1177 NE 100 St (5)786 - 251 -7913 PLEASE CALL
Passed
Inspector Comments C
b),2_,,t
Ki, w -e 0--
, 7, d ‘
Failed
Correction
Needed
Re-Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
M t s Number; I NSP -i 9275
Inspection Date: 06/07/2006
Inspector: Desharnis, George
Owner: RODRIGUEZ, JUAN CARLOS
Job Address: 1177 100 Street NE
Miami Shores Village, FL 33138-
Project: <NONE>
Contractor:
Tuesday, June 6, 2006
Building Department Comments
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Perrntt Nurn.r: BP. 2003 -1349
Permit Type: Imported Permit
Inspection Type: Final Building
Work Classification: <NONE>
Phone Number (786)251 -7913
Parcel Number 1132050190350
Lot:
Page 1 of 2
6/05/06
To: Current Owner
1177 NE 100 Street
Miami Shores Village, FL 33138-
Permit: BP2003 -1349
Address: 1177 NE 100 Street Miami Shores Village FL33138-
Date Expired: 2/11/04
Dear Sir or Madam
In order for us to serve you better, we need to keep our files up to date. Our records
indicate that the above reference Permit has expired.
The Building Department has determined that the work applied for has been completed
with out the required inspections and it has been more than 180 days since your last
approved inspection and thus your permit has expired as per Sec. 104.5.of the Florida
Building Code. You are required to renew your permit and schedule all required
inspections.
In the event you do not comply with the requirements herein, the Building Department
will file a complaint with Miami -Dade County Building Code Compliance Office for
possible disciplinary action against your licensed contractor And/or if permit was
obtained by the home owner the requirements of the Unsafe Structure Code of Miami
Dade County Sec. 8 -5. (3) will apply. "The building shall be presumed and deemed
unsafe and a permit shall be obtained to demolish the structure or bring the building in to
compliance with applicable codes as provided herein."
Please contact the Building Department, immediately upon receipt of this letter.
Sincerely,
Miami Shores Village
g
Mabel Val s
Administrative Assistant
Building Department
10050 NE 2 Ave, Miami Shores, Fl 33138
Tel: (305)795 -2204 • Fax; (305)756 -8972
BUILDING
PERMIT APPLICATION
FBC 2001
City t.a % SVC," . 4, o+- ag State F-1
Tenant/Lessee Name
Miami Shores Village
Cro \ Building Department
Architect/Engineer's Name (if applicable)
Architect/Engineer's Address
City
10050 N.E.2nd Avenue
2Q03 Miami Shores, Florida 33138
Tel: (305) 795.2204
,O Fax: (305) 756.8972
� P — X31
Permit Na� L -�
Master Permit No.
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) --TC.. 12 cam` �� Phone #
Owner's Address 11 JJ C 1 0 0 4�
Job Address (where the work is being done) / / 7 - 1 N c9:- o
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO >'
State
S Value of Work For this Permit . 42 1 2-* '
Zip 33 «�b
Phone #
Zip
3 +� 7.5-9 6 6,5
�3 S'
7
Contractor's Company Name �'"h}� • Phone # 3 o �c 7 S ) I, �, ¶
Contractor's Address
City State Zip
Qualifier
Phone #
Zip
Square Footage Of Work:
Number of: Bays Stories Families Bedrooms Baths
Type of Work: DAddition Alteration ❑New ❑ Repair/Replace ❑ Demolition
Describe Work: k
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit Fee $ / 25 8o Notar $ 5 % CO
County Escrow Fee $ � ... 0 �' 5
Education/Training Fee $ Tech .$ Scanning $ Radon $
Code Enforcement $ Bond $ Struct. $
Minus Plans Check Fee $ Total Fee Now Due $ a L 'i> -An (Continued on op osite
?Glad G"�4�
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Signature Signature
Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not , pproved a a reinspection fee will be charged.
Owner or Agent Contractor
The foregoing ' ' trument was acknowledged before m a this 15 The foregoing instrument was acknowledged before me this
day of1 20 6, by C.. QCC.1 i (I5G , day of , 20 _ , by
who is personally known to me or who has produced d7. tkil - who is personally known to me or who has produced
As idea ,,a,tiongairl � .. % Commission
5f90 °�-
NOT • • Y
ip C: = : Jul 13 , 2007 NOTARY PUBLIC:
' 1 •9 . "
Sign: 1� .�� � '1'OF ending', nc.
' Si gn:
ail. . nv�'w Print:
Print:
My Commission Expires:
My Commission Expires:
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
*****ss******: 4****************** * * * * * * * * * * * * * * * * * * * *s * *s * * *• * :* /******* s* * *ss *• * »s * * * * * * * * *ss * * * *ss * *s #s
APPLICATION APPROVED BY:
Chc7l7 /03
AUG 1 9 2003
Plans Examiner
Engineer
Zoning
OWNER BUILDER DISCLOSURE STATEMENT
I .7C- (2.42, . h-- being the legal
•
Located at: J l .� N- (04) M
Legally described as
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the
State of Florida, F.S. 489.103(7),,gnd I have read and understand the following disclosure
Statement, which entitles me to' 4ork as my own contractor, I further understand that I as the owner
must appear in person to complete all applications.
State law requires construction to be done by licensed contractors. You have applied for a permit under an
exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor
even though you do not have a license. You must supervise the construction yourself. You may build or
improve a one - family or two- family residence or a farm out - building. You may also build or improve a
commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It
may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the
construction is completed, the law will presume that you built it for sale or lease, which is a violation of this
exemption. You may not hire an unlicensed person as your contractor. It is your responsibility to make sure
that people employed by you have licenses required by state law and by county or municipal licensing
ordinances. Any person working on your building who is not licensed must work under your supervision
and must be employed by you, which means that you must deduct F.I.C.A. and with - holding tax and
provide workers' compensation for that employee, all as prescribed by law. Your construction must comply
with all applicable laws, ordinances, building codes and zoning regulations.
Proof of ownership provided ( )
Was acknowledged before me this 15 day of
By
�..v .A _
Produced au-u(A)---
VILLAGE OF MIAMI SHORES
BUILDING DEPARTMENT
DISCLOSURE STATEMENT
property owner, for the property ^ /
5��eg C-1 3 1 3 V,
initial of reviewing clerk. The foregoing instrument
L
who is personally known to me or who has
as identifica ion and who did take an oath.
Cu&
Notary
: Mabel Vargas
Commission #DD23198
,,
Y ;,•► „i13.2nn-
• „ ‘auk , Mabel V fy
.7is Commission #DD2 198 `
Expires: Jul 13, 2007
",,7nnr` Atlantic nd� Th,,
Bonding Co;, Inc.
II dimensions & size designations
ven are subject to verification on
7 site and adjustment to fit job
editions.
123
Tall end wood panel
used to finish end.
CW CB
274 %36
L
_
24 ~B1r
42 'L
W36C'
,24D 36
W30
48
W2142'
100i
Wood panel used to
finish back of island.
W3642
1861
55
W
DB I DB36 I DISH.
L L i IL
Use plywood across top
to lower valance
closer to top of window.
Center block to be built
to support countertop
use plywood w /toekick
around bottom.
30i
CW2742�
R
6RWD
1W
\ ;B15; 24
R 142
UT
18
DV
D30
36
AS
UT
18
511
35
68
1544
Designer r
Randy C Sparcello
THE
HOME DEPOT
This is an original design and must
not be released or copied unless
applicable fee has been paid or job
order placed.
82406DA0
Amer.Woodmark
JC Rodriguez
1177 N.E. 100th. Street
Miami Shores, FL.
Scale : 1/4 " = 1'
Design : 08/24/03
Date : 07/04/03
EL2003 -247
Imported Permit
Project: <NONE>
Owner: None None
Phone:
Job Address: 1177 100 ST Parcel: 1132050190350
Miami Shores Village, FL
Block: Lot:
Scheduled Insp # Inspection Type
Monday, June 5, 2006
Inspection History
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Status
Inspector Date Completed
10/17/2003 INSP2003 -4327 Electrical APPROVED None None 10/17/2003
ALL CONDUITS WERE BURIED. I COULDN'T FIND THE #8 BONDING CONDUCTOR. SERVICE NOT AS
PER PLANS AND HAS TO BE UPGRADED
Page 1 of 1
RECEIVE
Ue 5 2003
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building
Owner's Name (Fee Simple Titleholder) 3L 1 r ° 4 '' (.1 Phone # '3 SST' /
Owner's Address / / '7 °) A 6 /0 0 .5
City /v-7 SA 0 r L , State (-1
Tenant/Lessee Name
Miami Shores Village
uilding Department
Plumbing Mechanical Roofing
Zip ..33
Phone #
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No. 2(n--
Master Permit No. see ioc3 1s4
Job Address (where the work is being done) 1/ 1 1 C- /00S f
City Miami Shores Village County Miami -Dade Zip 3 3 I 3'
Is Building Historically Designated YES NO X
Contractor's Company Name T e N NI cif e. (e..,-,-,.,,.,o SPA' u, c.L Phone #
Contractor's Address (D q C 0 ! l 1 00 T ,,/
City hi • 'r-", ' C State - I Zip 17i 1 314
Qualifier 4t P. i.4 , bz e ,,
Architect/Engineer's Name (if applicable) )A` . Phone #
Architect/Engineer's Address
City State Zip
$ Value of Work For this Permit 111, C 'J 0 Square Footage Of Work:
Number of: Bays Stories / Families Bedrooms
Type of Work: ❑Addition ,, � ❑New ❑ Repair/Replace
Describe Work: (l e. r'-r 0 r-J n /�
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * * * **
County Escrow Fp$ Permit Fee $ ,0 /.01, Notary $
Education/Training Fee $ Tech $ Scanning $ Radon $
Code Enforcement $ Bond $ Struct. $
Minus Plans Check Fee $ Total Fee Now Due $ (6 I) .) (Continued on opposite side)
Baths
❑ Demolition
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
caner or Agent Contract
The foregoing ins � ; ent was acknowled: ed before me this The foregoing instrument was acknowledged before me this / /
day of J , 20th, by ZC_ , day of v 7 - 0 1)3, bye is p }-4 y- ,
who is personally known to me or who has produced a who • ersonall to me or who has produced
• dentification and ho did take an oath.
Signature
NOT
Sign:
Print:
As identification and who did take an oath.
`'' r r „ (Mabel Vargas NOTARY PUBL
�. I I ' '. oaro
. l � . m� ` ' ' 3 I 984�
�I, M Plejlifit/.L' : onded Thni
1 1
New I :,
Sign:.
Print:
My Co
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
My Commission Expires:
APPLICATION APPROVED BY:
Chc7/7 /03
B o., nc
Signature
- �Ou # CC 950055
. Bonded Thru Notary Public Underwriters Iri
/ . 4l . Plans Examiner
Engineer
Zoning
9
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
i O
CENTRAL HEATING
DISHWASHER
RECEPTACLES
i',
A/C (WINO)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
/1.
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
/
UNDERGROUND TANKS
LAVATORY
OVEN
/
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 If
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP _
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 HP
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
'HEATER -NEW INST.
GENERATORS. TRANSFORMERS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMMING POOL
OUTLETS COMMERCIAL
.
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS -
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTLRES
.
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
DRA I NF I ELD, 4' T I LE/RES: - ._"'" ..
" .... `
'
VIOLATION
PUMP 8 ABANDON SEPTIC TANK . . . . .
. . . . . . . .
. . . . . . . . . .R
E I N S P E C T I O N
SOAKAGE PIT CU. FT.
. _ ....
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING
PLUMBING
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
,,,OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
ELECTRICAL
MECHANICAL
DRIP LOOP
1 BE ]o'
-AFC, (MIN)
s
.' •Pi-
t:L,IIIP
•
' ;=00A
C-1 ET E R
• •
•
•
•
• FIIITSIIED GRATIE
lot
e' PLASTIC
BuC.lU116
L
MAIN 03
PANEL
j l
• t'YC SLED
i
U'0" N 1N 11FJ' Tl l
1
MMI M K114i
rte► lcnr
J 1r
SUB C L
'PANEL
P ER
•
'hlctpl�t
Conductor srte
• Condul•l stze
Conduit . type.-
Thru roof Y t ; P O
Ground wtrc t:•�e .
1. DISY0N1IECT
Ra•tlnO • ~' JAnps
Hatt Apps
Sub I3rnolcer~s Amps
I1'JSCDE PANEL
S.F.II.C, 460 5,201)
S I ;RATIJRE Of CORTRACToR
SUB -FEEDER
New _ Exis'UncJ.�'__
Typo
Size
Boni! :ate• -
•
•
Rnianp Nips
110n cl lug � ¥ e S _No
. L oca-tko n
' ,CONTR! 1.91Li
. • .
•
•
1
•
•
• NOTARY _,_ .._ •_ .__ ,_��__ ••••••
_�.,,,,__
I 1 \\/' I-
B
PL2003 -228
Scheduled Insp #
10/17/2003 INSP2003 -4310 Plumbing
Monday, June 5, 2006
Inspection History
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Type
Inspection Status
APPROVED
Imported Permit
Project: <NONE>
Owner: JUAN CARLOS RODRIGUEZ
Phone: (786)251 -7913
Job Address: 1177 100 Street NE Parcel: 1132050190350
Miami Shores Village, FL 33138-
Block: Lot:
Inspector Date Completed
None None 10/17/2003
Page 1 of 1
BUILDING
PERMIT APPLICATION
FBC 2001
�,,/ Mechanical Roofing /�
Owner's Name (Fee Simple Titleholder) , • `- �5 u-12 ii1.S.. Phone # 3D5- 9 ' 72 - '7`7 S
Owner's Address / c / 717 /V 7 • / O 57 ee l?
City / OM / J,4a/It 5 State
Tenant/Lessee Name Phone #
/V 7 Nf /1? .5i EST
zip 3
Permit Type (circle): Building Electric
Job Address (where the work is being done)
City Miami Shores Villaa_e County
Is Building Historically Designated YES NO
Contractor's Company Name %a Piui7 d M/i / -L /l/G
Contractor's Address X1'' 3 /(/( 94 46 B
State .Crlp/o,i-
City / Aafil /
Qualifier /o S uaQLz-
Architect/Engineer's Name (if applicable) - Phone #
Architect/Engineer's Address
City State Zip
$ Value of Work For this Permit 9O&
v
Number of: Bays
Stories Families Bedrooms Baths
❑New ❑ Repair/Replace ❑ Demolition
Type of Work: ❑Addition / Alteration / //
Describe Work: �i?- 17DGif/! 1'd' 7 1 1��'"i -4 �4 .deife---A- .se-;1 a - /A 74 '-
* * * * * * * * * * * * * * * * * * * * * * * * ** **Fees * * * * * ** * * * * * * * * * * * * * * * * * **
Miami Shores Village
Building Department
Permit Fee $
Miami -Dade
Permit No.
Master Permit No. «PZca3. _ l 349
zip 33/3 r
Phone #
dos -5 L -WO2 --
Zip 33/5;-.,
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Square Footage Of Work:
Notary $
County Escrow Fee
Education/Training Fee $ Tech $ Scanning $
Code Enforcement $ Bond $ Struct. $
Minus Plans Check Fee $ Total Fee Now Due $ (Continued on opposite side)
Gq4 2 v -.1
Radon $
Mortgage Lender's Name (if applicable) _
Mortgage Lender's Address
City
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of .all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and • inspection fee will be charged.
Signature
wner or Agent
ent was acknowledged before me this /5
20
6/ 3, 1c. .�
who is personally known to me or who has produced 1
As identification and who did take an oath.
th.
The foregoing
day ofAv
NOT • ' y r IC:
Sign:
Print:
My Commission Expires:
APPLICATION-APPROVED' $X:
: h c 7R /03
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
State
Signature
tractor
The foregoing instrument was acknowledged before me this
.1 200 by / DIZO D SL/lllG�
or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
P rint: �..
My
Zip
1Wirderengki, .4;'
a;A• Bond=. Thru
' "'"` Atlantic Bonding
Co:, Inc.
(Certilcateof Competency Holder)
State Certificate or Registration No. A FCp 41
/ � �
Certificate of Competency No.
Plans Examiner
Engin
Zoning
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WINO)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/IETER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE (MOUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 FP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
/
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
'FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 If
_
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
_
STRIP HEATER
FIRE SPRINKLER
•
GENERATORS TRANSFORMERS
HEATER -NEW INST.
GENERATORS TRANSFORMERS
I
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTURES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
ORAINFIELO, 4' TILE/RES.
VIOLATION
-
-
PUMP & ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING
_
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED,' OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ADDENDUM TO BUILDING PERMIT APPLICATION
ELECTRICAL
MECHANICAL