Permit 324-326 Plaza (vault folder) CITY OF ATLANTIC BEACH, FLORIDA
Approved by w Pp4ICATION FOR ELECTRICAL PIRMIT ^
TO THE CHIEF ELECTRICAL INSPECTOR: DATE: J 14
17
IMPORTANT NOTICE:
IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE WORK AS DESCRIBED IN THE FOLLOWING, WE
HEREBY AGREE TO PERFORM SAID WORK IN ACCORDANCE WITH THE ATTACHED PLANS AND SPECIFICATIONS,
WHICH ARE A PART HEREOF, AND IN ACCORDANCE WITH THE ELECTRICAL REGULATIONS, CODES AND CITY OF
ATLANTIC BEACH ORDINANCES.
JOURNEXM
ELECTRICAL FIRM: MASTER EdaRrmAk
NE ADDRESS; �.
AM
BLDG.SIZE BETWEEN;
RES.( i APT.( ) COMM.t }' PUBLIC t 1 INDUS. ( ! NEW( l OLD 1 i REW.l )
ADDITION ( l TRAILER I 1 TEMP.t } SIGNS ( ) SO.FT.
SERVICE. NEW( ! INCREASE JAREPAIR( ) FEE
QR SIZE AMPS 10
Q COPPER ALUM.
SWITCH OR BR AKER PH W 'T RACEWAY
EXIST.SERV.SIZE PH 3 W VOLT RACEWAY
FEEDERS NO. SIZE NO. SIZE NO. SIZE
LIGHTING OUTLETS CONCEALED` OPEN TOTAL
RECEPTACLES CONCEALED RPEN-41 TOTAL
0.30 AMPS, 3t-100 AMPS
SWITCHES
NCANDESCEl ,
FLUORESCENT,&M.V.
FIXED 0.100 AMPS. OYER
APPLIANCESBELL TRANSF.
AIR H.P.RATING " H.P.RATING
CONDITIONING COMP.MOTOR OTHER MOTORS AMPS EIL HEAT; KW-HEAT
0.1 OVER
MQTORS H.P. VOLTAGE PHS NO. 1 LP. ' VOLTAGE PHS
s
a ^. 'Aa.td � r� .� �r.�•
MISCELLANEOUS
row�ueenoiucQc. i Iuwnsm sim v Jill, OVER SIXI V.
CITY OF ATLANTIC BEACH, FLORIDA
APPrgWd by
APPLICATION EOR ELIRCTRICAL PIRMIT
] 7
TO THE C141EF ELECTRICAL INSPECTOR. DATE;
IMPORTANT NOTICE:
THE
IN CONSIDERATION OF PERMIT, GIVE
N FOR _DOING;THE. WORK AS DESCRIBED INLANS AND SPECIFICATIONS
HEREBY AGREE TO PERFORM SAID)WO COR ACCORDANCE
WITH YHEIELECTRICAL REGULATIONS, CODES AND CITY OF
WHICH ATLANTIC BEACH ORDINANCRE A PART ES D
ICIAN
ELECTRICAL FIRM:
MAST R E E
(� RFD BOX--
NAME J t t� 1 ADDRESS: psfif
BETWEEN:
BLDG.SIZE PUBLIC t ) INDUS. NEW
OLD:t ) REW t )
RES.( ) APT.I ) comm.( )
t ) '( )
ADDITION l ) TRAILER ! ) TEMP.( )
SIGNS i ) so.PT.
�y. FEE`
INCREASE REPAIR t i
SERVICE: NEW l ) ALUM.
CpNpUCTQR SIZE
AMPS COPPER
TCH OR BREAK
PH W
ER5l T RCE . Y
PH VOLT RACEWAY
EXIST.SERV.SIZE
FEEDERS NO. SIZE
NO, SIZE NO. SIZE
OPEN TOTAL
LIGHTING OUTLETS CONCEALED
OPEN TOTAL
RECEPTACLES CONCEALED ar.raa LAMPS•
o.SO AMPS.
SWITCHES
INCANDESCENT
FLUORESCENT&M.V. ----
FIXED o.roa LAMPS. OVER BELL TRANSF.
APPLIANCES " H.P.RA'T'ING
AIR H.P.RATING OTHER MOTORS AMPS EIL HEAT: KW-MEAT
CONDITIONING CAMP.MOTOR
OVER
•� *t e� H.P, VOLTAGE PHS NO. I NAVOLTAGE PHS.
*::^+'kS 43,a, aif f n[S
MI ELLANEOUS
__�,..... OVER300 V.
CITY OF ATLANTIC BEACH
DEPARTMENT OF BUILDING
800 Seminole Road-Atlantic Beach, FL 32233-Tel: 247-5826- Fax: 247-5877
PLUMBING PERMIT
T PERMIT INFORl411AT19N LOCATE ?N#NFORMATION
Permit Number: 21891 Address: 326 PLAZA DRIVE
Permit Typer- AJMBING- - ATLANTIC BEACH, FLORIDA 32233
Class of Work: RIGATIO.NIDRAINAGE Township: 0 Range: 0 Book:
FA
Proposed Use: SINGLE MILY Lot(s): Block: Section:0
Square Feet: Subdivision:
Est.Value: Parcel Number: _
Improv. Cost: - ---- O . ER INFORMATION - -
Date Issued: 5/03/2001 Name: IRVING CORNWELL
Total Fees: 885.00 Address: 326 PLAZA DRIVE
Amount Paid: 885.00 ATLANTIC BEACH, FLORIDA 32233
Date Paid: 5/03/2001 Phone: (904)249-9680
Work Desc: WATER TAP/CROSS CONNECTION
APPLIC,ATION FRES
WATER METER/TAP 525.00
CROSS CONNECTION 35.00
CAPITAL IMPROVE. 325.00
tri cztions Re
FINAL
NOTICE- INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION
BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC
SPACE, AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER
"FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE
PR PERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS"
ISS(otd ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION
FOR,Y10LATION OF APPLICABLE PROVISIONS OF LAW.
7,1
AT B CH BUILDING DEPT. = 6'
" CITY OF'ATLANTIC BE,A.CH v
APPLICATION TO MAK, ADDITIONS OR ALTERATION
Owner A" C,,e/J45/:�";.�`�'� AddresV�'
Architect = ✓ , Addressers, Phone
Contractor / Address Phone
Contractors License/Certification NLubers
Expiration Date
Property Address ' f :; ' �
Lot # Blcok or Unit Subdivision
Valuation of Construction $ S {�' Type of Construction '
Describe Work to be Performed , nt �' •• ` °-
Materials to be Used
Present Use of Building
Proposed Use of Building
Flood Zone
Dimensions of New Area:
MATED
GARAGE OR STORAGE
CARPORT OR PORCH d,
LECK
PATIO YES NO Nam.
Will there be an increase .in nwber,of units
Will there be a decrease in nunber of units? . '
Any additional, plLubing fixtures?
Anyt new fireplaces? "•
SUMLT TWO COMPLEL7J SETS OF PLANS INCLUDING SITE PIAN.
SignatureOWNEtt Date^.
Signature OONTRACIUR '; ✓' :" Date
,
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CITY OF
r�t�°�urtic �'e��i - Tw�caa
716 OCEAN BOULEVARD
P.O.BOX 25
�- ATLANTIC BEACH,FLORIDA 32233
TELEPHONE(904)249-2396
May 28, 1987
Mr. I. E. Cornwell
324 Plaza
Atlantic Beach, Florida 32233
Dear Mr. Cornwell,
We mis-calculated the fee for building permit #8715 issued to you
on May 27, 1987. The correct fee should have been $57. 00,
therefore the balance due is $28. 50. Please remit payment with
the enclosed invoice.
We apologize for any inconvenience this error may have caused
you.
Sincerely,
e�
Theresa Emery
Building Department
cc:file
PRICE. QUOS
APPLICATION FOR WATER AND/OR SEWER TAP
r
APPLICANT NAME_--- ------------------
MAILING
��—Gly -/CL�i e —�— --------------------
MAILING ADDRESS„_ _ _________
PHONE NUMBER_L C ���� 'Z-=--- DATE_ -
y
SERVICE REQUESTED_ -� C�
SERVICE LOCATION_ Z 7 (� ?1�� C -----------------------------
------------------------------------------------
DATE SENT TO / DATE RETURNED
PUBLIC WOR
KS_� '1� ____ TO BUILD. DPT.
----------------
DATE OWNER
NOTIFIED---------------------
r jj
; 1000pWORIC1 .
'
Atlantic Beach
JURISDICTION
OFFICE OF BUILDING OFFICIAL
This building has been inspected and
a General Construction NO PERMIT ISSUED
❑ Concrete, Masonry and Finish Cement Work
❑ Lathing
❑ Plastering
❑ Elevators
❑ Plumbing
❑ Mechanical Work
❑ Electric Wiring
❑ Gas Piping
1S NOT ACCEPTED
Please correct as noted below before any further work is done.
-- DATE
Jay, 4, 1987 Don C. Ford
Date Inspector
Do Not Romovo This Notice
DETACH and Bring this Portion of Card With You.
Location: 324 Plazat.'Driye_
Date Mar 4 1987
Atlnnt;r Reach
JURISDICTION
FORM 400.7
-Don C. Ford_
B-9 INSPECTOR
STOP WORK
Atlantic Beach
JURISDICTION
OFFICE OF BUILDING OFFICIAL
NOTICE
This building has been inspected and
X General Construction PERMIT FEE DUE
❑ Concrete, Masonry and Finish Cement Work
❑ Lathing .
❑ Plastering
❑ Elevators
❑ Plumbing
❑ Mechanical Work
❑ Electric Wiring
❑ Gas Piping
IS NOT ACCEPTED
Please correct as noted below before any further work is done.
- NOTE -
June 8, 1987 Don C. Ford
Date Do Not Remove This Notice . inspector
------------------------------------------
DETACH and Bring this Portion of Card With You
Location: 324 plaza
Date June 8, 1987
Atlantic Beach
ISD!
7
INSPECTOR
26903 nEOAOERFROM QUALITY DUSINESS njnms.JNc t99/2965652
w...._._
CITY OF
ATLANTIC BEACH No. 4592
FLORIDA
Ha 28
NAME I-E—Cerntieil
ADDRESS 2652 St Ate Highway 13
CITY Green Cove Springs 32043
Balance owed on mis-calaulated building permit #8715 $28.50
324 Plaza
Atlantic Beach 32233 P A I. D
JUN 111987
1`
4
When Signed, Dated and Numbered, This Becomes an Official Receipt
MAKE CHECKS PAYABLE TO Received Payment
CITY OF ATLANTIC BEACH, FLORIDA TREASURER
4 DEPARTMENT OF BUILDING 8715
f CITY OF ATLANTIC BEACH,FLORIDA PERMIT NO.r,
PERMIT TO BUILD
THIS PERMIT MUST BE POSTED ON JOB P0,50 T
Date May 22 19 87 !-11,1•5DrKT
l 9134 lit 5/27/6
Valuation$ 4:279.50 Fee$ 28.50 13715 •MCA
9134 I A /P,7/El
This permit not valid until above fee has been paid to City Treasurer,and is 10001
subject to revocation for violation of applicable provisions of law.
I
This is to certify that I.E.GOrnwell
has permission to build glass enclosure over existing decka.s rter
plans
Classification ReSidemial Zone
Owned by I.E.Cornwel l
Lot 11 Block 10 Slantic Beach
i
House No. 324 Plsot>ta
! According to approved plans which are part of this permit
NOTICE—ALL CONCRETE FORMS
AND FOOTINGS MUST BE IN-
SPECTED BEFORE POURING.
PERMIT VOID SIX MONTHS
AFTER DATE OF ISSUE
-� 4---1 0 Building material, rubbish and debris
i from this work must not be placed
in public space, and must be cleared
up anc h uled away by either con-
'� ",aTner.,
Building Official.
i
I� FOR OFFICE PERMIT DATE CONTRACTOR
USE ONLY NUMBER
I
PLUMBING
ELECTRICAL
SEWER
WATER
AM
Address• 5,;2�' /
heated Square Footage D @ $ SO per sq ft. =
Garage/Shed @ $ per sq £t
Carport/Porch @ $ j per sq ft = $ 72 ,5
Deck $ Per sq ft = $
Patio @ $ ' per sq ft = $
TOTAL VALUATION: $
Tota ' aluation 1st $ DOv.D
Rara&der Valuation 3 iD er thousand or
ortionthereof
--------------------------------------------portion
I Total Building Fee $ (� Q
ADDITIONAL PMUTS and/or F = ,S REQUIRED
-----�-- + k Filing Fee $
Mechanical , ' Fireplaces @ 15.00 $
Plumbing BUILDINGiPERMIT FEE $ 03 •�y
Electric/New
-------------- ----- --------------------------
Electric/Tapp -
Septic Tank BUILDING PERMIT $
Well WATER METER CHARGE $
&m* ming Pool SEWER IMPACT FEE $
Sign WATER IMPACT FEE $
Water Connection MISCELLANEOUS $
Sewer Connection $
Water Meter $
Elevation Certificate'
GRAND TOTAL DUE
- - `------------------------------- --- ' ----- T
-- -----------
CALCULATIONSand/orNOTES
� � ` c
CITY OF
/*&atic Veda - 9&uz a
800 SEMINOLE ROAD
-_----_-----_-------.-_-.--- -- ATLANTIC BEACH,FLORIDA 32233-5445
TELEPHONE(904)247-5800
FAX(904)247-5805
SUNCOM 852-5800
May 21, 1996
Mary L. Cornwell
2652 State Road #13
Switzerland, FL 32259
Dear Mr. Cornwell:
Our records indicate that you are the owner of the following property in the City of
Atlantic Beach, Florida:
324 Plaza Drive
a/k/a Lot 11, Block 10, Alantic Beach
RE#169959-0000
Investigation of this property discloses that I have found and determined that a
public nuisance exists thereon so as to constitute a violation of City of Atlantic Beach
Ordinance Section 17-8, i.e., Placing signs on trees, posts, fences, etc.
You are hereby notified that unless the condition above described is remedied
within one (1) day from the date of your receipt of this notice this case will be turned over
to the Code Enforcement Board.
Under Florida Statute 162.09, the Code Enforcement Board may impose fines of up
to $250.00 per day for a first violation and $500.00 per day for a repeat violation.
Sincerely,
r
arl W. Grunewald
Code Enforcement Officer
KWG/pah
cc: Public Safety Director
VIA CERTIFIED MAIL
RETURN RECEIPT REQUESTED
nterototoei ce
M E M Q R A N D U M
to: Karl Grunewald
Code Inforcement Officer
cc:
from: 1 C SMITH
re: Inspection of code violations
date: 1/29/95
I was contacted by Yvonne Merritt which was renting an apartment at
324 Plaza Drive(lower) apt.1 and she was concerned about the safety of
the residence. Upon inspection I found several items:
(1) No smoke detector present
(2) Fire extinguisher not certified and tagged. (101b ABC ext.present)
(3) Gas heater determined to be unsafe by Vision gas.
Note that the tenants vacated the property due to no heal and no smoke
detectors.
I would like you to look into this situation if you think that it violates
city ordinances.
from the desk of..
Yvonne Merritt 992-9142 (call to schedule appt.) IC$NTH
lieutenant
Atlantic Duch fire Racue
Landlord— Mary Gornwell 850kmincleRoad
Atlantic Duch, Florida 32233
(904)249.3173
fax (904)249-1566
ATLANTIC BEACH FIRE DEPARTMENT
DWELLING SURVEY
Q9a- 'Ad 3a q p
Name: Address:
Date: 9 Shift:
❑i�If not at home check here This copy Is used in duplicate
❑ Refused admittance
With your consent, the undersigned member of the local Fire Department has just completed a fire
safety survey of your home. Your cooperation in eliminating or otherwise correcting the common hazards which
he has checked below,will make YOUR home a safer place in which to live, and help us reduce the terrific
annual toll of life and property by fire. The Firefighter has been instructed to explain each of the hazards found
In your home and you are asked to phone the Fire Department should you need further advice or assistance.
IF THE FIREFIGHTER HAS CHECKED NONE OF THE FOLLOWING ITEMS,YOU ARE TO BE
COMPLIMENTED ON YOUR PERSONAL FIRE PREVENTION EFFORTS.
❑ Rubbish not properly taken care of
❑ Flammable liquids not properly stored
❑ Combustibles too close to stoves
❑ Unsafe wiring
❑ Roofing In danger of sparks
❑ Accumulations of paper/fumiture
❑ Tall grass too now buildings
❑ Oily rags/mops not properly stored
❑ Stoves not property installed
❑ Fuse box over fused
❑ Extension cord wiring, excessive defective
❑ Garage/sheds In bad order
❑ Paints not properly stored
❑ Unvented hot water tanks
Smoke detector not present
❑ Battery needs service (smoke detector)
Remarks:
r
iAi
1
W
KNOW WHAT TO DO IN CASE OF A FIRE IN YOUR HOME
1. Plan your escape route from your home or room NOWT
2. Know how to report a fire
THINK. . . PREVENT FIRESI SAVE A LIFEI DO NOT SMOKE IN BED.
For additional Information call 249-5606
ABFD
A
CITY OF
j*e4atic t;e d - 5'&,r4&
800 SEMINOLE ROAD
ATLANTIC BEACH,FLORIDA 32233-5445
TELEPHONE(904)247-5800
FAX(904)247-5805
Date s - 2 `n (
Dear Property Owner:
The costs to connect your building to the City sewer and/or
water system are as follows :
Sewer Tap - Labor and Materials to tap into
sewer main $
Water Tap - Labor and Materials to tap into
water main
Water Meter .- Cost of Meter $ —
Cross Connection Inspection - Inspection by
Public Works to ensure backflow
prevention $ •3 S
Sewer Impact Fees - Funds future expansion Ca
of the sewer plant $
Water Impact Fee - Funds future expansion
of the water plant $
Capital Improvement - Funds for improvements ,
expansion or replacement to
water system $
TOTAL COSTS $ 8
If you have any questions concerning these charges please call
the building department at 247-5826 .
Sincerely,
Don C . Ford
Building Official
DCF/pah
DAT5 -
E : --------------
PR.E-SERVICE DIVISION
JACKSONVILLE ELECTRIC AUTHORITY
233 WEST DUVAL, STREET
JACKSONVILLE, FLORIDA 3220
THE FOLLOWING FIi`tAL INSPECTIONt S ) HAVE BEEN ?LADE AND ARE
SATISFACTORY :
1
-0— ---� -- ---------
------- --- ----------
= �- --- -------
------ -------------------------------------------------
------ ------------------------------
-------------------
------ ------------------------------------------
-------
Enclosed are the blue copies of the permits.
RELY,
BUILDING INSPECTION DIVISION
cc : FILE
t-F F_'.c2 N a CO_D .
106.6—FOUNDATION PERMITS
When application for permit to erect or enlarge a building has been filed
and pending issuance of such permit, the Building Official may, at his dis-
cretion, issue a special permit for the foundations of such building. The
holder of such a special permit shall proceed at his own risk and without
assurance that a permit for the superstructure will be granted.
SECTION 107—FEES
107.1—GENERAL
A permit shall not be issued until the fees prescribed in this section shall
have been paid. Nor shall an amendment to a permit be approved until the
17 additional fee, if any, due to an increase in the estimated cost of the build-
ing or structure, shall have been paid.
107.2—FAILURE TO OBTAIN A PERMIT
(a) If any person commences any work on a building or structure before
obtaining the necessary permit from the applicable governing body, he
shall be subject to the penalty prescribed herein.
(b) Where construction is commenced before a permit is obtained, the
permit fees shall be doubled.
107.3—ACCURATE RECORDS
_�Building Official shall keep a permanent and accurate accounting of
aT[peit fees and other monies collected, the names of all persons upon
___<4ccount the same was paid, the date and amount thereof.
107.4—SCHEDULE OF PERMIT FEES
On all buildings, structures or alterations requiring a building permit, as
set forth in Section 105, a fee for each building permit shall be paid as
required at the time of filing application, in accordance with the schedule
as established by the authority having jurisdiction. (See Appendix "K" for
recommended fee schedules.)
107.5—BUILDING PERMIT VALUATIONS
If, in the opinion of the Building Official, the valuation of building,
rJJ alteration, or structure appears to be underestimated on the application,
permit shall be denied, unless the applicant can show detailed estimated
cost to meet the approval of the Building Official. Permit valuations shall
include total cost, such as plumbing, electrical, mechanical equipment and
other systems.
SECTION 108—INSPECTIONS
108.1—INSPECTIONS—GENERAL
(a) Before issuing a permit the Building Official may examine or cause to
be examined any building for which an application has been received for
permit to enlarge, alter, repair, move, demolish, or change the occupancy
thereof. He shall inspect all buildings and structures, from time to time,
1-9
CITY OF ATLANTIC BEACH
DEPARTMENT OF BUILDING
800 Seminole Road-Atlantic Beach, FL 32233-Tel: 247-5826- Fax: 247-5877
PLUMBING PERMIT
PERMIT INFORMATION
LOCATION INF RM TION
Permit Number: 21891 Address: 326 PLAZA DRIVE
Permit Type: PLUMBING ATLANTIC BEACH, FLORIDA 32233
Class of WorkL_lR 3.iGATlO1�IX9RAINAGE Township: 0 Range: 0 Book:
Proposed Use: INGLE FAMILY Lot(s): Block: Section:0
Square Feet: Subdivision:
Est. Value: Parcel Number:
Improv. Cost: O INl~fttAYtON - -
Date Issued: 5/03/2001 Name. IRVING CORNWELL
Total Fees: 885.00 Address: 326 PLAZA DRIVE
Amount Paid: 885.00 ATLANTIC BEACH, FLORIDA 32233
Date Paid: 5/03/2001 Phone: (904)249-9680
Work Desc: WATER TAP/CROSS CONNECTION
CONTtA Td S AP LICRTI N PEES. — -
WATER METER/TAP 525.00
CROSS CONNECTION 35.00 M
CAPITAL IMPROVE. 325.00
FINAL
NOTICE - INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION
BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC
SPACE, AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER
"FARE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE
PR ! RTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS"
e,
ISSQED5ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION
FOF V16LATION OF APPLICABLE PROVISIONS OF LAW.
AT LA B CH BUILDING DEPT.
CITY 4F
4&4 `. BWXt-4".
Office of Building Official
REQUEST FOR INSPECTION
Date Permit No,
Time A.M.
Received P.M. District No.
Job Address Locality
Owner's 1 r
ntractor �� ��'
Bt1lLDING CONCRETE IECTRIC P),UMBIN MECHANICAL
Footing ❑ Rough ir,ngd
Re Roofing C7 Slab O Temp Pole 0 Top Out E�1 � Heating
Lintel ❑ Final 11 Fire Place O
Pre Fab
READY FOR INSPECTION
Mon, L( T
es. Wed, Thurs, Friday P.M,
A.M. I j C.3
Inspection Made
InspectorFinal inspection
ca o Occupancy
Date
CITY OF
Office of Building Official
R QUEST FOR INSPECTION
Date � Permit No.
Time A.M.
Received PM. ^
Job Ad cality
Owner's
Name Contractor —_
BUILDING CONCRETE ELECTRICAL P UMBING HANICAL
Framing E, Footing E C Rough 0 Air Cond.& C'
Re Rooting C Slab C Temp Pole C Top Out C Heating
Insulation Lintei ❑ Final C Sewer C Fire Place C
Pre Fab
READY FOR INSPECTION
A.M.
Tues. Wed. Thurs, Friday P.M.
A.M.
PM.
' Final Inspeotio
Certificate o ccupancy u
Date _
`
City of At\adic Beacfi
REPRlNT
*** CUSTOMER RECEIPT ***
OPER: DSMlTH UC DRAWER; l
DAT[: 5/83/81 01 RECEIPT: 0054431
DESCRIPTION QTY AM8(IN[ TP T�:
WATER METERS-A.B 1 5525.00 *80 t�K
BACKFLOW PREVENT 1 $35.00 *56 CK
WATER CAPITAL lM 1 $]25.08 *57 CK
TENIKE R DETAIL
CK 519 $885.8Q
DATE; 5/03/81 TIME: 16:52:12
TOTAL CHECKS $8G5M
z 170 696 039
Receipt for
Certified Mail
No Insurance Coverage Provided
Do not use for International Mail
rros,.r serroicr
_ (See Reverse)
pMj Sent to
v
t Street and N
SZ tC/iia / 3
P.(V,State-and _ Code
o a n�l) A-
Postage
� $ 3z
E Certified Fee
Ui / i J
U) Special Delivery Fee
a
Restricted Delivery Fee
Return Receipt Showing
to Whom&Date Delivered (L b
Return Receipt Showing to Whom,
Date,and Addressee's Address
TOTAL Postage $ L
&Fees
Postmark or Date
i_
r+.
SENDER: t also wish to receive the
• Complete items 1 and/or 2 for additional services.
• Complste�,3 and 4a•& ., following services (for an extra
•'PffM yrr r mercer a�4d lil�irali an'the ravevsa of this form so that we can fee):
return this Bard to VQu.
• A#pch thr3'fomrto'th jinni o deilyieca,or on the.beck if space 1. gAddressee'S Address
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• Wrrta" eWan Receipt Requei*,''on the mailpiece below,t,1le article number. 2. F1 Restricted Delivery C
*' • The Rett lie t`hvilI show.to whom the article was delivered and the date C
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0 3.. Article Addressed : 4a. Article Number
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p ❑Registered C1 Insured
RA Certified El COD E
LU � ❑ Express Mail ❑ Return Receipt for
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GDate of Delivery 0
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6. Signature.(Agent) �
PS Form 3811,December 1981 *LLS.Wo:l Tta DOMESTIC RETURN RECEIPT
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