665 NE 97 St (3)' PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date a 7 '/. ` OIJob Address ye6. eve c i X6 Tax Folio
Legal Description
Owner/Lessee / Tenant
Owner's Address Phone)(( ) ?,37 4 / 0
Contracting Co. frit Address
Qualifier
State # Municipal #
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one). BUILDIN ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION)( fX TG 49,e
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
box
0, &4 boo
FEES: PERMIT 2 20 RADON
APPROVED:
r
Historically Designated: Yes No
ft47 Ro ir)2 /G' U4- v Master Permit # 7' y
y
SS# Phone
Competency # Ins. Co.
Address
Address
��r:✓77; Jq /N 1././i/; /4' Roo
9/11A/77 779 ie.6
Square Ft. Estimated Cost (value) ° f L%
tary as to Contractor
My Commission Expire
C.C.F. , 61 9 NOTARY
4/ 71/
Zoning C�� Building
hanical Plumbing
Electrical
deoe 00
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.
OWNERS AFF IDAVIT: 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 d
X'36,7 pp = /22-e
1.1);';7611.,_
1 - . •. ,�, ai1'. •
Igna , of ontrac or or Owner- Builder Date
• - - NOI AA Y S JCf'SS. F
GLADYS J VILLA R �I
NOTARY PUBLIC STATE O: FLORIDA
CONEVMISSION NO. CC714103
COMMISSIPINI FOP. MAR. 1.2002
S BOND
4L /O- '/
ate
TOTAL DUE al
Structural Engineer
i
• tl
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 1 401 Job Address 66.< n/ . 9 S TTax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant 419/ /j0 Master Permit # 4 g 759
` or /V e 97 S)- Phone (05) 9J? 46 90
Oli,/VC& Address /
Owner's Address
Contracting Co.
Qualifier
State #
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one):
SS#
Municipal # Competency */
Address
Address
Address
Phone
Ins. Co.
ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 1'/ J Cy / I /-'b a /9 T02DD /YI (.9.3/49, P,6 PL/gc,
/ 7eye v4-1.1- Tit LPS Z/DAP_S 471/.1) , »Ic - Zey ro✓,9.61, A04_ Pni;v '>' - S-/ i /K /9-A0
7-o•'L 4=7:s 1 2 P ' a -3 ,33, /v ect, / o Aid=s , �q�
Square Ft. Estimated Cost (value) Ll c Y 020, ( 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 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 w k sta
V A419- <
ignature of owner and/or Condo President Date ignatur• of ontr ctor or • er- Builder
Notary as to Owner and/or Condo President Date
My Commission Expires:
VA a. y //
�)P/
FEES: PERMIT r� r RADON
APPROVED:
Mechanical
(4o) /
Building V
Plumbing /
/ .• a, 41e0
as to Contract
y Commission Exp
C.C.F. ' NOTARY -� BOND
�r t _� • a
Pu � S AT,'s OF', ,ORIDA Date
es: COMMISSION NO. CC714103
IYIY COMMISSION EXP. MAR. 12002
4 - ,� 0 /
Date
TOTAL DUE
Electrical V Gf f .7--Y1
Structural Engineer
REVIEWER: / //a' NdG
SHEET NUMBER: ?
1
1
1 ,
ignature of Inspector
,/
Date Signed
PLAN REVIEW COMMENTS
PROJECT NAME: / 1 ' / % ) e' co s
PROJECT ADDRESS: 4r�� / C/
P to. e -,2 ( � S�
COMMENTS
a l 5 �r Xddlt P 5 S G/C, �� A �i
®Gi/ o, �G�G / j � D�i� / rr`- / 1.
Ci
DATE:
Title
Total Number of Hours
(PLEASE TURN IN A COPY OF THIS FORM AS YOUR TIME SHEET: FOR ALL PLAN REVIEW)
fr`
(DU
COURTESY NOTICE
10050 N.E. SECOND AVE,
MIAMI SHORES, FLORIDA 33138-2382
Telephone: (305) 795-2207
Fax: (305) 756-8972
, .
Dear Property Owner: '---. -- - -'
While making inspections in the area, I noticed the
i'. following items needing your attention:
0 Property is in need of mowing / cleaning
0 Trash on site
0 Exterior of structure requires maintenance
O Trees/bushes/hedges need trimming
• 0 Commercial vehicle in residential zone
O Inoperable vehicle on property
• 0 Vehicle parked in landscaped area
O Vehicle parking areas must be paved
O Vessel / boat not properly stored
17: Interior / exterior work requires permits
O Prohibited signs on property
O Non-domestic animals on property A0 , ( -- U lA / C1- 4 I- L,S 0A
O Other: C
JJ
-t -t-
qi
Corrective action needed by:
(Date)
LAIV.1` 0 6
Failure to correct the violation by the above date may
result in a Notice of Violation to appear before the
Code Enforcement Board which may impose fines up
to $500 per day. The Village residents have always
taken great pride in the community and we know that
you share in this effort to keep the "Village Beautiful".
Your cooperation is appreciated.
b.
Code Enforcement Officer • Date
(305) 795-2204
L._
7..
••■. `-
'911111M111111..
\ \ \\
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\\ \\
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\ \ \\‘ \
\ \ \\\
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I • : 2210E D52 ! Dwg no. i
I Note: This drawing is an artistic ,
• ;
1 interpretation of the general .
• •
... _ . .. . i HnuF nFpnT i abilio rodriauez
•
•
'
.4/
•• �
Note: This mmam»� 2z/o�os2 ��wnr�
drawing ms •
/"m,nnyanonn,muoen�a| |
•
•
Note: This drawing isanartistic -----'----'-
THE
interpretation of the general 1 I le•ta r- 1--
BUILDING
PERMIT APPLICATION
FBC 2001
State Certificate or Registration No.
$ Value of Work For this Permit
Type of Work: ❑Addition
Describe Work:
Total Fee Now Due $
(Continued on opposite side)
Permit Type (circle): (Buildi Electrical
1.
Owner's Name (Fee Simple Titleholder)
Si le
Owner's Address o ( l
City A°`"•n) 9 State
Tenant/Lessee Name
ob Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
Architect/Engineer's Name (if applicable)
Code Enforcement $ -
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
ck"?
Phone # (1)35 - 7; . L( '4/
P 0 5 1 P6d,
3313%
Contractor's Company Name ClZ 8a9z.. G, Phone # (0O 71'7 - i3
Contractor's Address 33 7 Ai c,
City Al /WA State
Qualifier f VJi I . \ C
❑Alteration
■zr
H o
County Miami -Dade
NO_>
Structural Plan Review. $
Plumbing Mechanical Roofing
Zip
Master Permit No.
Phone #
\/ S fic.c
&T
Zip 3
Phone #
Zip V5 r
Certificate of Competency No. 598S 00,J0... r
Square Footage Of Work:
❑New xf. Repair/Replace ❑ Demolition
Sis77A4 8 ' j<7 a 6
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Ge° Permit Fee $
Notary $ Training/Education Fee $
Scanning $ � Radon $
Permit No. 13P 05- 6owt
CCF $ 65 CO /CC
Technology Fee $ p 5
Zoning Bond $
s 54
Bonding Company's Name (if applicable)
Bondin g Company's Com an 's Address
City State Zip
Mortgage Lender's Name (if applicable) A y
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochur ill be delivered to the person
whose property is subject to attachment: Also, a certified copy of the recorded notice of comment ent ust be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In th abs ce of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
�/, ( atur e Signature
Owner or Agent
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 9
day of , 20 _ , by day of kPEi L , 20 OS by 74a/ii (EE
who is personally known to me or who has produced 14 6 4 5 et)f/ vho is sonally known to me or who has produced
00 , ,< 6 aW-As i% ntification and who did take an oath.
NOTAR
Sign:
Print:
My Commission Expire
Contractor
My Commission E
ion and who did take an oath.
NOTARY PUBLI
Sign► `.►:� VAtieti9.
Print:
***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * ** * ** * * * * * * * * * * * * * * * * * * * * **
**************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * *:i3 *************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Chc 05/13/03
ptti'�( 3 2g5
Plans Examiner
Engineer
Zoning
•' •' iP RMVMTi'tiPPLICA'rION FOR MIAMI SHORES VILLAGE
• ••• • • •
• • • • • • • • I tf
• • ••• • • •
Date Job Address (v /n 5 /I ti 92 54— Tax Folio
Legal Description 0 • jj /D t ' !Ur / Historically Designated: Yes No Lr
•
• • •
Owner/Lessee / Tenann c 11 + ST1 -e t(y ' e-c A (< Master Permit # •/00
Owner's Address J.D 40. :9_7; St Phone (7 05) 3 - 5'
• ••• • • • • ••
Contracting Co. ( ; s • IA : C.,
Qualifier ( 14,4 y-f 3 Ge> Y° C frin SS# Zb 3 - 08 - 2.,6 Phone 4 / la/ ( 2- 5"
State # Cp a 5 Municipal # Competency # Ins. Co.
Architect/Engineer 1L4 O jZ�e - IL (d (121,05v4 r a j /' y- • Address 5 7 5 5 /24t4itr1 L ,`qtr 62 a 9'r
Bonding Company
Mortgagor Address
Permit Type (circle one): UILDING ELECTRICAL PLUMBING MECIHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
A9 t
Address
Square Ft. Estimated Cost (value) 2
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 • or ,:': ted.
er an • or c • • • 'dent
My Commission Expires:
Plumbing
Notary : Contractor or Owner - Bu ilder
iJ
My Commission Expires:
C.C.F.
FEES: PERMIT V RADON
O i J ��. I ,1
APP D: ,
/�j� /// 7/ //� � 7�
Zoning �/ Building t Electrical
Mechanical (v o f 4 c 3
Address 7/ D AI 7 D 6
6 -z__
ontractor or Owner- Builder Date
OTARY S, 06 BOND t) D /
TOTAL DUE
x_ -ate
0
Structural Engineer
jJ '/6 /6
1 IVDOc ue s
A„4
.-/i€4 Ijr1
Si, 0
CONTRACTOR
Name CO CO/06/Rr CRaCi.
License No. G 4 ., G+ O S S'S is
Address 0/9iL • / Q /'?O 7
, ��d1 /8c`,1 /$ Pc- 3 t/ 3
Telephone _970 g472_ Fax ,S , 7s 2- / / Z
Qualifier Name i22 C ori / j4 , /
PROPERTY OWNER
New Construction
Name?)iLLi 1 SfFge 60 IT1
Address
l�ro -6%1 e/7r %.
/0/407/ 5/ cv
Home Telephone 34
31,A, - o6' z 6
Business Telephone
�
2g / d 515 do
Fax
Fax f). — - 's'6'— c3 &S
Demolish
ENGINEER
New Construction
Enclosure
Name (9 G d
ti P /(l
t ` '3
TZ-P /
/ ) C
License No. p t
7 � . .
Fax f). — - 's'6'— c3 &S
Demolish
Address /
pelf
Z/6.
,/4�/ ?c ' 3
Telephone s
3 b3 „
,,1 0 5 ,
J
Fax 3 . 9q j j cf
Add'l Attachment
ARCHITECT
New Construction
1,
Name Z /C i► � w•/ 11 i n 1 - 1 �
( , " 5
Enclosure
License •
n 16 77
Alteration Exterior
Address 625 1 s (std 7 &
0/4 /v/ 3 � I 4 3
7,4444,,,r_
c c.
Telephone n c . , ; 0990
4G
Alteration Interior
Fax f). — - 's'6'— c3 &S
Demolish
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'l Attachment
Other
Add'I Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step 1.
Step 2.
APPLICATION
Job Address:
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted
along with this permit application.
Submit the completed apolication with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your applicatj n, you may be asked to submit additional information.
646 /V/-a= 9e7
Address
ff l l Apt.
er/ I3 °
V 0 d Block 101
Folio Num
Lot
Subdivision PB PG
Current Use of Property gpS (n .
Proposed Use of Property ATS " /%/i Z.ciz_ .
Tenant Information �—
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Roofing
Fence
Other
Plumbing
LPGX
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
Master Permit No.
Subsidiary Permit No.
Mrl ./Y011.5-
City
City
PERMIT APPLICATION
aooa - Log
•
' State Zip
/0t/
Description of Work At 1177(?
Zoning Linear Feet
Units Floors
Square Feet
Value of Worl 7 v� Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
Page 2
IMPORTANT NOTICES
1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1 Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
STATE FLORIDA, OUNTY MIAMI -DADE '� F ' of O OF AMI DADE
Signature of Owner
L.): l (: _ t-..) : t- 3(l
Print Name
Sworn to and subscribed before me this .//1 f O
Signature of
SEAL:
tary Public - State of Florida
/AN Enrique Ch au
* 15 *My Commission.CC7087
s p tea 18, 2 . •
Type of Identification Produced:
i / 7/Ld ( C�.�... 7 4iA/
Sworn to and subscribed before me this day of CV
Signature of otary Public - Stag of Florida
SEAL:
ature of Contractor / Qualifier
Enrique Chau
- *My Commission CC70675
January 18, 2032
PERMIT APPLICATION
Personally known OR, Produced Identification J Personally known OR, Produced Identification
Type of Identification Produced:
SECTION
B .
D • E
Zonin:
-AT` `,:�
r *M %�
WFFf4Z
�/
Electrical
Mechanical
-
(.9 ...7% • 0 1
Plumbing
Fire
Public Works
Structural
�l
it 2®♦.I
Building Official
�.al
Page 4
OFFICE USE ONLY
" CKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.)
Inspector State Educational Fund $
State DCA (Radon)
Code Enforcement Fine
Zoning Review
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
( sq.ft. = x/1000
x t.60)
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
REVIEWED AND PREPARED BY:
��rj- ion
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
gd,004:b-y\o,z (5,z)o
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2Ni AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE
Service Repair
QTY.
A/C Central 1 -3 Ton
Dryer Vents, Number of
Fan
Ventilation, Cost
Outlet, Wall
Ductwork, Cost of
Service, Temporary
Periodic Inspections
A/C Central 4 -7 Ton
Fire Sprinkler System
Fire Pump
Outlet, Switch
Fireplaces, Number of
Signs
A/C Central 8-15 Ton
Fixture - Fluorescent
Oven
Space Heater (kw)
A/C Central 16-20 Ton
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
MECHANICAL
TYPE QTY.
Minimum Fee
TYPE
Condensate Drain
QTY. TYPE
Generator
QTY. TYPE QTY.
Refrigeration, Tons
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
PLUMBING
TYPE
A/C Condensate
QTY.
'TYPE
Drains, Roof
QTY.
'TYPE
Miscellaneous Fixture
QTY.
'TYPE
Soakage Pit
QTY.
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
.
- Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE: