1979 Selva Marina Dr (vault) (2) d'° FLORIDA ENERGY EFFICIENCY CODE
Azs FOR BUILDING CONSTRUCTION
SECTION 9—RESIDENTIAL POINT SYSTEM METHOD CLIMATE ZONES
FORM 900-A-84 DEPARTMENT OF COMMUNITY AFFAIRS NORTH 1 2 3
This form may be used to demonstrate compliance with the Energy Code for new single-family detached or multifamily attached dwellings under Section 9
of the Energy Code. An alternative to this method for single-family detached dwellings, and multifamily attached dwellings of three stories or less, is
provided in Section 10 of this Code.Only dwellings which are above ground frame(wood siding,brick veneer,etc.)or concrete wall type construction may
be calculated using Sections 9 and 10.Other types of construction must comply under Section 4 or Section 5 of this Code.Additions to existing residential
buildings shall comply with the requirements of Section 10 of this Code.Detailed information on how to complete this form may be obtained from your local
building department or the Department of Community Affairs,Energy Code Program,2571 Executive Center Circle East,Tallahassee, Florida 32301.
PROJECT NAME Les-r- / 56L_4 - • evTE PERMITTING OFFICE:
AND ADDRESS: pL'IA4,. co N.fri r-Li,/Q-&Q e.> CIRCLE CLIMATE ZONE: 1 2 3
BUILDER: L..I ft-r t Q Z I14 c- 2_ P PERMIT NO.:
OWNER: JURISDICTION NO.:
DETACHED IF MULTIFAMILY, NO.OF UNITS GLASS AREA AND TYPE
COVERED BY THIS CALCULATION: CLEAR TINT,FILM,SOLAR SCREEN
SEPARATE CALCULATIONS ARE REQUIRED SGL SGL
FOR EACH WORST CASE UNIT TYPE.CHECK IF _
r---1 ATTACHED THIS CALCULATION REPRESENTS A WORST
CASE CONDITION. 3 8 7 DBL DBL
NET WALL AREA AND INSULATION CONDITIONED CEILING INSULATION
CBS R= FRAME — R= FLOOR AREA UNDER ATTIC SGL.ASSEMBLY
1 I I 4 5 1 2 /.. 1 ) R= ?jd R=, f
COOLING SYSTEM PRIMARY HEATING SYSTEM PRIMARY HOT WATER SYSTEM
`0 CENTRAL NONE ELECTRIC STRIP GAS NONE ELECTRIC RESISTANCE SOLAR
•
ROOM OIL 1 I SOLAR 111 ///VVV HEAT RECOVERY GAS
l 11
PACKAGE TERMIN'1_L-AC ri'Vl ,JCAT pi A S. - ) 4 1- ^i r
• :,..: . F -
H I DED. HEAT PUMP:COP = l _ 1
EER/SEER = I 14 OTHER: 11
OTHER:
CALCULATED E.P.I.: l 7 5 CALCULATED E.P.I.MUST NOT EXCEED 100 POINTS
In accordance with Section 553.907 F.S., I hereby certify that the plans Review of the plans and specifications covered by this calculation indi
and specifications covered by this calculation are in compliance with the cafes compliance with the Florida Energy Code. Before construction is
Florida Energy Code. completed, this building will be inspected for compliance in accordance
with•Section 553.908, F.S.
OWNER/AGENT:. BUILDING OFFICIAL:
DATE: 2 /t 1
DATE:
—9-T1 PRESCRIPTIVE MEASURES(Must be met or exceeded by all residences.)
—
_ MINIM_UM REQUIREMENTS CHECK TO INDICATE
COMPONENTS .—_ REQUIREMENTS COMPLIANCE
WINDOWS(903.1) MAXIMUM OF 0.5 CFM per LINEAR FOOT OF OPERABLE SASH CRACK.
DOORS(903.1) MAXIMUM OF 0.5 CFM PER SQUARE FOOT OF DOOR AREA.INCLUDES SLIDING GLASS DOORS.
EXT.JOINTS&CRACKS(903.1) TO BE CAULKED,GASKETED,WEATHER-STRIPPED OR OTHERWISE SEALED.
CEILING INSULATION(903.9) MINIMUM OF R-19.
WATER HEATERS(903.2) MUST BEAR ASHRAE STANDARD 90-80 LABEL OR A MAX.4 WATT/SO.FT.STAND-BY LOSS.SWITCH
OR CLEARLY MARKED CIRCUIT BREAKER(ELECTRIC)OR CUT-OFF VALVE(GAS)MUST BE
PROVIDED.
SWIMMING POOLS(903.3) IF HEATED BY OTHER THAN SOLAR,MUST HAVE POOL COVER DESIGNED TO MINIMIZE HEAT LOSS.
ALL NON-COMMERCIAL POOLS MUST BE EQUIPPED WITH A POOL PUMP TIMER.
HOT WATER PIPES(903.4) INSULATION IS REQUIRED ONLY FOR RECIRCULATING SYSTEMS. IN SUCH CASES,PIPING HEAT
l LOSS SHALL BE LIMITED TO A MAX.OF 17.5 BTU /H PER LINEAR FOOT OF PIPE(SEE 504.4).
SHOWER HEADS(903.5) WATER FLOW MUST BE RESTRICTED TO NO MORE THAN 3 GALLONS PER MINUTE.
HVAC DUCT CONSTRUCTION CONSTRUCTED IN ACCORDANCE WITH INDUSTRY STANDARDS AND LOCAL MECHANICAL CODE.
(903.6) _ DUCTS IN UNCONDITIONED SPACE MUST BE INSULATED TO A MINIMUM R-4.2.
HVAC CONTROLS(903.7) A SEPARATE,READILY ACCESSIBLE MANUAL OR AUTOMATIC THERMOSTAT FOR EACH SYSTEM.
1 ,
L._ FORM 900-A-84 CLIMATE ZONES 1 2 3 I
WINTER _ SUMMER
OR AREA SGL DBL WOF GROSS OR AREA SINGLE DOUBLE SOF GROSS
(9F) WINTER CLR TINT CLR TINT (9F) SUMMER
POINTS POINTS
N 157.4 120.8 VT N 1 5 146 123 120 101 / / Se)O
NE 157.4 120.8 NE 221 186 190 159 t�//
C7 _E 1 2 t. 157.4 120.8 ,�f /5,�'�3...-7 E t 2.q 289 242 251 209 ,94 30,Sf-3 to
z SE 157.4 120.8 SE 261 219 226 189
a g 157.4 120.8 ,710 -13,2.1.o S 1,Li 4 190 160 160 134 .11 ;j,944,
0 SW 157.4 120.8 SW 261 219 226 189
0 W q 9 157.4 120.8 /4 /0,.4 I w I el 289 242 251 209 ,94 2...s%3 58
N W NW 157.4 120.8 NW 221 186 190 159
fA►- H 46.4 79.3 H 489 408 432 360
Q?
JW
7
J
U
Z
O F-
Z _ '
O
0
H= HORIZONTAL GLASS(SKYLIGHTS). FOR SC OTHER THAN 0.83 SEE SEC.902.2(a)5.TINT MULT.MAY BE
-�-y USED FOR GLASS WITH SOLAR SCREENS, FILM,OR TINT.
I- TOTAL GROSS WINTER POINTS "Z / S- (TOTAL GROSS SUMMER POINTS AP0�/ 1
- 1.14 //l(j r
R = 4.2-4.9 Al" ► 71-4773518A G R = a.2-aa - /490/119/
F-J R = 5.0-6.6 1.12 R=5.0-6.6 1.12
C.) R = 6.7& UP 1.09 R = 6.7&UP 1.09
a 2 DUCTS IN CONDI- DUCTS IN CONDI- .
TIONED SPACE 1.00 TIONED SPACE 1.00
I HSM FROM 9G /nS Q 2d z,'Cb 4Z,3,7. I I CSM FROM 9H //4 C441 X ,A I 9 ,, q-‘e) I
4 liP-
DIVIDE BY I j n DIVIDE BY I
CONDITIONED - ( �' !� CONDITIONED Q ,Alb - h
FLOOR AREA 42/52 V ( A�'O WINTER POINTS FLOOR AREA I `4l SUMMER POINTS
CALCULATE ENERGY PERFORMANCE INDEX
WINTER SUMMER HOT WATER E.P.I. ADJUSTMENT ADJUSTED CREDIT PTS. PENALTY CALCULATED
POINTS _POINTS PTS.(91) SUBTOTAL MULTI.(9B) E.P.I. _ (9C+ 9D) PTS.(9E) E.P.I.
/9.2 + '1I. $ - _ eDI , /.6.5 =fiVIC - S + '2 = q7.5
THE CALCULATED E.P.I.MUST BE EQUAL TO OR LESS THAN 100 POINTS.
9B ADJUSTMENT MULTIPLIERS
CONDITIONED 901- 1101- 1301- 1501- 1701- 1901- 2101- 2301-
FLOOR AREA(SQ.FT.) 0-900 1100 1300 1500 1700 1900 2100 2300 ABOVE
ADJUSTMENT 1.21 1.25 1.31 1.36 1.42 1.49 1.57 1.65 1.74
MULTIPLIER _
3
LI11 ut tiii.Ai.1iL 1 L1Lti
APPLICATION FOR PLUMBING PERMIT
r, PPROVED DATE
• c;-; ATLANTIC BEACH
eui' . : .^
NEW TYPE OF BUILDING
OWNER'S NAME
OCT 1 1 537 REPIPE RESIDENTIAL
,, �" ��J �,,-' ADDITION COMMERCIAL
LOCATION C
PLUMBING FIRM dr ADDRESS
MASTER PLUMBER •
please print
CITY/COUNTY OCCUPATIONAL LICENSE NO.
STATE CERTIFICATE NO.
BUILDER OR CONTRACTOR
/ SINKS ' I LAVATORY ,Z BATH TUBS URINALS FLOOR DRAINS
^7 CLOSETS 0 SHOWERS / WATER HEATERS / DISHWASHERS / DISPOSALS
' WASHING MACHINE OTHER TOTAL FIXTURE COUNT
INSTALLATION OF PLUMBING AND FIXTURES MUST /� @ ��
BE IN ACCORDANCE WITH THE MOST RECENT EDITION
OF THE SOUTHERN STANDARD PLUMBING CODE. SIGNATURE OF MASTER PLUMBER
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
FIXTURE UNIT BREAKDOWN
FIXTURE UNITS ARE ESTABLISHED AS THE MEASUREMENT OF WATER DEMAND FOR EACH WATER FIXTURE UNIT
INSTALLED AND CONNECTED TO THE CITY WATER SYSTEM. THE WATER SUPPLY CHARGE IS HEREBY FIXED AT
TEN DOLLARS PER FIXTURE UNIT CONNECTED TO THE CITY WATER SYSTEM. SEC. 27-3 (c)
I� BATHROOM GROUP CONSISTING OF BATHTUB (W/OR W/O OVER SHOWER STALL,
WATER CLOSET, LAVATORY & BATH HEAD SHOWER) (2 UNITS) DOMESTIC (2 UN.
TUB OR SHOWER STALL (6 UNITS) BIDGET (3 UNITS) LAUNDRY TRAY
COMBINATION SINK & TRAY (2 UNITS)
DENTAL LAVATORY
(3 UNITS) (1 UNIT) KITCHEN SINK
CONBINATION SINK & TRAY W/ (2 UNITS)
DENTAL UNIT OR CUSPI-
FOOD DIS. (4 UNITS) DOR (1 UNIT) KITCHEN SINK W
DRINKING FOUNTAIN (1 UNIT) WASTE GRINDER
0. DISHWASHER (2 UNITS)
FLOOR DRAINS (1 UNIT) / ' LAVATORY (1 UNIT) _ LAVATORY, BARB
LAVATORY, SURGEONS (2 UNITS) BEAUTY PARLOR
_5, SHOWERS GROUP PER HEAD (2 UNITS)
SURGEONS SINK (3 UNITS) (3 UNITS)
POT, SCULLERY
FLUSHING RIM SINK (8 UNITS) SERVICE SINK TRAP SINK (4 UNITS)
STAND (3 UNITS)
URINAL, PEDESTAL, SYPHON JET URINAL STALL,
BLOWOUT (8 UNITS) URINAL, WALL LIP WASHOUT (4 UNI
URINAL TROUGH EACH 2' (4 UNITS)
WASHING
MACHINE RES. WASH SINK EA S
SECTION (2 UNITS) (3 UNITS) OF FAUCETS
WATER CLOSETS, TANK- WATER CLOSETS, VALVE (2 UNITS)
OPERATED (4 UNITS) OPERATED (8 UNITS)
TOTAL FIXTURE UNITS
MAP SHOWING SURVEY OF
LOT 3 , SELVA NORTE ' UNIT ONE AS RECORDED IN PLAT BOOK 39 , PAGES 94 , 94A AND
94B OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
' ! /1---/ _--,4// , Y . -- ..�/7-.
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, � 2_s_17_ __)/L_____ �/ : 90.//" Q'?B�4 79.
2 e./ Al Olo' 43' 3o w C q°-//.
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ccL VA MAR/,vAQ�,DR/I/E
S 6FC,QME��v o s,,-/E,e e
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%/.//S /5 A LANG SURVE>!
•,.4:7 B//,c04./G RESTR/CT/O" L,,/E B✓ •°4'47.-
•FLOOO ZONE ':4"/5 /A/ 7-/./E .4. 'E4 of 77./4- /oo YE.4F
FLGbO. ,z-Loci ZONE "8' /5 87 ' ',v" T,•'E /00
4A/, 500 1 E,4Q Ft Oop ARE-45.
• ELE✓AT/ONS 5Noi•v// 7'V//5.'(1/22) ANO .?e- 4-,E" TO
././47-/c44./.44 GEOOETK vERT/CAL o.4TUM.
I hereby certify that this survey meets the
minimum technical standards as set forth by
the Florida Board of Land Surveyors, pursuant
r N. A. DURDEN to Section 472.07 Florida Statutes.
IV& ASSOCIATES INC. efi;
R[OI/T[R[D SU VRYOR NO/O�/LA.
LAND
SURVEYORS OCT03r.Q ?� lO 8¢
SIGNED Post Office Box 50670
830 Beach Boulevard SGALE: / ��
Jacksonville Beach,Florida 32250
THIS SURVEY NOT VALID UNLESS THIS PRINT IS EMBOSSED WITH THE SEAL OF THE ABOVE SIGNED.
,
/338
� a �a
•
CITY OF ATLANTIC BEACH
APPLICATION FOR PLUMBING PERMIT
DATE 1 d —02 9 /
LOCATION 19 L VA M A R I Al A e/f,
PLUMBING FIRM
MASTER PLUMBER /�
CITY/COUNTY OCCUPATIONAL LICENSE NO. � t') �/
STATE CERTIFICATE NO. g[ 75-f)23
BUILDER OR CONTRACTOR # 4'A'7
TYPE OF BUILDING p kJ
****)******************************************************************
/ SINKS SHOWERS
, LAVATORY 2 WATER HEATERS
BATH TUBS ) DISHWASHERS
URINALS J DISPOSALS
CLOSETS / WASHING MACHINE
FLOOR DRAINS
OTHER
/5 TOTAL FIXTURE COUNT
************************************************************************
INSTALLATION OF PLUMBING AND FIXTURES MUST BE IN ACCORDANCE WITH THE
MOST RECENT EDITION OF THE SOUTHERN STANDARD PLUMBING CODE.
DEPARTMENT OF BUILDING PER WI NO. 6_I2__KT
?U"4 n n
CITY OF ATLANTIC BEACH,FLORIDA .00C AC
PERMIT TO BUILD 61U9 CAC
THIS PERMIT MUST BE POSTED ON JOB
Date__M=1.2________19_114_
pEj gBING Fee$ 62. 50
Valuation$ I
This permit not valid until above fee has been paid to City Treasurer,and is
subject to revocation for violation of applicable provisions of law.
�A
FUR BLUMHIN ll xz 1'
This is to certify that
has permission to gigtd INSTALL PLUMBING
RESIDENTIAL Zone RS1
Classification
Owned by HENRY W. KEEEER
Lot 3
Block________S/D Sr "–
House No.
197' S = ►i= e ` . I '
According to approved plans which are part of this permit NOTICE—ALL CONCRETE FORMS
t AND FOOTINGS MUST BE IN-
SPECTED BEFORE POURING.
• PERMIT VOID SIX MONTHS
.n AFTER DATE OF ISSUE
�♦ O Building material, rubbish and debris
/�� F from this work must not be placed
in public space, and must be cleared
u, ;nd hauled away by either con-
t
,�ojw�ner. J�
�°"Z w—
,� Budding Official,
-
FOR OFFICE _
DATE f CONTRACTOR �I
USE ONLY
milloffill
PLUMBING
ELECTRICAL
SEWER
I WATER
CITY OF ATLANTIC BEACH, FLORIDA ` , .t,"/
•
l
Approved by
APPLICATION FOR ELECTRICAL PERMIT
I ,
TO THE CHIEF ELECTRICAL INSPECTOR: DATE:
IMPORTANT NOTICE:
IN CONSIDERATION OF PERMIT GIVEN FOR WITH OTHE AT ACHEDBPLANS AND SPECIF CA IO OF
HEREBY AGREE TO PERFORM SAID WORK IN ACCORDANCE
WHICH ARE A PART HEREOF, AND IN ACCORDANCE WITH THE ELECTRICAL REGULATIONS, CODES AND
ATLANTIC BEACH ORDINANCES.
/�/J 1 / �" Co�✓/� '
!/57 a �� �� JOURNEYMAN
ELECTRICAL FIRM: MASTER ELECTRICIAN SIGNATURE
NAME /ten/ y ir.P2 /21-_ —ADDRESS: /97 ,C'42 %) ,ASP A RFD BOX
BLDG.SIZE BETWEEN:
RES. APT. ( 1 COMM.( ) PUBLIC ( 1 INDUS.( ) NEW(V OLD ( ) REW. ( )
ADDITION ( 1 TRAILER ( 1 TEMP. ( ) SIGNS ( 1.
SQ. FT. - •
t FEE /0.6)0
SERVICE: NEW P INCREASE ( ) REPAIR ( )
�U AMPS gene) COPPER ( ) ALUM.(PC) �.T. 4 O
CONDUCTOR SIZE
SWITCH OR BREAKER O?04 AMPS / PH 3 W yhVOLT ..5:‘47-i RACEWAlf4
--
EXIST.SERV.SIZE -
AMPS PH W VOLT RACEWAY '
.� — —
FEEDERS NO. SIZE 1N0. SIZE NO. SIZE .
LED OPEN TOTAL ,
CONCEALED LIGHTING OUTLETS
CONCEALED .- OPEN TOTAL
RECEPTACLES O-'O AMPS. 31-100 AMPS.
- -
SWITCHES
INCANDESCENT ._
•
FLUORESCENT&M V., , -
FIXED FIXED o-loo AMPS. l OVER
APPLIANCES _ _� _ BELL TRANSF.
AIR H.P.RATING H.P. RATING
CONDITIONING COMP.MOTOR OTHER MOTORS AMPS CEIL HEAT: KW-HEAT
Y
0-1 - . ff OVER
1,H.P. VOLTAGE PHS
MOTORS- ,._H.P.• VOLTAGE PHS. NO. '.
MISCELLANEOUS �• - .
TRANSFORMERS
x:'',- UNDER 600 V. II OVER 600 V.
NO. KVA III NO. KVA .
NO.NEON TRANSFt NO. VA. Ell MOTOR SIZE SWITCH. FLASHE-4
EACH SIGN ` -
;, , '' . 1
1
FORWARDED.
TOTAL FEES j - , Q__
s ,
r'
•
,,„_,.\ i \ i
olr 41
.e-- / (nirtifirfltt of ®rru4fnrg N.
CITY OF # -
Brpartmrnt of Vuilding Jnoprrtion ,.,
This Certificate issued pursuant to the requirements of Section 109 of the Southern Standard .,
Building Code certifying that at the time of issuance this structure was in compliance with the
various ordinances regulating building construction or use. For the following.
Bldg.Permit No.
Use Classification
Fire District. e`h'
�` Group_--T Construction £
Address—— - -
Ot Owner of Building
Locality_
Building >
JO' Building Address
♦ By: —
Building Official Date:_------ t, .."4.S
1, ,p Jy,
POST IN A CONSPICUOUS PLACE T!'
*►t `I, / t \ o t `'4 I t \ Pi t \ of t N4 / t
CITY OF
rP ,*14n Val e% 96 I.ieu
716 OCEAN BOULEVARD
P.O.BOX 25
. ATLANTIC BEACH,FLORIDA 32233
1 TELEPHONE(904)249-2395
January 18, 1985
Pre-Service Section
3rd Floor
Jacksonville Electric Authority
233 West Duval Street
Jacksonville, Florida 32202
The following final inspections have been made and
are satisfactory :
Permit #4155 - 1979 Selva Marina Drive,
Permit #4156 - 2029 Selva Marina Drive
Permits are issued to Allstate Electrical Contractors .
Sincerely,
John M. Widdows
Building Inspection Supervisor
JMW:ra
I
Af
/ 1 ,4)1 Wit: CITY OF' bel
�41la fic L eaCII-ql vuca / n /i
1 a IT�V .
ell
Office of Building Official ►R GIUEST FOR INSPECTION /�'�,/
Date /
c..�- / Permit No.
(C%%
Time /� /A:M'
Received District No.
' ‘772.,11//4-$A-) W.- _,I-L-/----'
Locality ,
Job Address ���p., / IP
Owner s �i J' ./ // Contractor �h=',-
ELECTRICAL PLUMBING MECHANICAL
BUILDING CONCRETE Air.Cond.& ❑
Framing Footing ❑ Rough Wiring ❑ Rough ❑ Heating
in
Re Roofing ❑ g
Re Roofing ❑ Lintel ❑ Temp Pole Cl Top Out Cl❑ Fire Place ❑
Lintel ❑ Pre Fab
BEADY FOR INSPECTION A.M.
Mon. Tues. ed
Thurs. Friday P.M.
y A.M.
Inspection Made
/. /745 p� P.M.
Final Inspection
Inspector
619127#6.?"------ Pt '
Certificate of Occupancy
Date
INSPECTION
LOG • •
JOB ADDRESS GG' -4% L ���G{
CONTRACTOR /y/61t -L_-
OWNER
BUILDING PERMIT If ELECTRICAL PERMIT If
PLUMBING PERMIT If MECHANICAL PERMIT #
FLOOD ZONE /1(:, DATE SURVEY FILED
called in approved JEA
Temp-pole
SCE
Slab
//—c2(o //—a-ta �-, �6 i Se-11'14- ,�.y.-
Footing /7) -/F /C'
Framing //'02
Plumbing (R) /W3 / //-/
Electrical (R)
Mechanical l /� � 7.'e"
Fire Place // 7
Top Out //' �' )- 7
Other
Electrical Final — / 7 l`- r, / -
FINAL INSPECTION /- / — K 2 /
Certificate of Occupancy Issued
COMMENTS _
CITY OF
411aattic Beach-4Iasca
Officg.of Building Official r
REQUEST FOR INSPECTION
Date /(:)// Permit No.
Time A.M.
Received P.M. pistrict No.
Job Address
�Locality��t 4_. Contractor J�/J/f X 7—.6
V
BUILDING CONCRETE / ELECTRICAL PLUMBING MECHANICAL
Framing ❑ Footing le' Rough Wiring ❑ Rough 9 ❑ Air. ng & ❑
Re Roofing ❑ Slab ❑
Temp Pole ❑ Top Out ❑ Heating
Lintel C Fire Place ❑
READY FOR INSPECTION Pre Fab
Mon. Tues. �1l A.M.
yy�� ( �C� Thurs. Friday P.M.
Inspection Mace /[/—/r 5,___e_c0 I A.M.
P.M. r C
� �
Inspector �7JLJ Final Inspection❑
Certificate of Occupancy •
Date
CITY OPj •..
411catisc Bpi-Ilatici
Office of Building Official
REQUEST FOR INSPECTION
Date �� l --
Time Permit No
A.M.
Received
P.M. District No.
Jo.Address - „c
Owner's „ Local t
Name
Contractor L C /
BUILDING ❑ CONCRETE ELECTRICAL PLUMBING
Framing Footing ❑ Rough Wiring ❑ Rough �// Air. A
Slab ❑ Temp Pole ❑ g G' Air•Heating
& •
Lintel ❑ Top Out ❑ Heating
Fire Place p
READY FOR INSPECTION Pre Fab
Mon. Tues.
Thurs. A.M.
J Friday_____P M
/
Inspection Made —1 A.M.
P.M.
Inspector .�. Z,..-----4
Final Inspection❑
Certificate of Occupancy
Date
CITY OF �`
F'
00 ii'
Office of Building Official
�"j_-'
REQUEST FOR INSPECTION
/
Date `�� f I
Time /l Permit No. U
Received L` + V
SDistrict No.
Job Address
Locality
Owner's (.15
Name U[)
Contractor U f �,�/ C
BUILDING / CONCRETE ELECTRICAL PLUMBING `
Framing IY Footing ❑ Rough Wiring Rough MECHANICAL
Re Roofing ❑ Slab ❑ g ❑ Air.Cond.& �}�
C Temp Pole ❑ Top Out �i Heating
Lintel
Fire Place ft
READY FOR INSPECTION Pre Fab
Mon. Wed.
Thurs. Friday
Inspection Maae //� 2 J z
l/i/�f A.M.
Inspector
P.M.
--1�• —Z-)(DO Final Inspection CA' Certificate of Occupancy
Date