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ELECTRICALPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 01 /19 / 200 (lob Address 55 NF, 99 ST TaxFolio 11-3206-011-1990 Legal Description Historically Designated: Yes No Owner/Lessee/Tenant M A R T A C T, A U D I A O T, A S O Master Permit # 961/ Owner's Address 55 NE 99 ST MIAMI SHORES VILLAGE Phone 305 - 757 -6305 Contracting c IVE D CORPORATION Address 2910 NW 32nd ST Qualifier ANGEL GUTIERREZ SS# Phone 305 - 633 -3660 State# ER- 0009181 municipal # 30- 1231026 c ompe t ency #CC000014912 Ins. Co.UNION AMERICAN Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION WILL REWIRE ALL CIRCUITS AROUND THE HOUSE.AND WILL REPLACE ALL ELECTRICAL DEVICES AS OF RESEPTACLES SWITCHESAND LIGHTS FIXTURES Square Ft. Estimated Cost (value) $3000.00 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOU" 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.) 1 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. : N'vand/or Condo President 2 _ t �0��� O°N NUYBER , I.: `CC797277 9 t F "R MY COMMISSION EXPIRES OF FA DEC. 17,2002 Si ture of owner and/or Condo President otary as to Own My Commissi ., ,O A Ott FEES: PERMIT r‘r RADON APPROVED: Zoning Mechanical 62 Date Date Building Electrical Notary as to Contractor or er- Builder My Commission Expires: C.C.F. NOTARY BOND ,69-7e6„, �'"►•� Ivelisse Cohen * ,!. :,y *My Commission CC887088 %„n Expires December 13, 2003 TOTAL DUE / ate Plumbing Structural Engineer ITEM BATH TLB UNIT FEE ITEM SWITCH OUTLETS UNIT No `c" 1 "kM ITEM SPACE HEATcE S CENTRAL '€.&T I NG UNIT FEE � BIDET LIGHT OUTLETS DIMS-ER RECEPTACLES te 7z2 A/C (AIPO) • DISPOSAL SERVICE TEMPORARY A/C (:131TRAL) DRINKING FOUNTAIN 'SERVICE SIZE IN APS GLtT UK FLOOR DRAIN I. SERVICE REPAIR/METER CHANGE 1 REFRIGERATION GREASE TRAP APPLIANCE OUTLETS • /j/ 4 PROCESS AND PRESS PIPI INTERCEPTOR l RANGE TCP 74 I UM3ORMID TANKS LAVATORY OVEN ABOVE MIND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSLRE VESSELS CLOTHES WASHER 1.OTCRS 0- 1 HP ( STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK. POT/3 COMP. LOTCRS OVER 3- 5 If I MECHANICAL VENTILATION SINK. RESIDENCE MJTCRS OVER 5- 8 HP I TRANSPORTING ASSEbBLIES SINK. SUP MOTORS OVER 8- 10 HP 1 ENATORS/ESCALATORS TEMPORARY WATER CLOSET I )OTCRS OVER 10- 25 HP FIRE SPRINKLER SYSTE)S URINAL KITCRS OVER 25-100 HP I COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES A/C WINDOW I 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 SWIM % POOL • OUTLETS COI4 RCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -MUER FIXTURES SEPTIC TANK ANTENNA • RELAY TELEVISION OUTLETS GRAINFIELD, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINS?ECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER • FIRE STANDPIPE POOL PIPING —� I LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING (AN APPLICATION FOR BUILDIING PERMIT MUST ACCOMPANY THIS ADDENDUM. I? A MASTER PERMI= HAS 3. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION ELECTRICAL MECHANICAL CHECK ENT. DIST. SERVICE SERVICE : . 'MOTORS MOTORS NEON RADIO TOTAL SW. CAB. TEMP. PERM. 0.1 HP 1.8 HP TRANS. CONTR. LIST Increase service to 130 Am 2,OC CHECK Permit No Z S' Owner's Name and Address MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT 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. Chas. Manday No 55 Date July 8, 1963 Street 99 Registered Architect and /or Engineer Tel FL" 1 Employing Electrician's Name Lewis C, Wagner Electric No.9930 ....I ..- .7 ...AV Street Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No 55 Street 99 State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories 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 acce r r his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws • 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. STATE OF FLORIDA, COUNTY OF DADE. I ss' (Signed) 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 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 L LIGHT P PLUG F FIXTURES R REFRIO. I IRON R RANGE R RANGE W WATER W W. HEAT. A ACE S STRIP T TOTAL CONTR. LIST 3 3 1 1.5C Permit No Z S' Owner's Name and Address MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT 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. Chas. Manday No 55 Date July 8, 1963 Street 99 Registered Architect and /or Engineer Tel FL" 1 Employing Electrician's Name Lewis C, Wagner Electric No.9930 ....I ..- .7 ...AV Street Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No 55 Street 99 State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories 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 acce r r his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws • 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. STATE OF FLORIDA, COUNTY OF DADE. I ss' (Signed) 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 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. 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 compli d 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 Amount of Permit $ STATE OF FLORIDA, 1 COUNTY OF DADE. I APPLICATION FOR ELECTRICAL PERMIT Registered Architect and /or Engin er Employing Electrician's Name 1lQ Ss. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT No Street SI No ! Street WZ" Location and Legal Description Lot Block q, Subdivissio 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 Service Overhead Site Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation -- Conduit Tubing B.X.L Metal Moulding (Signed) C ' i4 ' , " . The undersigned applicant for this building permit does hereby certify that he understands and a labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws has complied with the provisions thereof, and will require similar compliance from all contractors or work to be performed under this permit; and will post or cause to be posted for inspection on the site as are required by the Act. The undersigned agrees to employ only such sub-contractors, on work to licensed by Miami Shores Village. (Signed) Before me, the undersigned authority, a notary public, duly authorized to administer oaths appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he of the above described construction, and he has carefully read the foregoing application, and therein by him stated are true. Date. ®� o o 7 3.-17 5° Electrical Inspector. ccepts his obligations as an employer of of Florida Permanent Supplement, and sub-contractors employed by him in the of the work such public notice or notices be peyformed under this permit, as are Master Electrician. and take acknowledgments, personally is the that he did sign the same, and that all facts 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 REFRIG. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. apcit HEATER STRIP HEATER TOTAL CONTR. L187 IET CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0-1 HP MOTORS 1 -5 HP N EON 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 compli d 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 Amount of Permit $ STATE OF FLORIDA, 1 COUNTY OF DADE. I APPLICATION FOR ELECTRICAL PERMIT Registered Architect and /or Engin er Employing Electrician's Name 1lQ Ss. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT No Street SI No ! Street WZ" Location and Legal Description Lot Block q, Subdivissio 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 Service Overhead Site Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation -- Conduit Tubing B.X.L Metal Moulding (Signed) C ' i4 ' , " . The undersigned applicant for this building permit does hereby certify that he understands and a labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws has complied with the provisions thereof, and will require similar compliance from all contractors or work to be performed under this permit; and will post or cause to be posted for inspection on the site as are required by the Act. The undersigned agrees to employ only such sub-contractors, on work to licensed by Miami Shores Village. (Signed) Before me, the undersigned authority, a notary public, duly authorized to administer oaths appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he of the above described construction, and he has carefully read the foregoing application, and therein by him stated are true. Date. ®� o o 7 3.-17 5° Electrical Inspector. ccepts his obligations as an employer of of Florida Permanent Supplement, and sub-contractors employed by him in the of the work such public notice or notices be peyformed under this permit, as are Master Electrician. and take acknowledgments, personally is the that he did sign the same, and that all facts 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. BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Address of Building 0 0 r , Architect Contractor or Builder J ' Legal Lot Description MIAMI SHORES VILLAGE, FLORIDA PERMIT N° 4842 Subdi- vision Bl. Contractor's Li License No. / Work to be performed under this Permit DATF 7-1 Value of I) Amount of Project $ II Permit $ 1957. 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 thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings cr in the statements o 0speci cations and that he assumes responsibility for work done by his agents, servants or employees. Signed 7/ /" 1 BY ° INSPECTOR ` In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances arid regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shore Village. In ac- cepting this permit I assume responsibility for all'vnork done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY •'1 AUTHORITY BRACKETS RECPTACLES SWITCHES STOVES WATER HEATERS SIGNS OTHER APPARATUS SUBS BRANCHES LIGHTS CEILING BRACKETS IENT / DORS FIXTURES ONLY NUMBERS OF TOTAL OUTLETS SIZE OF SIZE SERVICE CONDUIT No, CIRCUITS MAIN SUBS BRANCHES LIGHTS CEILING BRACKETS IENT / CZ I 69 JD_ ■ I Desiring your certificate of Approval, application is hereby made for an inspection of the electric installation in the premises stated below, for which undersigned agrees to correct any infractions of the National Electric Code and the City Ordinance pointed out by Inspector. LOCATION AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED OR APPLICATION WILL BE RETURNED LOT NUMQ `a/ , BLOCK UMBER � / SUBDIVISION `� � _ OCCUPANT STREET. AND NUMBER OWNER OCCUPIED As BUILDING- -NEW OR OLD (UNDERLINE WHICH) H. P. OF EACH MOTOR VOLTS TOTAL AMPS CEILING KIND OF INSTALLATION OPEN OR CONCEALED FL BASE FIRST SECO THIR FOUR REMARKS RECEIVED BY INSPECTOR PROGRESS WILL INSPECT AGAIN ROUGH WIRING FINAL No. CORRECTED TEMPORARY __— DAYS DATE ISSUED APPLICATION ELECTRICAL DIVISION OF THE CITY OF MIAMI REMARKS FEE REMITTED iioi j SIDE WORK -- ADDITIONAL, NEW, ALTERATION OR REPAIR SPECIFICATIONS KNOB, RX.. BX., MLDG., CONDUIT, METALLIC TUBING ADDRESS • INSPECTION WANTED DATE SPACE BELOW FOR INSPECTOR'S USE ONLY INSPECTED ( NO �T AW 1931 PHASE INSPECTOR ' 1 j ELECTRICAL PERMIT N. B. —This Permit must be on display on the premises during the construction. Owner of Building Contractor or Electrician STREET PART OF LOT LOT BL'K NO. Outlets Motors Receptacles Generators Stoves DESCRIPTION OF WORK dd(iami Jhores9 llage F L O 8 ID A OFFICE OF ELECTRICAL DEPARTMENT Miami Shores Village, Fla , 19 LO CATI 0 N Water Heaters NUMBER OF Signs Billboards Other Apparatus SUBDIVISION N° 296 Permit Fee This Permit is granted upon the express condition that all facts stated in the Application are true and that the construction complies strictly with the plans and specifications submitted and are in accordance with the Electrical Laws of the State of Florida and with the Electrical Ordinances and Code of Miami Shores Village and the rules and regulations of the Electrical Department of Miami Shores Village. This Permit may be revoked at any time upon the violation of any provisions of said laws, ordinances, or rules and regulations, or upon any change in the plans and specifications unauthorized by his Department. , Electrical Inspector. In consideration of the issuance to me of the foregoing Electrical Permit, I hereby agree to do the proposed construction in strict conformity with e Application and the plans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all Electrical Laws of the ate of Florida, all the Electrical Ordinances and Codes of Miami Shores Village, and all rules and regulations of the Electrical Department of Miami ores Village. Dated , 19 (Seal) NO. STREET PART OF LOT LOT BL'K SUBDIVISION Water Heaters A Z . `r; Pi v l (5 e l t 1 17 9 i At- NUMBER OF Outlets Motors `Ilte+cpts'` iale*c Stoves Water Heaters Signs wgods Other Apparatus Permit Fee 71 i • • ®a ELECTRICAL PERMIT N. B. —This Permit must be on display on the premises during the construction. Contractor or Electrician aiami chores9illage F 1. 0 R 1 D A OFFICE OF ELECTRICAL DEPARTMENT f Owner of Building td Miami Shores Village, Fla , /L LO CATI 0 N DESCRIPTION OF WORK This Permit is granted upon the express condition that all facts stated in the Application are true andthat t` construction complies strictly with the plans and specifications submitted and are in accordance with the Electrical Laws of the State of Florida and wi the Electrical Ordinances and Code of Miami Shores Village and the rules and regulations of the Electrical Department of Miaalli Shores. Village. This Permit may be revoked at any time pon the violation of any provisions of said laws, ordinances, or rules and regulation p or on any hangs in the plans and specifications unauthorized by his Department. In consideration of the issuance to me of the foregoing Electrical Permit, I hereby agree to do the proposed construction in strict conformity with Application and the plans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all Electrical Laws of the to of Florida, the Electrical Ordinances and Codes of Miami Shores Village, and all rylees-an re lati is of the Electrical Departm nt of Miami res Village.-d . Dated N° 296 • , Electrical Inspector. (Seal) THIS CERTIFICATE MUST BE PRESENTED TO THE ELECTRIC COMPANY WHEN APPLYING FOR SERVICE. by for TOWN OF MIAMI SHORES Office of Electrical Inspector N? CERTIFICATE OF INSPECTION THIS CERTIFIES that the wiring and apparatus installed at d V r' y d ^ Address Other Apparatus has been inspected and current is authorized to be turned on, until otherwise notified, for: Lights: Number of lamps ,, Heating: Stove % �',� T F ;=`sf watts. Water Heater watts owner, and occupied as Watts Power: Connected load H. P. volts phase cycle 125 Electrical Inspector. PERMIT APPLICATION FOR MIAMI SHORES VIILLAGE Date N UU .29, I '1 Job Address 55 N' 9 T Tax Folio /I 3266 - ` 3 -1 27D G Legal Description 1 6 N /a r (7 (31 CL <1 Historically Designated: Yes No Owner/Lessee / Tenn' t ' C ftS 0 Owner's Address Signature Not 1' PERMIT APPROVED: Zoning Mechanical My Commission Expires: g 91 7i e7 Contracting Co. Op +I (Y1 q. 5e CCt(1,n ,,N,( Address Qualifier CiAa Oes -J L ) SS# / State # E A 000 y Municipal # 3 0 3 2'i ' Competency # Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDIN WORK DESCRIPTION ( IC{ K fl M VLl/ i 3 twe( - Square Ft. Estimated Cost (value) 110 0 ---' 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. of owner and/or Condo resident Date RICK ZABIELINSKI ;.'= MY COMM13SIf N.# CC 3173f5t W EXPIRES: Septe!i~cr `n, 19t• 4L _ z ____s -- o RADON Address Address Address PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN Signature of Con actor or Owner-Builder Notary as•to My C . NOTARY Building Master Pernut # A/// �C7Z Phone N/4 4 1`168 St-71 w irr(c .. Phone 235 / 5yr 7 Ins. Co. <14 f) — Wt'' tractor or Owner- Builder ssion Ex • ires: 1J i 5 Date /bv 25 9 Date TOTAL DUE (2 ID Plumbing Engineering