Florida Perinanen upplement, and Ilan com- p lied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors •toyed by him in the work to be performed under this permit; and will post or cause to be posted for inspection a site of the wor c public notice or notices as are required by the Act. The undersigned agrees to employ only such su tractors, work to fprm;• nder this permit, as are licensed by Miami Shores Village. F ` Before me, the undersigned authority, a notary public, duly authorized to admirter oaths and take aclmowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the . - • - _ - .... ........ .. .••_ --• -- -- .._ _.. of the above described construction, that be 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 as•iospoctiou Is mads by improper notice for inspection, or faulty material and /or workmanship. PERMIT APPLICATION FOR MIAMI SHORES VILLAGE D a t e 4-- L - ( J o b A d d r e s s I O 6 9'45 Tax Folio Legal Description L4 7 `o r> ; - 94 Historically Designated: Yes No A `34. - e 2 r m io 3'7 Owner/Lessee / Tenant Master Permit # 4 sS 5 1 j 7 9 93,7 Owner's Address t..N.S e. k Phone Contracting Co. p d. Address �'JZ� `• � :) �' �`' Z. M A M r—, Qualifier J State # C- rC' k L1/4 42'c\ Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL bi >> 1 INcv/ MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION 2- .3 Square Ft. Estimated Cost (value) 15 i 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 zou_ Furthermore authorize the above -named contractor to do the work stated. Signature of owner and/or Condo President Date Not. ' as t Ovicer and/or Condo President My Commission'Expires: 1�► Y o Oo SCOTT W. MOKHhR , ••, COMMISSION # CC 646585 EXPIRES MAY 12, 2001 BONDED THRU flf P- ATLANTIC BONDING CO., INC. FEES: PERMIT V /,�8 RADON PAENA.4ge_ SS# ✓ �f�4C, �` a of •ntractor or Owner - Builde S C.C.F. D 1 Not . t • C • actor or Owner - Builder My Commission tractor NOTARY . -- 0 * 0 p scan W, MOKHkk ,., r, COMMISSION # CC 646585 ", a EXPIRES MAY 12, 2001 � �� BONDED THRU +CF F\ ATLANTIC BONDING CO., INC. BOND TOTAL DUE / a ' APPROVED: Zoning Building Electrical Mechanical Plumbing Engineering ITEM BATH TU3 Id1 r FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WINO) OISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AM'S DUCT WORK FLOOR (RAIN SERVICE REPAIR/METER GORGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY 3 OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER 1 MOTORS 0— 1 HP STEAM BOILERS SHOWER MOTCRS OVER 1— 3 HP HOT WATER BOILERS SINK, POT /3 CHAP. MOTORS OVER 3— 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTCRS OVER 5— 8 If TRANSPORTING ASSEMBLIES SINK. SLOP _ MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTCRS OVER 10— 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET 2 MOTORS OVER 100 HP 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 SBIMIMING POOL OUTLETS COMdERCIAL WATER SERVICE • SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY—SEWER SIGN TIME CLOCK UTILITY —WATER FIXTURES SEPTIC TANK ANTENNA ' RELAY TELEVISION CUTLETS . .. 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 POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE — METER SET (GAS) GAS PIPING /Us') I � 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 Date 5 Legal Description WORK DESCRIPTION rsA — L"k 2 • PERMIT APPLICATION FOR MIAMI SHORES VILLAGE \ Job Address t —yU N `kb S ` Tax Folio SEA Z.P - - e_, y --c L`3® Owner/Lessee / Tenant U V , ;}-t Owner's Address "J `'t c N `.. k4, '1) Square Ft. Estimated Cost (value) Notary as to Owner and/or Condo President Date APPROVED: Zoning Building Mechanical Plumbing Historically Designated: Yes No Master Permit # Phone Electrical Signature of owner d/or Condo President Date gria ; e of Con : ctor or Owner- Builder Structural Engineer o' . 75 ) Li-q) Contracting Co. M oJ. Hip P, 6- Address gc' J E) '6) Q , N 6 F\ Qualifier ,Scwt, - -\ (v..© SS# Phone 3c 5 L1L-I6 'Era icsb State # G FG- p Z ( W bq Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN 5� ��P, P` - Pt N(N < 'VLc4, + n- vE�2.v � C_E 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 wile do ,. in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the •rk s � / a�G ntracor er- : uilder Dat My Commission Expires: 1 y Commission Expires: 1P'czy p OFFICIAL I , O 1, _G L , ■ S 2 n oo ,,. �jp_ 4 CC74165_ f OF f... p FEES: PERMIT J5 o RADON C.C.F. "' 0 `'' NOTARY, O 7) BOND TOTAL DUE f) - ITEM BATH TUB 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 AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/WIER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY >j 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 TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET 1 MOTORS OVER 100 HP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. 2 GENERATORS TRANSFORMERS J HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL - WATER SERVICE 1 SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS - UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELD, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. ;ATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN 300E INLET SOLAR WATER HEATER :IRE STANDPIPE 'OOL PIPING _AWN SPRINKLER SYSTEM AS RANGE 4ETER SET (GAS) AS PIPING (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 ADDENDUM TO BUILDING PERMIT APPLICATION ELECTRICAL MECHANICAL