ROOFING1
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date a D Job Address 1 f WA St Tax Folio
Legal Description
/Tenant Bill Brcdy
ME4, IDI.6+►
Contractin Co. < &LU &t +r'iJ< R MA,0
Pa4A]
Owner's Address
Qualifier
State # Municipal #
Historically Designated: Yes No
Master Permit # /./ Vgg
Phone (o5') J73C--- 3 tIES
Address ! t S MEt 9 n d st
SS# - /® aTQi Phone (3P5) 0 19
Competency # 1.2 BSV Ins. Co. 1_.e6k• �• ��
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
nA ff
WORK DESCRIPTION fear a? 51 n v) 1 1 wwo p k ck h e,
[Aotrl er o(cr-W\rvco+ ry 11 coN,G' e -ft [e' Cook All tiles saott eo %v-
Square Ft. 4,2 R.00 or aa Estimated Cost (value) 4 I fLf 0012 00
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER
OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work
will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S A}FIuAVrr: I certify that all the foregoing information is accurate and that all work will be done m'�compliance with all applicable laws regulating
construction and zoning. urthennore, I authorize the above -named contractor to do the work stated.
Pi. 042 5 76 ' o 4 4 fr)
Signature Qf owner and/or Condo Presi
Notary as to Owner and/or Condo President
My Commission Expires:
FEES: PERMIT
Date Suture of Contractor or
J/7
ARLENE J. BYRD
MY COMMISSION # CC 655074
.1 'WIRES: June 12, 2001
a F4 Bonded Thni Notary Public U
APPROVED:
Zoning
Mechanical Plumbing
er- Builder
3 ) ' 7) x /
Date
• , /t
• • o Cons : t. or - m . • FFICSF•L �0 ' I " Date
My Commission Expires: 01 e ANGELA as F ' `'
2 fir' r (" cOMM •O': ,n, - lei; J
it O
NOTARY c 0 d
Electrical
to
's-OF 0 - ° NOV. IS °
. ON r I.
c Ce7aGCc 7
BOND 300
TOTAL DUE
Structural Engineer
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOLIO NO.
STATE OF FLORIDA:
COUNTY OF DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property. and in accordance with
Chapter 713, Florida Statutes, the following information is provided dd in this Notice of Commencem en r
1. Legal description of property and street address: ( Litt I " eE ° 101 �' �` �U` ( ,5);b1-c6
` L-
2. Description of improvement:
3. Owner(s) name and,address:
4. Contractor's name and address:
6. Lender's name and address:
Interest in property:
Name and address of fee simple titleholder:
P&LL W& 1eK, H45 ME GI d
M hot- e6 FL.._. =;1I ;
5. Surety:(Payment bond required by owner from contractor, if any)
Name and address:
Amount of bond $
1 H r E OF FLORIDA, COUNT OF DADE
I HFR =o v CERTi!'Y (;, tills is a tr
original fil
• ..n
/
AMERIIP
A
W/TN =SS my harm n . • % J
HAtRJEY RUVfN
t C
•'':
7. Persons within the State of Florida designated by Owner
1
s��ryother` , • served as provided
by Section 713.13(1)(a)7., Florida Statutes, f/ /
Name and address:
8. In addition to- himself, Owner designates the following person(s) to receive a copy of the Uenor's Notice as provided in
Section 713.13(1)(b), Florida Statutes.
Name and address:
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
different date is specified)
ignature of Owner
Print Owner's Name
LuiI !IC#rt
Sworn to and subscribed before me this
Notary Public
7ri;it Notary's Name ' cne. V
My Commission Expires Li
Q I i 1 Bra') 1• ! q v0E4, 101 .431, o re5
NQ COU
CLERK
hr
PY of the
d.
of
b. L 0 L I2S610
"i(
1 day of t'1'y{� ih
C)
0 1R 1 10974 2001 IIIAR 03 14:
Prepared by 'KW C11�t, R lek
.;;';;: , ARLENEAdi s'
,
655071 MY COMMISSION Y CC B5507T
' ' yam, MIRES Juno 12, 2001
• j y N° Y Bonded hN Notary Public Unthi iters
W5 N•E
'ih.,ra f
2
Contractor's Name:
❑ (Low Slope Application)
Pain Kawa l eJS
❑ (Asphalt/Fiberglass Shingles) ❑ ( Metal Roofs \Wood Shingles & Shakes) ❑ (Other)
ROOF TYPE
❑ New Roof W Re- roofing ❑ Recovering ❑ Repair ❑ Maintenance
Flat Roof Area (ft') V Sloped Roof Area (ft') c2A0D Total (ft') Iq Master Permit No.
Exposure category (per ASCE 7 -88): Building Classification category (per ASCE 7 -88 table 1):
Ft.
n
v
Ft.
V
A
NO i
Deck type:
ATTACHMENT
Fastener Type:
SPACING
Field: Perimeter: Corner:
123.01 -78 4/99
DETAIL 1 & 2
Appendix "E"
UNIFORM ROOFING PERMIT APPLICATION
PROCESS No.
ROOF CATEGORY
❑ (Nail -On Tile)
Job Address: 1 I L 1 1 4E, (0
ROOF HEIGHT AND SYSTEM DETAILS
(Draw details as needed)
Page -1
(Mortar- Adhesive Set Tile)
ROOF PLAN
Rid a Ve t' n'
MEAN HEIGHT
Deck type:
\C
A z Underlayment
Insulation:
12"
ROOF SLOP[
D E T A I L 3
:1 � k X (Aerodynamic Multiplier):
(Pmax2: 1X (Aerodynamic Multiplier):
(Pmax3: I2Si1 ? (Aerodynamic Multiplier):
Appendix "E "'
UNIFORM ROOFING PERMIT APPLICATION
PROCESS No.
SLOPED SYSTEM DESCRIPTION
- 430 F�1t'
N /Ac
Fastener type & spacing:
Vq" ing shank nai l ii ok e
l
d �'
Cap Sheet: `410 S
Roof Covering: Mona- ro11� Ip colic r d 0'or
1 4-hro
TILE CALCULATIONS
M 5 M �� /PCA: 66
M 5 = M PCA: 9 'J
M = M +PCA: /65
Drip edge:
a xa w h 11
ATTACHMENTS REQUIRED
1) Fire Directory Listing Page
2) Miami -Dade County Product Control
Notice of Acceptance -Cover Sheet
a) Specific System Description
b) Specific System Limitation
c) General Limitations
d) Applicable Detail Drawings
3) Municipal Permit Application
4) Other Component Approvals
Po y
S��
APPENDIX "F"
REQUIRED OWNERS NOTIFICATION FOR ROOFING CONSIDERATIONS
As it pertains to this Appendix "F', it is the responsibility of the roofing contractor to provide the owner with the required
roofing permit, to provide the owner with this appendix and to explain to the owner the content of this form. The provisions
of Chapter 34 of the South Florida Building Code (SFBC) govern all the minimum requirements and standards of the indus-
try for roofing system installations. Additionally, the following items should be addressed as part of the agreement between
the owner and the contractor. The owner's initial in the adjacent box indicates that the item has been explained.
1. Aesthetics - Workmanship: The workmanship provisions of Chapter 34 are for the purpose of providing that the roof-
ing system meets the wind resistance and water intrusion performance standards. Aesthetics (appearance) issues are
not a consideration with respect to workmanship provisions. Aesthetic issues such as color or architectural appearance,
that are not part of a zoning code, should be addressed as part of the agreement between the owner and the contractor.
‘ Renailing Wood Decks: When replacing roofing, the existing wood rocf deck may have to be renailed in accordance
with the current provisions of Chapter 29 of the SFBC. (The roof deck is usually concealed prior to removing the
existing roof system.)
8�.
123.01-12 PAGE 2 7/99
Common Roofs: Common roofs are those which have no visible delineation between neighboring units (i.e. town-
houses, condominiums, etc.). In buildings with common roofs, the roofing contractor and/or owner should notify the
occupants of adjacent units of roofing work to be performed.
Exposed ceilings: Exposed, open beam ceilings are where the underside of the roof decking can be viewed from
below. The owner may wish to maintain the architectural appearance, therefore, roofing nail penetrations of the under-
side of the decking may not be acceptable. The SFBC provides the option of maintaining this appearance.
2 5. Ponding Water: The current roof system and /or deck of the building may not drain well and may cause water to pond
(accumulate) in low -lying areas of the roof. Ponding can be an indication of structural distress and may require the
review of a professional structural engineer. Ponding may shorten the life expectancy and performance of the new roof-
ing system. Ponding conditions may not be evident until the original roofing system is removed. Ponding conditions
should be corrected.
f 3 6. Overflow Scuppers (wall outlets): It is required that rainwater flow off so that the roof is not overloaded from a build
up of water. Perimeter /edge walls or other roof extensions may block this discharge if overflow scuppers (wall outlets)
are not provided. It may be necessary to install overflow scuppers in accordance with Chapter 23 of the SFBC.
U3 7. Ventilation: Most roof structures should have some ability to vent natural airflow through the interior of the structur-
al assembly (the building itself). The existing amount of attic ventilation shall not be reduced. It may be beneficial to
consider venting which can result in extending the service life for the roof.
t1 3 8. The owner may contact the Miami -Dade County Consumer Services Department for further information regarding
the above.
Owner's /Agent's Signature
3)bJ o( irluziPedl
Date Contractor's Signature
Monier Lifcri LLC
135 NW 20 Sr.
Boca Raror. .
/ •
12.30,1599
FL 33431
•
PRODUCT CONTROL NOTICE OF ACCEPTANCE
.••
CODE ?aopLc
' •- • •
312 DING CODE COIPLIANg
- 3 DtN C
=37 F.: AC; E?. ST?.EET. 3TZ :O3
375•2';C: FAX 375-2903
r L:CENSINC SF-CTION
375;2..5:7 F. 375-255;
COY7.RACTOR ENFORCE:4ENT.5ECTION
- ..'7.5-2.';-36 FAX f.3;35) 37-29C,3
?':0
375-2;C: FAX t305, 372-633;
VZIL Rot/ Capri r
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APPROVED :Dec
EXP RI'S :December- 16.200'
NOTICE OF ACCEPTANCE: STANDARD CONDITIONS
SCOPE
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5.73C :3, c:o no: -in
27 using ya:u..ts 4 ne.7t:n. rne
zalcu:a::o 7.S 3Z e. 0:1.2 as a 77.0
PRODI:CT DESCRIPTION
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a: . 7.;2s. rakes. :
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'•i'��IER, IE=TILE LLC• .ACCE ?T.A CE Y.
NOTICE OE ACCEPTANCE: STANDARD CONDITIONS
?_1 Components or products manufactured by ochers ohs
Y
N/ ]' :23
Tesz
5277:7..3
—
A??ROVED :December 30,19
EXPIRES :December 16. 200'
... .. _'se: Toe _.._
YC
C:,. ..._. • ._..
P.0
M(ONIER EIFETILE LLC
NOTICE OF ACCEPTANCE: STANDARD CONDITIONS
Test Produce
Product Dimensions SSnecificatiorrs Descriorion Manufacturer
P.A _� ?r CSC_. ..._"_: V. R. 3c. -. ai o.
r or:a: se.
S et ? CA
ACCEPTANCE \o..
APPROVED :December 30, I9.99.•
EXPIRES :December 16.2002
Two comccr_.._
adnes: _ se:
roc:
1 - _
7.
•
3.2 ... :ric .... O aCnes: e. se.
-::"`," ' _C. ! acccrciance RAS 106.
•:e a:.. •h.e s�.r is s o: \. � "?i-D ad.. Coun:y
terra C'uC�_. , :esc in accor'-nc '.Y:C:t ?A i l2. accendix Suc'
shall sub'-" " -"^_ CO :he 3ialC;in Code COrrtoll.''..^.Ce OC" C.'.Cr
3.= Mirumum '_nderlayr.ents shall be in cornoliar.ce with the applicable Roofing
.
Applicators Stliear s listed section 4:1 neretn.• •
3.5
30'90 ::o_ mobbed '..adre.'la`%me: ^.0 a o1 caC;cins rna• %' :.e tnstalleC". 7e. 'C:c::' _o
: :00: sioce unless s:a:ec: oii e -v ?se b7 Cale" :'i?de rla ;: : ^.,e ^C . ^.:a:_." :al r:.ali_ : :....""'s.
^'_blis:'.e'- ii:-:
This
-:.e : :, 29 SF3C.
'JV 1. \i :.:., ..� ...
. . v
I, 7�
Ex.2......_r
snail
.1ONIERft...1FETILE Ur:
•
4
INSTALLATION
4.! Monier Li Ceti:Le Viif.a, Roil., and Cac: Conc7-te. RocfTL and its components staU
' in strict cocr.:31:anc,t with D;'e C.'- RcJir ApcLication
RAS 18,S 119. and R_A 120.
4.2 Lm Far Cz...1diilations
Fzil (..2;:tcri 0.257 0.25;
NOTICE OF ACCEPTANCE: STANDARD CONDITIONS
e'
Tile.
Profile
Table 2: Reszoring du e :o - fL (f7:-!b)
3":12"
215:r T. .7.‘•
• 2-10d Srr.cc:h or SorF....w
Shank Nails
1 #.3 Screw
Scrw
- Smooch cr Scre
Shank Nail (Field Cicl
Qc Smoot or Screw
Shank Nail (Eave Clio) l
1 2-10d Srhotth or Screw
Shank iails"(Fieid Clip) i
2-10,d Srncetn'or Screw
Sark Nails (Eave. Clic)
Table 1: Aerodynamic Multipt:ers (ft)
Eat.71:r, Applicazion
(rr;r1 1532"
24.3
••
APPROVED :December 30,1999.
EXPIRES :December 16, 2002
5:12" 5:12"
• E....;...7::er3 LIrec:• Dec:
• Dck.
Zacr: 5.57 .5.30 . 5. . 5.27 . 5.35 ••• • 5.'-30 5.73 .
Tat:e 3: -;"41.
for Sys:erns
Dire::: Deck
Direct Deck Application.
24.3
31.3.
e.
2-10C R;rg Shank Naiis' 43.0
a 4 :tie . rleadac and faszerners are 'cca a - rin. :f Arn
7:1" or
cre.a:er
4.7
25.3 22.;
43.1
22.1
,
35.5 •
31.9 J. • •
rranufac :1r es accrcval fcr :r.scaila; ion racuirer ePis.
- x :Cie , .cc.;c :s . r"car.y I i leScrld Average weight :er a :/ ...— grams.
Pr:cuc :. •n•c. •A' %erage. ''lent :er Ja::V 3 grams.
ile
Profile
— ... :a: :'f - ace' •ar: -i - -_rams
Tile Aaalite :ian
M .TFETILE LLC '.- CCEPTA`CE,N;:
.APPROVED :Decemb6 199'9
EXPIRES :December 16, 2062
NOTICE OF ACCEP =TANCE: STANDARD CONDITION
Table Attachment Resistance Expressed as a Moment M, (ft -lbf) i
for Two Patty Adhesive Set Systems
Tile ! Tile Application Minimum Attachment
Profile j Resistance
Mcnier i ifo.ile ' /;la, Pell, and Adhesive 2
_
Ca: i %l.=
Table 4A: Attachment Resistance Expresse.d as a Moment - M, (f-lbi)
for Single ?at'y Adhesive Se: Systems
Minimum A.- achment
Resistance
Ta e. .. ::achmen: Resistance Extresse: as a :VI '� - "�1.(i.-i
:i -
i :'i1:r7_.r Set Systems
. I(° iii= A...- ac"r^,an:
:e .A.-,-,ciicat:on R e.sis :anc
LABELING
'v(:am - Dad_ `.O! : t; 7 :o ict
BUILDING PERMIT REQLIRE:MIENTS
6.1 Application. for vv ^l1IiC g Ce,::�1: s%11E 3Ccoi":o=' tz.. t) •. s •,.... :O1 0
6.1.1 This Notice of Acceptance. _
6.1.2 Any other docu„ terifs re' i:lreCi o'+ Building Of.'c'a' or the Soum Flona�a'
Bui[ding Code (SF3C) in roCe '; ° va uaie Of this >VS.
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trrz:r a 'r�'. 1 ' :
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1._!*FETILE LLC
PROFILE DRAWLNGS
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ACCEPTAN
. -
:December 30. 19‘)9.,
:December 16,.200i
APPROVED
EXPIRES
NOTICE OF ACCEPTANCE: STANDARD CONDITIONS
r =7 :7\. 1.
Villa
MONIER LIFETILE ROLL CONrRETi." R00:-"-TILE
r•
�!O\tER LIFETILE LLC
MONIER LIFETiLE CAPRI CO:N; _ROTC ROOF TILE
: a
ACCEPTANCE No. 9q- 0)1
APPROVED :December 30; 119.
EXPIRES :December 16, 2002
NOTICE OF ACCEPTANCE: STANDARD CONDITIONS
aa RAC
Root rig Produce Conr.rof Exam: ^.r
\IO•N.IER LIFETILE LLC
END OF THIS ACCEPTAN
ACCEPTANCE No.: 99- 1012.02
APPROVED :December 30, 1999
EXPIRES :December 16, 2002
NOTICE OF ACCEPTANCE: STANDARD CONDITIONS
1. Renewal of this Acceptance (approval) shall be considered after a renewal application has been
filed and the original submitted documents, including test : supporting data, engineering documents,
are no older than eight (3) Nears.
?. Any and all approved products shall be permanently labeled with the manufacturer's name, city,
state, and the Following, statement: "Miami-Dade Count~: Product Control Approval ', or
specifically stated in the specific conditions of this Acceptance.
3. Rene'.vals of Acceptance will not be considered if:
a. There has been a char.v,e. in the South Florida Building Code ai.ecting the evaluation of .hi
product and the product is not in compliance with the. code. changes.
1 i I er :he a (identical) ica one ori'ainall` aooroved.
b. The product is no onp same pro..uc: (,tee, t...��) s ...
c. wi th a il :'he. ,ui,_�:�ents 'or this aCCeptance
[ t the .AC... � Ltar� - > iil;ld�r has nl;i complied ., „ ' C '
includin` the correct installation o(the product.
d. .The engineer ‘who orii7inall; ore ^are^, sic7ned and wale:. :he, re ouir _C d)C::mentatior. i ^...,a't
submitted, is no lor,',er practicing _..,. ermine_. in_ pro le»:. ..
„n r:-....vision V •visiOn or char in :he mate. :a;s. c. 1r.o:'C" 7''n•'u: _ O :
:he product or or•oCe;5 shal:
~ o a :or .;' :._:i armor ai as pee..
automatically be cause .�1 ...; :n i.. ., nl .. ...:s ._. - ..,_.�
requested (throu�r tiling of a revision aoolicat4 . '" ria... ro e) a nd and bl. his
office.
9. This Notice of Acceptance consists of pares l through 3 and this last pa'g::9.
_loaga, 9 R`
aro::uc:
.An'' tilt ioli0' .. ;HI': also be :Or r_.,.0'' ...2.'. . :i
1. ` :neat :�ilctor r :br..a :`ice til:5 pr._'uc: ... __'_]3 .
o. pia..__ as an enclorse<<._ - :. sales. ad. _ _• .
V rifer purposes.
' e,~er he. %cords �.ihami-Dade County. -.1a. an:.
5. Tile �+otice of ..c .eetance pumper pre by : � _ -
followed by the expiration date may be displayed in adverzisir.T.
literature. [ any portion of the
Notice of Acceptance. is displayed, then it siia!I be dome in l s
A copy o f well as approved dry nzs other documents, where it applies.
this acceptance as as � '.yi . any oa1.. �o
shall be provided to the user by the manufacturer or its distributors and shall be available For
inspection at the job site at all time. The engineer need not reseal the copies.
S. Failure to comply with any section of this .Acceptance shall be cause for termination and removal
of Acceptance.
Test Location
Uplift Pull
Test (P or F)
Test Location
Uplift Pull
Test (P or F)
Test Location
Uplift Pull
Test (P or F)
Test Location
Uplift Pull
Test (P or F)
1
1:74,4 4 V. D
2 6
FA ea?
51
FA .4e._D .
76
2
27
52
77
3
28
53
78
4
29
54
74
5
30
55
80
6
31
56
81
7
32
57
82
8
33
58
133
9
34
59
84
10
35
60
85
11
36
61
86
'
12
37
62
87
13
38
63
88
14
39
64
89
15
40
65
90
16
41
66
91
17
42
67
92
18
43
68
93
19
44
69
94
20
45
70
95
21
46
71
96
22
47
72
97
23
48
73
98
24
49
74
99
25
50
75
100
s
THIS REPORT SUB %' D BY:
Civil Engineer:
Lab Certification # 98- 0608.04
State of FL Certificate Authorization # 4100
U.S. SOUTH
Engineering & Testing Lab., Inc.
6065 N.W. 167th Street, Suite B -23 • Miami, Florida 33015
Telephone: (305) 558 -2588 • Fax: (305) 362 -4669
ON -SITE CONCENTRATED UPLIFT LOAD TESTING OF ROOF TILE IN
FULL ACCORDANCE WITH METRO -DADE BUILDING CODE COMPLIANCE
PROTOCOL PA 106
SITE SPECIFIC INFORMATION ri
Owner's Name: t I I & R l4 b v Permit #. `"I 811 g1
Job Address: l IA 4 t� >~ l O 1 5 1 - ., ( ► b4r.) Cf.
Roofing Contractor: k<41/4 F Lt ..),
Type of Tile kA (.‘ TY ? Ve)Aft S.T Date Installed. 3/20/6
Approximate Roof I l eight . IA.feet Roof Pitch` 4 * ` t 2 .
Type of Access to Roof: Scaffolds ✓ Ladder Other
Approximate Square Footage of Roof: ft
Required Testing Force: 35 lbs. Testing Equipment: Chatillion 100
Date Tested: 4 -1 - o t
TEST RESULTS
P = PASS, F = FAIL
IN ACCORDANCE WITH THE CRITERIA OF PROTOCOL PA 106, THIS ROOF ASSEMBLY HAS PASSED THE STATIC UPLIFT
QUALITY CONTROL TEST.
Project
N2 000938
KETCH OF ROOF
JOB
A t 4 4 lot 4T.,
" - OF
SHEET NO. ;� ^—
CONTRACTOR Fn s - F '- [1�-�
" 1
CHECKED BY DATE
SCALE
!i!IIiIUI hik,&
111■ •111■1■■ME o _/
Irk EIVETTNEPAII
uiiUiIiPI
_Etammu. i Era
lcommi 1I /�■■ a ■i'2
i .■, f�■■ , eTi ■1
I' ■I
1 <mmu■`ice I
1 �I
1 ■ ■ /7 \ ■ ■ ■C�'' /T' L•x 'Fill
1■■L'J P\■''.
1 :', �'� �" 64" 1 NI 4
s f
NOTES:
Date - 3 Job Address // "7 //
yy
Legal Description t.L;f ie/7 / 2 7
Owner / Lessee / Tenant /At CO. ✓tea 6
Owner's Address // 4 / ' // 5 / 0 /
Contracting Co. 4 4Ve-S 6i,/,%•: d /6 A -t•�•
Qualifier ...1a695
Signature of
Date :17%1y 7%1y (s
Notary as to Owner and /or Condo
My Commission Expires:
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FEES: PERMITS' td
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
owner and /or Con %o President
/ 993
)79.1A
RADON
President
, q::av' €,, EMMMA. GRANT
x = MY COMMIS$tON B CC 231685
ARC ,.:
Bonded ' '
EXPIRES: September 27, 1996
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y ��� �`• � de�ro
twrrs
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C.C.F.
Fire
Zoning Buildin
Mechanical Plumbing
/°/ Tax Folio //. 3 .7 0-5 v / j0V C a J
Master Permit #
Phone
Address //0D /i/4
SS# / - . Phone's - 3 0
State # 77./ 4 Waicipal 4P Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUUILDING ELECTRICAL PLUMBING MECHANICCAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 4 /Pa / 6 Geo � ///, k
Square Ft. Zriozlo Estimated Cost(value) off"' e7-0
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 -na'-d con to do the work s -ted.
ignature of Contractor or Owner- Builder
ate: *nu/ 6 , / 9 9 3
Notary as to Contractor or Owner- Builder
My Commissio
* * *
0 0 NOTARY TOTAL DUE!WI 00
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Other
Electrical
Engineering