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284 NE 102 St (8)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 build- ing 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 � ,1971 Owner's Name and Address 46M t; %r . / /.R No Z Street.../VE /Oi - K 4 ' Registered Architect and /or Engineer ..._. / / ' 1/x/ 01 Name and address of licensed contractor d2We" Qt` ✓✓ Location and legal description of lot to be built on: Lot / r 2 Block "8 Sub 'vision__._ �a" 5140".11, S Street and Number where work is to be done a AL' / O a ~ — STATE OF FLORIDA, COUNTY OF DADE. j ss State work to be done and purpose of building (by floors) Disapproved -- - Date -- (Signed) - and for no other purpose. R epairs New Building Remodeling Addition X No. of S ones To be constructed of G Kind of foundation &1!! P.C4d 6 Roof Covering T� " amp Estimated Total cost of improvements $ 5 O Amount of Permit $. /r: O Zone cubage required .Plan Cubage Distance to next nearest building Size of Building Lot 8 x- . ./rs'° Maximum live load to be borne by each floor I hereby submit all the 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 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 from all contractors or sub contractors employe by him in the work to be performed under this permit; and will post or cause to be poste . nspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only tractors on wor perform id under this permit, as are licensed by Miami Shores Village. Remarks (Sign Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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 constructio ; 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. g Permit No / Date ` ;` Y- e7 1 Read, Sworn to and Subscribed before me. Notary Public, State of Florida My o mission Expires PLANNI BOARD DATE Chairman Member lfernber Member Member . Member Council Approved Date Disapproved Date NOTE: A c•: arge of $1.00 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 51.00 will be charged when such re inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. fr tr PROPERTY OWNER Name V - Ab4 1 1 ik lif.)( ✓! Address 2 a 4 AIL 10 2 57 i wt 1 A IA% i 5 `I oPFts 3313€2, Home Telephone 3o9 75 .- 7007 Business Telephone 3 J _, (J sit _/ 643 Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address: Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. 2E4 N E 10z S 7 7 it./ 1Alt4 Shoke P-Lo,e , t Address Folio Number 1 1 3� Q,6 ( OR r1/7) Lot J Block Subdivision �L` ft tt,DPB Current Use of Property:. Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other G7v PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Apt. City D escription of Work Master Permit No. Subsidiary Permit No. SD 33138 State Zip )HLAt ih/ 24:1 ,4i2z PERMIT APPLICATION Zoning ----- Linear Feet Square Feet / / Units Floors "Value of Work 4,2 co . I Bldg Value Tax Assessed/Ap aised Value / Flood Zone / Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. \Address Telephone Fax Qualifier Name Page 2 IN-IPORTANT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through -Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. .Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. 1. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1°' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. S FLORI A, OUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE 1L. Signature of Owner Signature of Contractor / Qualifier VG.A.n /wt / � Print Name Print Name ,� Sworn t and subscribed before me this day of ' , Sworn to and subscribed before me this day of Ld PERMIT APPLICATION ignature •' Notary text ;Florida - - _._ _. Signature of Notary Public - State of Florida ,=.al. ,: - ;F.B SEAL: O '{ ....:.,...c.., �..,.. <F SEAL: r, Personally known �OR,Pr Identification Personally known OR, Produced Identification Type of Identification Produced: t 1 y - Va I d.1, 5 Q • f 05 ' 0 Type of Identification Produced: ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16 -20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE Refrigeration, Tons Q'I'Y. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth • Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY D TE / /Yf Zoning as 1 Z� Electrical oo'' Mechanical Plumbing Fire Public Works Structural fl / / Q/ Building Official G L Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) LI OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ o Metropolitan Dade County (C.C.F.) $ 1 S ( sq.ft. = x/1000 x ¢.60) $ 0 (¢.005 / sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $ ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2 AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com rl.� S _ MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No 7 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. '/ � 1 Owner's Name and Address 9a/�ry�? e2,...5,/h, w No 491 Street /vim raz �� c� Registered Architect and /or Engineer I�f /..e ,f? ,. ern eld Employing Electrician's Name f.�. /1 e e No Street Location and Legal Description Lot /_, c' Block 3S Subdivision /'�A met -y... AM...SC OS Street and Number where work is to be performed —No Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. f 6° ' (Signed) (Signed) Repairs Date //'� 11 Street r/� iD ST State work to be performed and purpose of building (By Floors) Cai:f..'.T..Clt.C/ c', -r,. New Building Remodeling Addition „t No. of Stories Service Overhead Amps Size Feeders Conduit Main Sw Amps Main Fuses Am Underground p p Type of Installation — Conduit 4 Tubing B.X.L .Metal Moulding Electri Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations n employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanen upplement, and has complied with the provisions thereof, and will require similar com pliance from all contractors or subcontractors empl 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 pu is notice or notices as are required by the Act. The undersigned agrees to employ only suc h subcontractors, on work to be performed under this permit, licensed by Miami Shores Village. as are C ade( e re) 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 OUTLETS LIGHT OUTLETS PLUG RECE'P'T's FIXTURES NO. LAMPS REFRIO. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL CO LIST NTR. / /Q / Z CHECK ENT. SW. DIST. CAS. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1 -5 HP NEON TRANS. RADIO TOTAL CONTR. LIST 1 I'r CHECK rl.� S _ MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No 7 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. '/ � 1 Owner's Name and Address 9a/�ry�? e2,...5,/h, w No 491 Street /vim raz �� c� Registered Architect and /or Engineer I�f /..e ,f? ,. ern eld Employing Electrician's Name f.�. /1 e e No Street Location and Legal Description Lot /_, c' Block 3S Subdivision /'�A met -y... AM...SC OS Street and Number where work is to be performed —No Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. f 6° ' (Signed) (Signed) Repairs Date //'� 11 Street r/� iD ST State work to be performed and purpose of building (By Floors) Cai:f..'.T..Clt.C/ c', -r,. New Building Remodeling Addition „t No. of Stories Service Overhead Amps Size Feeders Conduit Main Sw Amps Main Fuses Am Underground p p Type of Installation — Conduit 4 Tubing B.X.L .Metal Moulding Electri Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations n employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanen upplement, and has complied with the provisions thereof, and will require similar com pliance from all contractors or subcontractors empl 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 pu is notice or notices as are required by the Act. The undersigned agrees to employ only suc h subcontractors, on work to be performed under this permit, licensed by Miami Shores Village. as are C ade( e re) 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 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 __ _ ©rs /ll _ - __ - _ _ No. ZBY _ /" / O Z S/ -- _- - __ -__ Street .._.... / - -- Registered Architect and /or Engineer Employing Plumber's Name C2W.lZ No. Location and Legal Description Lot ___1 Blorlc 3S Subdivision I.zz. _..4- s Street and Number where work is to be performed -No C'8 �-- // ,, ``// Street 'Ye" / / OZ �S • State work to be performed and purpose of building (By Floors)___ e4c. a _�4--_ - - - -1 r/e21 -' 4fra24 f 6�t/_4 `/' New Building Remodeling —__ _. _ Addition_________.________._._ Repairs No. of Stories. Size Septic Tank_ c x..6.5 % __-____ -_ Type of Tank Feet of Drain Tile __. .Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City - Well.____— __I__________._____— ____Size of Soakage Pit Amount of Permit $__ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed)- P1 bing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations a employer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Sup ment, and has com- plier with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed im 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 sub-contra ork to be performed under t}kis permit, as are licensed by Miami Shores Village. ( Sign Date._ 9 / - Street_ Capacity Gals- _- .___.I2.SQ_._ .. 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 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 P lumber. CLOSETS BATH TUBS SHOWER, LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS U CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST / / J Ci -- 8 CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL. 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 __ _ ©rs /ll _ - __ - _ _ No. ZBY _ /" / O Z S/ -- _- - __ -__ Street .._.... / - -- Registered Architect and /or Engineer Employing Plumber's Name C2W.lZ No. Location and Legal Description Lot ___1 Blorlc 3S Subdivision I.zz. _..4- s Street and Number where work is to be performed -No C'8 �-- // ,, ``// Street 'Ye" / / OZ �S • State work to be performed and purpose of building (By Floors)___ e4c. a _�4--_ - - - -1 r/e21 -' 4fra24 f 6�t/_4 `/' New Building Remodeling —__ _. _ Addition_________.________._._ Repairs No. of Stories. Size Septic Tank_ c x..6.5 % __-____ -_ Type of Tank Feet of Drain Tile __. .Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City - Well.____— __I__________._____— ____Size of Soakage Pit Amount of Permit $__ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed)- P1 bing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations a employer of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Sup ment, and has com- plier with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed im 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 sub-contra ork to be performed under t}kis permit, as are licensed by Miami Shores Village. ( Sign Date._ 9 / - Street_ Capacity Gals- _- .___.I2.SQ_._ .. 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 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 P lumber.