1201 NE 98 St (10)Date 11k1n
3246
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Type Insp'n (JACk1
Permit No. EI., wU
Name V�r� C JCG C cat&
Address 1 i-o\ C(16
Company r ? X
Phone # ' — 9124-
Inspection Date 08 /& /
Approved
Correction
Re -Insp' n Fee
1405
'bC
'0 it
MIAMI SHORES VILLA(
BUILDING DEPARTMENT ` 4
305- 795 -2204
Building Inspection Request
Date t7.3‘05
Type Insp'n r 1 A(&\ f-L
Permit No. t L Z0DS - 163
Name Gt(A.4c.)
Address 12 Di Wt. - 1S
Company W.LTi l(,
Phone # .05 - 5 S T24
Inspection Date : 1.510
Approved
Correction
Re- Insp'n Fee
3513
MIAMI SHORES VILLAGE T h/x
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
e �
Date _
Type Insp'n ROu) 14
Permit No. UL 2003 1
Name 5tV' CAuk-
Address t7_01 NT. 'U `J
Company E
+ '�
Phone # ;) bS 1 6 $S — 04 ( Z.
Inspection Date 1111 OS
Approved
Correction
Re- Insp'n Fee
72/
/1/`&' ' / /22 7 ���
sijz. (:" s' ' 4
� � /
Electrical Permit
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305- 795 -2204 Permit Number: EL2005 -163
Printed: 6/6/2005
Applicant: SOLIMAR MARKARIAN
Owner: GARCIA ENRIQUE
JOB ADDRESS: 1201 NE 98 ST
Contractor P & M ELECTRIC INC
Local Phone: 305 - 949 - 6373
Parcel # 1132050090220
Contractor's Address: 1936 NE 148 ST
Page 1 of 1
Legal Description: EARLETON SHORES PB 43 -80 LOT 10 LESS E2OFT BLK 2 LOT SIZE
Fees: Description Amount
FEE2005 -7131 Building Fee $150.00
FEE2005 -7132 CCF $2.40
FEE2005 -7306 Notary Fee $5.00
FEE2005 -7307 Training and Education Fee $0.80
FEE2005 -7308 Technology Fee $3.75
FEE2005 -7309 Scanning Fee $3.00
Total Fees: $164.95
Total Fees: $164.95
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 11/15/2005 Construction Value: $3,400.00
Work: INSTALLATION /WIRING OF NEW UNDERGROUND SRV W / 225A METER MAIN 200A MAIN DISCONNECT
Signed: (INSPECTOR)
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict
conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
JUN 2 7 PAID
cK # SI4Z
3000 sq. ft. X (3) = 9000
(2) appl. @ 1500 = 3000
Laundry @ 1500 = 1500
13,500
Adjustments:
1st 3000 @ 100% = 3000
Remaining 10,500 @ 35% = 3675
6675 ( Gen. lighting )
Gen. lighting = 6675
A/C (Heat) @ 100% = 10000
(2) HWH @ 4500 = 9000
Stove = 8000
Dryer = 5000
Pool Pump = 1200
Pool Heater = 7000
46,875
ELECTRICAL
CONTRACTORS
1936 N.E. 148th Street
North Miami, Florida 33181
(305) 949 -6373
Dade CC #16353
Broward CC #86- CME- 1046 -X
LOAD CALCULATION
46,875/ 240 = 195.31amps
Ines Hegadus Garcia
1201 NE 98th Street
Miami Shores, FL. 33138
ELECTRICAL
CONTRACTORS
1936 N.E. 148th Street
North Miami, Florida 33181
(305) 949 -6373
Dade CC #16353
Broward CC #86- CME- 1046 -X
225a
Meter/ Main
Panel A
2 "c. vvl(3)
310 thhn
1
0
200amp
M.B. Disc.
2" U.G. from FPL
No.4 gr. cond.
z
c.w.
Ines Hegadus Garcia
1201 NE 98th Street
Miami Shores, FL. 33138
Laundry Room
Existing
200a M.B.
d0cir.
Panel B
10' gr. rods min. 6' apart
2" c. w/ (3) 2/0
/ , 'e $ —
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building
Owner's Address 12,0 ( N E E
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Owner's Name (Fee Simple Titleholder) 111(S ' Oj 9 s US--(7 Phone # SOS ' `i S I . 0?) 2 2.
City l ,,ores State FL zip 33.3b
Tenant/Lessee Name
A
Job Address (where the work is being done) .-SD rY") e •
City Miami Shores Village
Is Building Historically Designated YES NO
County Miami -Dade Zip
Contractor's Company Name Ai- / � A . Phone # SO S 2) 9 � • ' 73
Contractor's Address / 3 , /l/' //
City State ` /G' . Zip -.?_7/27/
Qualifier fie � -
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit 3; 00 . OD
Total Fee Now Due $ 1 b .
(Continued on opposite side)
)irAiteration New
Permit
Master Permit No.
Plumbing Mechanical Roofing
Phone #
Square Footage Of Work:
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
e rn " iC i
MAY ffi9 ).°
•
Type of Work: EAddition /
Describe Work: //I 5 /4 7 i�,!? /s✓r r; :1 /. e7 ,,z1 eiiv? oirea.-red
❑ Repair/Replace ❑ Demolition
Submittal Fee $ Permit Fee $ /5 ej // " �� a�'' ' CCF $ D . CoiCC
Notary $ > Training/Education Fee $ .sv Technology Fee $ -
Scanning $ - O() Radon $ (------ Zoning Bond $ /--
Code Enforcement $ Structural Plan Review. $ l' / /
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
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 brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
0 er or Agent , Contractor
The foregoing instrument was acknowledged before me this /l0 The forego g in s ment was acknowledged before me this I �I (�
day of GC. E 20 6s, by t/.. S' , day of L , 20 5by
who F is person ly known me or who has prod who is persona known to me or who has produced Et/
As identification and who did take an oath. identification and who did take an oath.
Signature �I
NOTARY PUBI,JC
Sign:
Print:
My Commission Expires:
xpires 04/18/2009
NOTARY PUBLIC: / ,' "or
Sign:
Print:
My Co ; s ion Expires:
**************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Chc 12/15/03
* * * * **
(Certificate of Competency Holder) �
o �
State Certificate or Registration No. Certificate of Competency No.
******************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ******************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY: ��!� 1 �_ ��`��; � /�//�� Frans Examiner
Engineer
Zoning
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 f 2.61 A
/
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE (ROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
MOTORS QVER 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
i
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 IP
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
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
_
FIXTLRES
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
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS 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
Date /D -20-`9 Job Address / Zo/ /VF 9S57 Tax Folio
Legal Description
Owner / Lessee / Tenant _�i A /Pa to Master Permit # 3‘4q7
Owner's Address (2o/ 4/F 98 37f Phone 7 S 7" 9l6 o
g �Gf'! Address 97V /.i � Z J S
< it : FL 3 319ic)
Contracting Co. � o'/ /��G ���c�' /G �/'/C
Qualifier C�VIDLCfS N'1 SG c4 6'C) SS# Phone - 5 - Z 3 3 -!��{ 2-5
30-
State #122/ - * $ 3 Municipal # g 240 Competency # 1g 632 Ins .Co . - 1 rca velea
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION Seruv .e e e- Lt C,6 • 2 - Z!D ..p_s
P I s-k 0 - P. �'G ce i �- F o 1 - P o s-c b C e S P c t . s'o ` -rumps z yo
Square Ft. Estimated Cost(value) 1 t.(•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 • in compliance with all applicable laws regulating construction and zoning. Furthermore, I
•� i ze the abo a -n =iced contractor to do the work star d.
au
Andhor-Condo President
OTARY sEM
m�},e1 k9D �51F�1Me t .
0 !, SANDRA M MONTIEL. k
2 i f * COMMISSION NUMBI
** * N, � Q CC40126`•.
Y �, A l COMBASION E.y.. 1 * *
�OFF�O� AUG. 17.�:i1 a....
Notary as to
My C
FEES PERM RADON
APPROVED:
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Mechanical
F ir e A'
Building
Signature of Contractor or Owner- Builder
Date: /o -ZV-. 9 y
Electrical
Plumbing Engineering_
7 r /of2_c3
Notary as to Contractor or Owner- Builder
My Comm spp.conPVgarmeeL NOTARY SEAL
O <i SANDRA M MONTIEL
* COMMISSION NUMBER
Q CQ40126
* * * 1 - r„ .gy MY CO MISSIO EXP. , **
OF fyo AUG. 171998
C.C.F. It 6 NOTARY po TOTAL DUE
Other
A /911411r
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 2,a0
(
DUCT WORK
FLOOR DRAIN
-
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
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 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 IP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
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 .- �' col+
�
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
DRAINFIELO, 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 RAKE
METER SET (GAS)
GAS PIPING
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
APPLICATION FOR ELECTRICAL PERMIT
5
Permit No Date 3
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address Q..4= eJ e 4.4agre 4
Registered Architect and /or Engineer
Employing Electrician's Name Y ?f1..1.' Id'..G.�� ,11 l" �
Location and Legal Description Lot lI 8
Street and Number where work is to be performed— No.. ..J. 0 f
State work to be performed and purpose of building (By Floors)
New Building ✓ Remodeling Addition
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
Overhead
Service Underground Slze Feeders.. Conduit..../ ..`l...l Sw
Type of Installation — Conduit Tubing B.X.L Metal Moulding
STATE OF FLORIDA,
COUNTY OF DADE.
Amount of Permit $ / (Signed)
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the
work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices
as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. 7 ��
ss.
No Street
° No. 43 1 Street cA.fr a r',
Block Subdivision � 2 A G c 1„ 3cg?d
1... ... 9�y . Street '.i
Repairs No. of Stories
(Signed)
Amps Main Puses Amps
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 w eing by me first duly sworn, upon oath deposes and says that he is the
of the above describe onstruction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him sta are true.
My Commission Expires Notary Public, State of Florida
OTE: 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
RE
FIXTURES
PS
NO. LAMPS
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
HEATER
SPACE
STRIP
HEATER
TOTAL
CONTR.
LIST �
‘
�"` 9,
A 2 4 "
/
/
C
f
,_, ( �
, _
1
S
•
/
(' �
sa�
"
CHECK
/It I
.;
1
.,
ENT.
SW.
��
DIST.
CAB.
SERVICE
TEMP.
(d 1,1J
SERVICE
PERM.
� �j7.. � p �
�`c..
N .)
MOTORS
O. HP
/ ti
d"
MOTORS
1•5 HP
.7 i
NEON
TRANS.
IGv'
f
/a /,
RADIO
4J -
> .`,›
TOTAL
c- V
CLIST'
CHECK
APPLICATION FOR ELECTRICAL PERMIT
5
Permit No Date 3
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address Q..4= eJ e 4.4agre 4
Registered Architect and /or Engineer
Employing Electrician's Name Y ?f1..1.' Id'..G.�� ,11 l" �
Location and Legal Description Lot lI 8
Street and Number where work is to be performed— No.. ..J. 0 f
State work to be performed and purpose of building (By Floors)
New Building ✓ Remodeling Addition
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
Overhead
Service Underground Slze Feeders.. Conduit..../ ..`l...l Sw
Type of Installation — Conduit Tubing B.X.L Metal Moulding
STATE OF FLORIDA,
COUNTY OF DADE.
Amount of Permit $ / (Signed)
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the
work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices
as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. 7 ��
ss.
No Street
° No. 43 1 Street cA.fr a r',
Block Subdivision � 2 A G c 1„ 3cg?d
1... ... 9�y . Street '.i
Repairs No. of Stories
(Signed)
Amps Main Puses Amps
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 w eing by me first duly sworn, upon oath deposes and says that he is the
of the above describe onstruction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him sta are true.
My Commission Expires Notary Public, State of Florida
OTE: 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.