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640 NE 101 St (11)Issue Date: 7/26/2006 Owner's Name: JOHN GRUNDHAUSER Permit Type: Mechanical - Residential Work Classification: Addition /Alteration Job Address: 640 101 Street NE Additional Information Miami Shores Village, FL Com ments: CHANGE OUT 3 MINI SPLITS; 2 MS2 -A09 WA, MUZA09 WA 1 MS Al2WA = MUAl2WA Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Expires: 01/22/2007 Contractor(s) JOSEPH BLOCK NC Phone 954 - 389 -2297 Primary Contractor Yes Tons: Classification: Residential Additional Info: In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Building Department File Copy Applicant Signature Parcel #: Block: Section: Permit Status: APPROVED Permit Number: MC -7 -06 -1985 Phone: 1132060172090 Lot: PB: Total Square Feet: 0 Total Valuation: $ 4,500.00 Required Inspections Rough Final Fees Due Amount CCF $2.70 Education Surcharge $0.90 Permit Fee - Additions /Alterations $157.50 Scanning Fee $3.00 Technology Fee $3.94 Total: $168.04 Invoice Number MC - 7 - 06 - 25701 Total: Amt Due $168.04 Amt Paid NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES . BUILDING PERMIT APPLICATION "' �'" ;Master Permit No. FBC 2004 Permit Type (circle): Building Electrical Job Address (where the work is being done) City Miami Shores Village FOLIO /PARCEL# 1/ ,3ao City U..t.. State State Certificate or Registration No. Architect/Engineer's Name (if applicable) Value of Work For this Permit $ Submittal Fee $ ❑Alte ion Permit Fee $ Notary $ _ ". Training/Education Fee $ Scanning $ j. Radon $ Bond $ Code Enforcement $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 !.,..1 ATE 1 7 [RY: I ['New DPBR $ Plumbing Owner's Name (Fee Simple Titleholder) 6(L Xid Owner's Address `L-j`I C /J E ) sf City in t ) j 54,6 State Tenant/Lessee Name 0 17 C9 c.� Is Building Historically Designated YES NO • Contractor's Company Name I� #' Contractor's Address / Zip County Miami -Dade Type of Work: ❑Addition Describe Work: a ■ ' 0 0 —nl SZ. • to .� .. ►_ Phone # Phone # l # Phone # Permit No. 3313 Zip 3330) Qualifier Name - 13 - , `'} 1)J ` L Phone # 95 Li l J = a� Certificate of Competency No. ( Square / Linear Footage Of Work: . dU •10 Technology Fee $ ). " 1 Double Fee $ Nc, CG-19H5 ecbanical Roofing 3Co -75/ -Jkc Zip ,3S/ 4 95Q/ - SO' Repair/Replace ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** C O /CC ❑ Demolition Zoning $ Structural Review. $ Total Fee Now Due $ () U • 0 l See Reverse side - > Bonding Company's Name (if applicable) Bonding Company's Address City Mortg a eF's Name (if applicable) Mortgage Vender's Address City State y � Zip Application is hereby made to obtain a permit to do the work and instaIThtions fs 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 Signat Owner or Agent The foregoing instrument was acknowledged before me this Ce day of _ \L 20 04 by (Revised 02/08/06) Si Print: My Commission Expires: APPLICATION APPROVED BY: State Zip who is personally `known to me o r, has produced cAft;?Altieation and who did take an oath. NOT ' PUBLIC: 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 a proved and a reinspection fee will be charged. Contractor The foregoing instrument was acknowledged before me this 5 day of , 20 `(z; by f j` who is personall known to me or who has produced pQrsiyi (i (,(/ r t - -{�= -� rte as identification and who did take an oath. NOTARY PUBLIC: Denise ComPe My Commission 0 , (7 Juty25,ADD j My Commission Expires: 1 - 2-4e16 se Compton My Commission D03401_ID iv s ;2004 Plans Examiner Engineer Zoning • • SUBMITTAL DATA: MS -A09WA & MU -A09WA 9,000 Btu /I WALL- MOUNTED AIR - CONDITIONING SYSTEM . ,, HVAC Advanced Products Division M SSUBISI{I ELECTRIC �1C o6-14 Sptit•ducdess A/C and Heat Rumps Job Name: Purchaser: Submitted to: Unit Designation: GENERAL FEATURES • Limited warranty: one year on parts and defects and six years on compressor • Compact side discharge outdoor unit • Zone control • Wireless remote controller • Automatic fan speed control • Quiet operation — both indoor and outdoor units • Auto restart following a power outage • Self check function — onboard diagnostics • Advanced microprocessor control Rated capacity 9,500 Btu/h SEER 13.0 Total input 690W Power supply 115V, 1 phase, 60 Hz Voltage Indoor - Outdoor L1 -N 115V, 1 phase, 60 Hz Indoor - Outdoor 2 -N 115V,1 phase, 60 Hz Indoor - Remote Controller wireless Indoor unit MCA 1.2 A Fan motor 0.63 F.L.A. Airflow (Low- Medium -High) 183 -261 -335 Dry CFM 162- 233 -300 Wet CFM Sound level) (Lo-M1-M2-Hi) 26 -32-40 dB(A) DIMENSIONS INCHES MM W 30 -11/16 780 D 8 -1/4 210 H 11 -3/4 299 Weight (Ibs/Kg) • 23 / 10 Field drain pipe size I.D. (inches/mm) 1/2 / 12.7 Location: Engineer: 1lertmte Crndro Indoor Unit MS -A09WA NOTES: Test conditions based on AR! 210 Rating conditions (cooling) indoor. D.B. 80°F, W.B. 67 °F outdoor: D.B. 95 °F, W.B. 75 °F. Operating range • • •• • Date: For ❑ Reference ❑ Approval ❑Construction Schedule No.: W 31 -ve D 11=1M•• H 21.5/5. • • • Outdoor Unit MU -AIBWA Outdoor UnIt Compressor Rotary R.LA. 9.3 LR.A. .,..... 47 MCA • .. Breaker size .....14 Fan motor 0 Sound level DIMENSIONS INCHES • • 15A 12.A. 47 c(A) Weight (lbs/Kg) • • .. • 7i / 35 Refrigerant type •••••• R41OA Refrigerant pipe size O.D. ( inches/m e • • •" • liquid side , • 1/4 7 t'35 gas side • .. • • ;18 /.9.5 Max. refrigerant pipe length (Wm) 65 / 20 Max. refrigerant pipe height difference (ft/m) 35 / 11 Connection method flared Low ambient operation to 10°FDS is possible by installing a Low Ambient Head Controller, Part No. ICM326HM1 • • • • • • Notes: • •• • • • • • • •••• • • • •.. • •. ••••• • • • • Indoor intake air temp. Outdoor intake air temp. Cooling Maximum 951DB, 71 °FWB 115108 Minimum 67°FDB, 57°FWB . 67°F•B • • SUBMITTAL DATA: MS -A09WA & MU -A09WA 9,000 Btu /I WALL- MOUNTED AIR - CONDITIONING SYSTEM . ,, HVAC Advanced Products Division M SSUBISI{I ELECTRIC �1C o6-14 Sptit•ducdess A/C and Heat Rumps Job Name: Purchaser: Submitted to: Unit Designation: GENERAL FEATURES • Limited warranty: one year on parts and defects and six years on compressor • Compact side discharge outdoor unit • Zone control • Wireless remote controller • Automatic fan speed control • Quiet operation — both indoor and outdoor units • Auto restart following a power outage • Self check function — onboard diagnostics • Advanced microprocessor control Rated capacity 9,500 Btu/h SEER 13.0 Total input 690W Power supply 115V, 1 phase, 60 Hz Voltage Indoor - Outdoor L1 -N 115V, 1 phase, 60 Hz Indoor - Outdoor 2 -N 115V,1 phase, 60 Hz Indoor - Remote Controller wireless Indoor unit MCA 1.2 A Fan motor 0.63 F.L.A. Airflow (Low- Medium -High) 183 -261 -335 Dry CFM 162- 233 -300 Wet CFM Sound level) (Lo-M1-M2-Hi) 26 -32-40 dB(A) DIMENSIONS INCHES MM W 30 -11/16 780 D 8 -1/4 210 H 11 -3/4 299 Weight (Ibs/Kg) • 23 / 10 Field drain pipe size I.D. (inches/mm) 1/2 / 12.7 Location: Engineer: 1lertmte Crndro Indoor Unit MS -A09WA NOTES: Test conditions based on AR! 210 Rating conditions (cooling) indoor. D.B. 80°F, W.B. 67 °F outdoor: D.B. 95 °F, W.B. 75 °F. Operating range • • •• • Date: For ❑ Reference ❑ Approval ❑Construction Schedule No.: W 31 -ve D 11=1M•• H 21.5/5. • • • Outdoor Unit MU -AIBWA Outdoor UnIt Compressor Rotary R.LA. 9.3 LR.A. .,..... 47 MCA • .. Breaker size .....14 Fan motor 0 Sound level DIMENSIONS INCHES • • 15A 12.A. 47 c(A) Weight (lbs/Kg) • • .. • 7i / 35 Refrigerant type •••••• R41OA Refrigerant pipe size O.D. ( inches/m e • • •" • liquid side , • 1/4 7 t'35 gas side • .. • • ;18 /.9.5 Max. refrigerant pipe length (Wm) 65 / 20 Max. refrigerant pipe height difference (ft/m) 35 / 11 Connection method flared Low ambient operation to 10°FDS is possible by installing a Low Ambient Head Controller, Part No. ICM326HM1 • • • • • • Notes: • •• • • • • • • •••• • • • •.. • •. ••••• • • • • CHANGE OUT 3 MINI SPLITS; 2 MS2 -A09 WA, MUZA09 WA 1 MS Al2WA = MUAI2WA Passed Inspector Comments \.7/ \i Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until 1 Inspection Date: 01/17/2007 Inspector: Grande, Claudio Owner: GRUNDHAUSER, JOHN Job Address: 640 101 Street NE Miami Shores Village, FL Project: <NONE> Contractor: JOSEPH BLOCK A/C Building Deaartment Comments Thursday, January 11, 2007 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue;�Miami Shores, FL , Phone: (305)795 -2204 Fax: (305)756 -8972 'Inspection Number: INSP -23157 Permit Number: MC -7 -06 -1985 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition /Alteration Block: Phone Number Parcel Number 1132060172090 Lot: Phone: 954 - 389 -2297 Page 1 of 1 UNITED STATES POSTAL SERVICE I 0 0 1 First -Class Mail Postage & Fees Paid LISPS Permit No. G-10 • Sender: Please print your name, address, and ZIP +4 in this box • MIAMI SHORES VILLAMS 1CD N.'„PO — YI�Tx •u- ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. • Print your name and address on the reverse so that we can return the card to you. • Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: Miriam Pastor 1228 NE 98 Street Miami Shores, Fl 33138 PS Form 3811, February 2004 Domestic Return Receipt ❑ Agelt ❑ Addressee C. Date of D3Ilvery D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No Ice Type Certified Mall 0 Express Mall ❑ Registered ❑ Retum Receipt for Merchandise ❑ Insured Mall ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) 2. Article Number 7005 1160 0000 5203 6417 (fl nst r from service label}-- - 7005 ❑ Yes 102595-0240.1540 INSTALL 2 1/4 TIP MOTOR FOR ROLL UP SHUTTERS Passed Inspector Comments �/- — 1 J -,' © �- f 9 Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid . until • Inspection Date: 01/19/2007 Inspector: Devaney, Michael Owner: RUDNICK, SPENCER Job Address: 60 102 Street NE Miami Shores Village, FL Project: <NONE> Contractor: ADVANCED ELECTRICAL SOLUTIONS INC. Building Department Comments Thursday, January 18, 2007 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Block: Phone Number Parcel Number 1132060131461 Lot: Phone: 954 - 327 -9212 Page 1 of 1 Dateb Legal Description Contracting Co. ** * APPROVED: z / .1 FEES: PERMIT PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Addressen40 1\1'G l0 j � Tax Folio Owe / Lessee / Tenant on 1-50E74 Owner's Address l a 4 Q • 1 0 1 - Phone 1 ,C4, -5 a C n - 11Z)=:; L Qualifier NPC +o SS4k Phone Wn6D State #/;A SMunicipal # Competency # Ins.Co.a /W / /R £(Aup Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING ( CHANIC ROOFING PAVING FENCE SIGN WORK DESCRIPTION Pilo C'ho.,mO �L* 5Ofl Square Ft. Estimated Cost(value) 4 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 regulatin construction and zoning. Furthermore, I authorize the above -named contractor to do the work ed, Signature of owner and /or Condo President 'igt(4ure of Contractor or •.er- Builder Date: Daie : * * * * * Address (.3LD 'KJ otary •s to C My C. ission Master Permit # ? 6t1 ** C.C.F. NOTARY TOTAL DUE •5(' 7 Fire Other Zoning Building Electrical Mechanica i y y1 � t�. i,Plumbing Engineering 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 in this Notice of Commencement. 1. Legal description of properly and street address: (4O 1 al t R yU1 1 2. Description of improvement: Signature of Owner Print Owners Name Z Notary Public Print Notary's N My Commissi NOTICE OF COMMENCEMENT 4 C. Ch 9. Expiration date of tflis Notice of Commencem • different date is specified) J 1. S. Surety:(Payment bond required by owner from contractor,, / if any) Name and address: _ NO/l11 • Mown r 1 ft_ Amount of bond S G. Lender's name and address: 70 Sworn to and subscribed before e this eQ0 day of . 19 94835 1277 1994 JUL 21 13:56 3. Owncr(s) name and address: <c=-d LE- I b1 Interest in propeny: Name and address of lee simple titleholder: 4. Contractor's name and address: ( "i _0./7-fZA - 74/ei f ?� $;�) g/ ; 'l 5 3( l 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provider by Section 713.13(1)(a)7., Florida Statutes, /j I Name and address: ` 66) /U 13. In addition to himself, Ownor designates the following person(s) to receive 3 copy of the Licnor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: aliop }9 jsd1 yea k from t h e d Y 1 r A prding unless a ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING /a.6 Kw DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEIJ'ORARY A/C (CENTRAL) a� cur 5r0 DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK �J FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP _ APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS /ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECT ION 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 SWIMAING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION: CUTLETS DRAINFIELD, 4" TILE/RES. VIOLATION PUMP E ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE 0 POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL Name and address of licensed contractor STATE OF FLORIDA COUNTY OF DADE. }SS. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING 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 the work. Date 9/y Owner's Name and Address Ma j ilton / 640 N. E 101 ST No. Street Registered Architect and or Engineer Sears/ 20701 S.Allapattah RD Location and legal description of lot to be built on: �9 1A L Lot 3 "r $ F .S Block 103 Subdivision +yam+.4 - A NI I/ a' yj� �/ Q 5L il II J /a '7 £6 Street and Number where work is to be done 640 N.E 010 qt State work to be done and purpose of building (by floors). state exterior colors (submit samples) Window A/C 1 unit 12000 BTU- and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covell Estimated Total cost of improvements S Amount of Permit S '1a Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an em4loyer of Labor under the Florida ■1'orkrren - Compensation Act. being Section 5966. Compiled General Laws of Florida. Permanent Supplement. and has complied with th 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 11 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 employ nl • such .subcontractors. on work to be performed under this permit. as are licensed by Miami Shores Village. / P g 4/ O ,i - / % "'' Remarks (Signed( { Before me. the undersigned authority. a notary public. duly authorized to administer oaths and take acknowledgments. personally appeared 19� 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 he e foregoing application, and that he did sign the same. and that all facts therein by him stated ar, :rue Permit No. , Y �Y"a a ���Da```te / // /949 Read. Sworn to and Subscribed before me. Disapproved llate (Signed) _�_QrV�� Notary Public. State of Florida Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member _ Member Member Member Member Council Approved Date Disapproved NOTE: A charge of S25.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of S25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and or workman-hip Date