ELECTRICALSignatur
APPROVED:
Zoning
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date q Z /I Job Address 63 iU 9Ss Si Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant L 7 9 • 501 / 771
Owner's Address � NE. S
Contracting t/ 00 141 �LC (�) NZL
Qualifier JO r 1 n , - fz,
State # rr :zo f ( Municipal # �—
Architect/Engineer /Q
Bonding Company / -
Mortgagor
Permit Type (circle one):
WORK DESCRIPTION
Notary as to a er
and/
My Commission E xpires:
FEES: PERMITx j2 ' "O RADON
0.• $2; ent OFFICIAL N U '
a MARY P BRIGGS
2 5' ! 0 COMMISSION NUMBER
( 'UP. a CC741860
9 t c..".• MY COMMISSION EXPIRES
F O F F�. MAY 11,2002
Address �7/Uai Q /7Sr
SS# (
Competency # /6b0 / b0 !i Ins. Co. U/ Zi/fe-/C-//
Address
Address
Address
Building
Master Permit # 76 00
Phone
BUILDING LECTRIC PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
626 i - Sc,•UK F ire, /5z 0
Square Ft. Estimated Cost (value) j (0C
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 forego' ' information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Furth ore on e above -named contractor to do the work stated.
tik4 9/
'
. f
LItA
and/or Condo President Date
a.(sa?)
SEAL
der
Date
/
/ L ao r ,,I
1.
0
9
Signature of Contractor or Owner -Bu
Notary as to C • ntracto
My Commission Exp
C.C.F. / 4 0 NOTARY 0
I AL NOTARY SEAL
MARY P BRIGGS
* Ii COMMISSON NUMBER
:.4 Q CC741860
- 37l F " N . kW COMMISSION EXPIRES
r OF Fin W"Y '11,200/
BOND
TOTAL DUE
Electrical 7 "�{ / ,A 9 , C?
Plumbing Structural Engineer
MOODY ELECTRIC, INC.
669 N.W. 90 STREET
MIAMI, FL 33150 -2166 S ' td 1 % tt
TEL: (305) 891 -1374 53 NE 9 8 T
FAX: (305) 758 -2000
M,a m i 6In 61-
I
M 5
1p0 pP
441
0 7N//AJ
di
4,044
I piici
3
OFFICIAL NOTARY SEAL
.‘0769 PUBC, NICOLE A BERG ERT
g414. cow�I 2 67
O ON EXPIaES
O� MY� 2001
OF i�
of6 &_e
1
MOODY# ELECTRIC, I NC .
669 N.W. 90 STREET
MIAMI, FL 33150-2166
TEL: (305) 891 -1374
FAX: (305) 758 -2000
RESIDENTIAL DEMAND
w / sQ. rr / Sao
REFRIGERATOR
APPLIANCES
DISHWASHER
GARBAGE DISPOSAL
MICROWAVE
CLOTHES WASHER
DRYER
RANGE
WATER HEATER
OVEN
FREEZER
TRASH COMPACTOR
GARAGE DOOR MOTOR
JACUZZI
JACUZZI BOOSTER HTR.
IRONING BOARD
POOL EQUIPMENT
SPRINKLER PUMP
LANDSCAPE LIGHTS
STEAM SHOWER
A/C WALL UNIT
SPARE CAPACITY
SPARE CAPACITY
TOTAL CONNECTED LOAD
FIRST 10 K.W. @ 100% �
REST @ 40%
A/C @ 10% .1bKW 1-kitAir
S M IT'�
S' 3 ,,,o cigs r.
/`'li 4,#v • i S,A(n.te, /G,4 .
.2410
LOAD CALCULATIONS
5'• y K.W.
I • K.W.
•a K.W.
ItS K.W.
K.W.
1 .5 K.W.
115 K.W.
5.0 K.W.
I • D K.W.
4 1 , 5 K.W.
K.W.
K.W.
K.W.
K.W.
K.W.
K.W.
.ir K.W.
K.W.
K.W.
K.W.
K.W.
K.W.
/''5 K.W.
K.W.
IMMO
715
39.7o K.W.
10.0 K.W.
/1.$8 K.W.
IO,G K.W.
3I t g K.W.
TOTAL DEMAND LOAD QQ �� �
31.6e K.W. / 240 VOLT = / 3 OI' Iv1PS
8128 1 3Q4 ��
Ed-ooaii99
APP
:�. 6T -
A BERGERT
1 w 0 COMMISSION NUMBER
C661267
ct• MY COMMISSION EXPIRES
e or,Fvo JAY 2,2001
ZONING
STRUCTURAL
IjB1ECT TO COMPLIANCE WITH ALL FEDERAL, STATE AND COUNTY
RULES MD REGULATIONS.
;',1411 SHORES VILLAGE ASSUMES M SP O PLANS.
FOR ACCURACY'
OF OR RESLI iS FRO
COMPLIANCE WITH THE SOUTH FLORIDA BUILDING CODE AS ADOPTED If"
Pfd SHORES VILLAGE IS REQUIRED. THE ARCHI' tCI, 1 UILI;i.R & SU a
s r �t � SAO "�' EDGE OF A' I R' - '" 1 }obi;
JNTRACTORS ARE CHARGED WITH TBF. K
:EGULATIONS WHETHER OR NOT SPECIFY :ALLY INDICATED
ert
Permit No
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Way 23rd, 1961
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.
Vr. Foster K n T
Owner's Name and Address No 51 • E •
Registered Architect and /or Engineer None
Employing Electrician's Name ALLSTATE ELECTRIC CORP N o 7311 S.T. 41S
Srtreet Y!`S' 'ml "'SYIOre's
Street ....98.... ,}: -t-r-Ee-t
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
x # 1 R.T
Service Overhead Feeders Size Feed Conduit.i...1/4ain Sw
Underground 100A Amps Main Fuses Amps
Type of Installation — Conduit Tubing B.X.L Metal Moulding
Amount of Permit $ r (Signed)
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts h'• .bligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Fl; a Permanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub• tractors 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.
Master Electrician.
STATE OF FLORIDA, l
COUNTY OF DADE. J j s ''
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'S
FIXTURES
NO. LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
$uACE
HTER
STRIP
HEATER
TOTAL
CONTR.
LIST
1
1
1
2
1
CHECK
ENT.
SW.
DIST.
CAB.
T
SERVICE
TEMP.
SERVICE
)) PERM.
20U A
M OTORS
0.1 HP
1- r". F.
M OTORS
1.8 HP
�
A.0
N EON
TRANS.
OUTLET
220
RADIO
V.
TOTAL
CONTR.
LIST
CHECK
ert
Permit No
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Way 23rd, 1961
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.
Vr. Foster K n T
Owner's Name and Address No 51 • E •
Registered Architect and /or Engineer None
Employing Electrician's Name ALLSTATE ELECTRIC CORP N o 7311 S.T. 41S
Srtreet Y!`S' 'ml "'SYIOre's
Street ....98.... ,}: -t-r-Ee-t
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
x # 1 R.T
Service Overhead Feeders Size Feed Conduit.i...1/4ain Sw
Underground 100A Amps Main Fuses Amps
Type of Installation — Conduit Tubing B.X.L Metal Moulding
Amount of Permit $ r (Signed)
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts h'• .bligations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Fl; a Permanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub• tractors 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.
Master Electrician.
STATE OF FLORIDA, l
COUNTY OF DADE. J j s ''
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.
MAN!! ! 1 'SHOR VILLAGE, FLORIDA
ilLHLDI
IL T ICA PERMIT N? '
Co i
Work to be performed under th P
A. Ci a tirri i
)wne of
iuildrng
'.rchitect
: ontractor
,r Builder
-,ega1 Lot
?esoription
onsideration of the
eta and in strict co.
permit I assume row
CONTRACTOR OR BUILDER
Subdi-
vision
kddress o s ; Value of
"'►� Project
This permit is granted to the contractor or buil med above to construct the building or to install the equipment or device
r ation herefor in strict compliance with all ordinaaa4es pertaining thereto and with the understanding that the work w l be performed in
Bans, drawins, statements or specifications that may have been submitted to and approved by the proper municipal authorities. : This Permit may
t any time the work is not done in compliance ith su h ordinauces or if the plans are changed without authorization. A further condition upon whirls thb
,errnit is granted is the understanding that the ee actor or builder named above assumes the responsibility for a thorough knowledge of the ordinances aed
egulatjons pertaining to the work covered hereby hether shown on the plans or drawings • the state is or specifications
ibility for work done by his agents, servants or amp oyees.
sigaodt
Amt.
Permit of
INSPECTOR
ork covered hereunder in compliance with all or
eoifications submitted to the proper autbosities o
nt, servant or employee.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building 1-; il
CONTRACTOR OR BUILDER
MIAMI S
PERMIT
Architect
Contractor
or Builder • t. 4'1
=
Legal Lot
Description
Address of
Building ` AI
420 A1417 4/ r Y
1 X
HORES VILLAGE. FLORIDA
Bl
1■19 4193
Work to be performed under this Permit
This permit is granted to the contractor or builder named above to construc the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a orough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the stateme s is or s - cifications and that he assumes responsibility for work
done by his agents, servants or employees.
igned• (—)
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work co red hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specificatio submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume responsibility for all work done by either, myself, my gent, servant or employee.
.- C } ,1 1 i.
BY
Subdi-
vision
Value of
Project $
DATE Y - t 1955._
Contractor's
License No.
Amount of
Permit $
22 a
BY
AUTHORITY
JOB:
BUILDING
ELECTRICAL
PLUMBING •
•
•
•
•
•
12 47-
The Following is ready for inspection :-
Inspector's Report: -
ADD: ✓ 3 ?j
WORK
DONE BY:
REQUESTED : WILL BE READY
1
1
1
A
t
f
v
(17
/ A 4
2.
3
3
/6 I
JOB! ADD:
BUILDING
ELECTRICAL : •
. WORK
: .
. DOZE BY:
PLULIBING : •
: REQUESTED : WILL BE READY
• .
. .
r .
•
The Following is ready for inBpotion:-
Inspectorts Report: -
/6
3 ?
JOB:
BUILDING
ELECTRICAL
PLUMBING
ADD:
The Following is ready'or inspection:-
Inspector's Report: -
: WORK
:
DONE BY:
: REQUESTED : WILL BE READY
•
t •
Permit No
Amount of Permit $
1
STATE OF FLORIDA,
COUNTY OF DADE. ss.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
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.
My Commission Expires
Owner's Name and Address 4 W __________. Street
Registered Architect and /or Engineer
Employing Electrician's Name .__ .,___ No.
Location and Legal Description Lot __ Block _____ Subdivision_ ___�___4
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
Service Overhead Size Feeders Conduit._ Main Sw ..
Underground
Type of Installation— Conduit___ ___ __________ Tubing____________ B.X.L. Metal Moulding _____
(Signed)
(Signed)
Street__
6-
Repairs ____ No. of Stories
Amps. Main Fuses_ __Amps.
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 com-
plied 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
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, 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.
Notary Public. State of Florida
Master Electrican.
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.
LIST
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVIC
PE
MOTORS
0-1 HP
MOTORS
1 -5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
Permit No
Amount of Permit $
1
STATE OF FLORIDA,
COUNTY OF DADE. ss.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
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.
My Commission Expires
Owner's Name and Address 4 W __________. Street
Registered Architect and /or Engineer
Employing Electrician's Name .__ .,___ No.
Location and Legal Description Lot __ Block _____ Subdivision_ ___�___4
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
Service Overhead Size Feeders Conduit._ Main Sw ..
Underground
Type of Installation— Conduit___ ___ __________ Tubing____________ B.X.L. Metal Moulding _____
(Signed)
(Signed)
Street__
6-
Repairs ____ No. of Stories
Amps. Main Fuses_ __Amps.
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 com-
plied 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
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, 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.
Notary Public. State of Florida
Master Electrican.
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.
Owner's Name and Address
Registered Architect and/or Engine
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
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.
Employing Electrician's Name
Location and Legal Description Lot
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs__
Block
Service Overhead Size Feeders Conduit._________ Main Sw _ _ ., Amps.
Underground
Type of Installation— Conduit Tubing_____________ B.X.L. Metal Moulding
Amount of Permit $
27:15
ss.
My Commission Expires
(Signed)
(Signed)
Stet
Date__ k/
Street...
No. – – – -- – – Street- --
Notary Public. State of Florida
No. of Stories._ _______–
Main Fuses _____Amps.
Electrical I . spector.
The undersigned applicant for this building permit does hereby certify that 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 com-
plied 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Electrican.
STATE OF FLORIDA,
COUNTY OF DADE.
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
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
FIXTURES
NO.LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
..,
�_
I
!
/
CHECK
•a
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0-1 HP
MOTORS
1 -5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
Owner's Name and Address
Registered Architect and/or Engine
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
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.
Employing Electrician's Name
Location and Legal Description Lot
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs__
Block
Service Overhead Size Feeders Conduit._________ Main Sw _ _ ., Amps.
Underground
Type of Installation— Conduit Tubing_____________ B.X.L. Metal Moulding
Amount of Permit $
27:15
ss.
My Commission Expires
(Signed)
(Signed)
Stet
Date__ k/
Street...
No. – – – -- – – Street- --
Notary Public. State of Florida
No. of Stories._ _______–
Main Fuses _____Amps.
Electrical I . spector.
The undersigned applicant for this building permit does hereby certify that 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 com-
plied 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Master Electrican.
STATE OF FLORIDA,
COUNTY OF DADE.
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
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.
}
THIS CERTIFIES THAT the wiring and apparatus installed at
by 1 : ) Address
for
MIAMI SHORES VILLAGE
Office of Electrical Inspector
CERTIFICATE OF INSPECTION
r
PERMIT
-
owner, and occupied as "'�'�
has been inspected and current is authorized to be turned on, until otherwise notified, for:
Size of Service Number of Lighting Circuits
Range watts. Water Heater watts
Power: Connected load H P. Space Heaters watts
Other Apparatus
ELEC'1•RICAL INSPECTOR
for
THIS CERTIFIES THAT the wiring and apparatus installed at
by Address
has been inspected and current is authorized to be turned on, until otherwise notified, for:
Size of Service Number of Lighting Circuits
Range watts. Water Heater watts
Power: Connected load H. P. Space Heaters watts
Other Apparatus
MIAMI SHORES VILLAGE
Office of Electrical Inspector
CERTIFICATE OF INSPECTION
owner, and occupied as
PERMIT
No.- .
ELECTRICAL 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. „/".,
Owner's Name and Address _________ "' "" No Street
Registered Architect and /or Engineer
Employing Electrician's Name
and Legal Description
No Street__
Block
Street and Number where work is to be performed —No ,,,d- __ Arad- _ �_� 1 Street__ ____________________
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition
Service Overhead Size Feeders Conduit
Underground
Type of Installation —Conduit Tubing ___ B.X.L Metal Moulding
00 MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
e
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Lot_
Main Sw
(Signed)
Amps.
Date
// 7/4/;
Repairs ____ No. of Stories ______ __________
Main Fuses___— _____Amps.
1___
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that be 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 com-
plied 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
lifensed by Miami Shores Village. /
(Signed) A _
,
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, 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.
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.
Master Electrican.
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
RECE'P'T'8
FIXTURES
NO.LAMPS
REFRI G.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
H EATER
STRIP
HEATER
TOTAL.
CONTR.
LIST,.•.�
Ifrr �_�_
/
CHECK
i
jjj
ENT.
SW.
DIST.
CAE.
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. „/".,
Owner's Name and Address _________ "' "" No Street
Registered Architect and /or Engineer
Employing Electrician's Name
and Legal Description
No Street__
Block
Street and Number where work is to be performed —No ,,,d- __ Arad- _ �_� 1 Street__ ____________________
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition
Service Overhead Size Feeders Conduit
Underground
Type of Installation —Conduit Tubing ___ B.X.L Metal Moulding
00 MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
e
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Lot_
Main Sw
(Signed)
Amps.
Date
// 7/4/;
Repairs ____ No. of Stories ______ __________
Main Fuses___— _____Amps.
1___
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that be 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 com-
plied 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
lifensed by Miami Shores Village. /
(Signed) A _
,
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, 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.
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.
Master Electrican.
Amount of Permit S - --
ss.
APPLICATION FOR ELECTRICAL PERMIT
Permit N o _ _ _ _ _ _ _ _ _ _ _ _ __________ 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.
Owner's Name and Address _ _ No. — _________— —___ —_ Street__
Registered Architect and /or Engineer
My Commission Expires
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
t
Employing Electrician's Name _�,!e__�__r_ ____— No ____ —___ Street__
Location and Legal Description Lot_ Block Subdivision_ —___— ' --
'
Street and Number where work is to be performed —No _�„.
–
. .F –_ �! _ - -__ Street __ �/
.
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition.. Repairs
Service Overhead Size Feeders______ Conduit
Underground
Type of Installation— Conduit Tubing B.X.L. Metal Moulding
Main Sw __
(Signed)
Amps.
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that be 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 com-
plied 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
STATE OF FLORIDA,
COUNTY OF DADE.
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, 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.
Notary Public. State of Florida
No. of Stories
Main Fuses___ — ___________Amps.
Master Electrican.
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'S
FIXTURES
NO. LAMPS
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0-1 HP
MOTORS
1 -5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
L X
CHECK
Amount of Permit S - --
ss.
APPLICATION FOR ELECTRICAL PERMIT
Permit N o _ _ _ _ _ _ _ _ _ _ _ _ __________ 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.
Owner's Name and Address _ _ No. — _________— —___ —_ Street__
Registered Architect and /or Engineer
My Commission Expires
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
t
Employing Electrician's Name _�,!e__�__r_ ____— No ____ —___ Street__
Location and Legal Description Lot_ Block Subdivision_ —___— ' --
'
Street and Number where work is to be performed —No _�„.
–
. .F –_ �! _ - -__ Street __ �/
.
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition.. Repairs
Service Overhead Size Feeders______ Conduit
Underground
Type of Installation— Conduit Tubing B.X.L. Metal Moulding
Main Sw __
(Signed)
Amps.
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that be 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 com-
plied 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
STATE OF FLORIDA,
COUNTY OF DADE.
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, 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.
Notary Public. State of Florida
No. of Stories
Main Fuses___ — ___________Amps.
Master Electrican.
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.
APPROVED:
Zonin
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
5 72 E 91- c—
Date ax Folio
al 7 /9 ' J o bAdd ress
ription
Owner / Lessee / Tenant i,//9iu b/94 Master Permit # 3
Owner's Address AS Alelev.'
1 Phone 0
Contractin_ Co.
Mechanical
nicipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor
Permit Type(circle o
WORK DESCRIPTION k kC C ( C -( 1 Oi✓ ( 19--x)
( 4 Ic•60
Square Ft. Estimated Cost(value)c0
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 AFFIDAV tify at all the foregoing information is accurate and that all work will
be done com' ianc ih a applicable laws regulating construction and zoning. Furthermore, I
autho the above =• co actor to do the work stated.
: BUILDING 'LECTRICAI PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
owner and or Co do President
0 0m1104 01
01
2 �' A` ,T
, c I 1 , e �
Notary as to iwtick ndf
My Commissions pi Mi4336
.
)
* * 11/111 St0‘ * *
FEES: PERMIT 1 RADON C.C.P. *-
Signature
Date:
(Address 26 2t&
Phone aS O L
Address
of Con mpagsw, 4/ o Owner- Builder
Oaralk
V,..-
s z,9m L
Notary as tdE €dntratctvr • • ilder
My Commissioijc cpfRW
i •Y 7A!egr cX
NOTARY TOTAL DUE ,
Fire Other
Building Electrical
lumbing Engineering
Alr Co diigning
,.
•o� 01
Carrier
• b•.e.
Crr.n C«pO.0 1
_
Carrier Parkway
Syracuse. New York 1 :1221
•
Commercial Air Conditioning
11
I . . 1 . ;
r
l
I 1 r
I`1 1 ..I
.1. I ,...
1.
.1
1.
; .1 .
1. . i 1
:;
RESIDENTIAL Am CONDITIONING CO,
20750 NE 16 Cqu T
Nofi1H MIAMI BEACH, Fi. 93179
•
1� j�
• prepered tor, Ri N `` bJ Ate
AddressJ Re R s
•m�c�� S �-4��,�5
Estlmetot '15 4 "' / O4 g ' j.
5alesmr �'
144 a wk
Job-No g43- 942.5
Unto
..
ii •.1
1.. .1.r 1 .
1 . r .
' • r r.
1 1 1.,• r I .
1..1 : :I r, • - r
I r 1 . r
-.- 11 1 1. 1 1 L-. I `i1 Ji
artier
Air Condiioning
• CMMr cn•0o'.1.0•1
.
• Carr/ill'
Cahler Parkway Sricuie. New void 1:1771
Commercial Air Conditioning
TIESIDENT1AL ton cotannof IINQ co,
207.50 NE 1 CQpUf)r
NO111I1 MIAMI BEACH, EL 93I7
• i•
011E*
1
• •
Prep/nod for. Rk Ate
Addl ett 53 t - 1 R S •
R�5
Ettinintor 04 1R
SnIes111rIn 5 . 14 1 a La‹.
Job No,
El
5 t 'T" t • 1 + ea,
t f I 1 : 1 1{
•
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11-
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'.r
Permit No 415
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
As, JA.
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 co plied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work. .J
.?�'✓ No.
No C3 7 Street q r
Owner's Name and Address
Registered Architect and /or Engineer f _ . –
Employing Electrician's Name
Location and Legal Description Lot `` Block Subd ivjpion � �
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 o. of Stories
9
Street
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation— Conduit Tubing B.X.L Metal Moulding
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 fro. a - tractors or subcontractors employed by him in the
work to be performed under this permit; and will post or cause to be posted fo
as are required by the Act. The undersigned agrees to employ only such sub-
licensed by Miami Shores Village.
on the site of he work such public notice or notices
n work to bjperfo d under this it, as are
STATE OF FLORIDA, 1
COUNTY OF DADE. J j
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.
85.
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'7'S
FIXTURES
NO. LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANG
CONN.
WATER
HEATER
W. HEAT.
CONN.
ACE
H ATER
STRIP
HEATER
TOTAL
CONTR.
LIST
(
J /
- �
, t
i
7J
ai
CHECK
ENT.
SW.
DIET.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.8 HP
N EON
TRANS.
RADIO
TOTAL
CONTR. I ST
LIST
/fi
,�
�
CHECK
Permit No 415
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
As, JA.
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 co plied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work. .J
.?�'✓ No.
No C3 7 Street q r
Owner's Name and Address
Registered Architect and /or Engineer f _ . –
Employing Electrician's Name
Location and Legal Description Lot `` Block Subd ivjpion � �
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 o. of Stories
9
Street
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation— Conduit Tubing B.X.L Metal Moulding
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 fro. a - tractors or subcontractors employed by him in the
work to be performed under this permit; and will post or cause to be posted fo
as are required by the Act. The undersigned agrees to employ only such sub-
licensed by Miami Shores Village.
on the site of he work such public notice or notices
n work to bjperfo d under this it, as are
STATE OF FLORIDA, 1
COUNTY OF DADE. J j
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.
85.
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.
Date 5S Job Address
Lessee / Tenant ISryik
Owner's Address "5 3 ou & 9 15 rre-er
Contracting Co. +1q N bid J SPC L/a ( )
State # E6-0'X
Architect/Engineer N
Bonding Company N
Mortgagor
Square Ft. 2058
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
rv if(
Notary as to 0 r and/or Condo President
My Commission Expires:
I1EES: PERMIT L I I / RADON
53 No STf 71TaxFolio 4 ) — Cal ' ,l/ 7
Legal Description L 0 4- J q y? 0P- L01 19 Leg Historically Designated: Yes No
Qualifier C k G l / ( 4-EG N U/lJ SS# P h o n e 3 / 2 3 3
Municipal #
Permit Type (circle one): BUILDING ECTRI I PLUMBING
WORK DESCRIPTION &1 /q 2 A- l g M
1"/W 31 q-- , ))e c
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.
Competency #
Address
Address
Address
Building
Master Permit #
756 s C)
Address 1'18Y/ Sv (? (1
MECHANICAL ROOFING PAVING FENCE SIGN
Estimated Cost (value) 100
Signature of Contractor or Owner- Builder
1111
s'on Ex ires:
m
RICK ZANIELINSKI
MY COMMISSION 1 CC 917967
t; EXPIRES: September 20, 1997
laded Thou Nosey Put* Itndenrrllus
Notary as to Cone for or Owner- Builder
My Co
C.C.F. NOTARY
APPROVED:
Zoning
Mechanical Plumbing
Electrical 10
Ins. Co.
TOTAL DUE Itt k a
,/
Dat
ate
Engineering