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HomeMy WebLinkAbout01-0745 BUILDING PERMITN~ 0745 bJ. B9 ELECTRICAL CITY OF ZEPHYRHILLS (813) 788~6611 bl. ~ PLUMBING Permit 5";~. ~ BUILDING '-Iv. ~ MECHANICAL Date l\ - f 5...0 , l17g. ~ ~ ~o. tE 180.'9 Sewer Conn Water Conn: P'operty Own." \( ev,.... bt Q '" Job Address: 5"'10:5 Va: r 1'- 5 l-~ .,.e Dr, Parcel J.D. # 'D - ~ ~.. 2 I, I) ,10 - 00000- 0 '" 0 0 Zoning: Energy Code: Radon Gas: --l ~. Descriotion of Work (": .... 9 Ie ~CA.t"\; I Y ~ Water Meter: T.I.F.'s: --- 0'2. - NO OCCUPANCY BEFORE C.O. FINAL C.O. -t!? ~ DATE _P::L Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances. DATE Valuation or Contract Price "~l{ ~O. ~ Inspector Pe'm;t Fe"J~S]. '1.9 Signature,.--",--<.(...R ) q Company f~A<::7 City License Registration # State Certified License# Address Telephone# 7 Yd--()ID5 l.'IINta'" Lo~ s+. BUILDING 2ft.{ Ftr. ll- /1..-0 I K l.l( /1-/9-01 Pre SLB Lintel FRM. V:~LI~O'- Ql..-i.(. Insul. CL /;'7-02. JeCf Wl 1h4r\:~ " Glee. D-en,., ;- ~ l..AJ: l ( ; Cu'" ~ PLUMBING I ~ 20 Driveway t/l-;U ,,~ fL 'f ELECTRICAL q 7 (~jO II-/Cf- D I R.L'I Tp:-Serv. SLB /1-~fi'DI f.l-r Rough In /i-L./-Dl.. PLY Tub Set .1I-2-O'J- Rc..X HTo Meter Can Water Const. Pole !/-.;If}-OI1?Lfl sewe:.f!~/1-P'). '&~It'.JD Pool Final 3-/-0.:2_L y "'e'M~~ 1,_:l~:1. ~'f Final L3 - -CJ.:J. R L_ Breakers , Ducts Insl.../ Compre~or Final v'3-/-C7.2 -eLY i)}12. t (.,- ;;< -OJ.. 7 _ 0;)... 5 AH 1'1 k J: tJ~ U tJ.R.J3_C-. I' - 3ft)-i.? ( :5h8'V"/Jl.. 1/:0'1 & REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a charge of Twenty Five and 00/100 Dollars ($25.00) shall be made for each trip for each trade: a. Wrong Address b. Condemned work resulting from faulty construction. c. Repairs or corrections not made when inspection called. d. Work not ready for inspection when called. e. Permit not posted on job site. f. Plans not at job site. g. Work not accessible. The payment of inspection fees shall be made before any further permits will be issued to the person owning same. .-X t!r~ "\"" ~o OWNER'S NAME ~'4IN~r>\~ ; JOB ADDRESS 'lac V CO"\~~ ~(?9tJS) LEGAL DESCRIPTION: LOT(S)~ BLOCK SU~DIVISIOr~<Q&~O M~~", PARCEL ID # \0 -~- "2.\ - 0\'0) -~- o~ (OB'lrATN FROM PROPERTY TAX NOTICF,) WORK PROPSED: ~EW CONSTRUCTION 0 ADDITION o ALT ERAT I ON 0 REPAIR 0 INSTALL APPLICATION FOR PERMIT CITY OF ZEPHYRHILLS II -U ( BUILDING DEPARTMENT~0-" DATE RECEIVED - 9 --0 l . ,-i'LANS REVIEW FEE - O1lY r ? /1 . ~ PHONE 7B2 -a~2S &- DSIGN PROPOSED USE: ~L FAMILY DWELLING o COMMERCIAL o MOVE o DEMOLISH DMULTI-FAMILY o INDUSTRIAL 0# OF UNITS o SWIMMING POOL DMOBILE HOHE o OTHER ~ o RESTAURANT & HEALTH DEPARTMENT APPROVAL DESCRIPTION OF WORK CoN~ ~ ~~~ ~\-i ~, BUILDING SIZE 37/4--1' X .s~'" SQUARE FOOTAGE \.902 HEIGHT ~ I W.J\\J..S 'I RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. ri BUILDING riELECTRlCAL g' PLUMBING ~MECHANlCAL o GAS ~ROOFING VALUATION OF TOTAL CONSTRUCTION AMP SERVICE o FLORIDA POWER 1)(' W.R.E.C. $ (~\OCo,CO VALUATION OF MECHANCIAL INSTALLATION o SPECIALTY o OTHER ~RAME o STEEL o OTHER TYPE OF CONSTRUCTION: 0 BLOCK 1/ FINISHED FLOOR ELEVATIONS B ~t~N~~ IS PROJECT IN FLOOD ZONE AREAD YES ~O COMPANY RYMJl.N r.ONS'l'Rnr.'l'TON. TNr.. STATE CERT OR REGIST # (,,1=l(,,_O~l:i' ~4 CITY PROCESSING # 274 ****************************************************************** ELECTlUCIAN ~~~ COMPANY M~ R'l' T N 'RT. 'Rr.'T'R T r. STATE CERT OR REGIST # ER 013449 CITY PROCESSING # J7~ ****************************************************************** PLUMBER SIGNATURE ~ ~~ COMPANY DENNI S WILLIAMS STATE CERT OR REGIST # RF-O'1?fiO CITY PROCESSING # /C;~O ****************************************************************** MECHANICAL' COMPANY: BAHR'S GAS AND A/C ~ I ~~ /l \ STATE CERT OR REGIST # CAC-043948 SIGNATU~..LJl-- ' Dc::..M. ~ ) CITY PROCESSING # 1/7' ***************************************************************** OTHER ~ =- :>---, ---- --...... COMPANY RYMAN CONSTRUCTION, INC. STATE CERT OR REGIST # RC-0016148 CITY PROCESSING # ~". SIGNATURE ***************************************************************** .CITY OF ZEPHYRHILLS "NOTICE" OF ADDITION OR CORRECTION BUILDING DEPARTMENT / /:0 if 4f'r\ 5~~SS Pn1~ g (}Z. /I_;'A~~I ;'";/; I THIS JOB HAS NOT BEEN COMPLETED. T~e following additiqns or corrections shall be made before the job , will be accepted. DO NOT REMOVE ~~, ,nt~ ~,kr~l ~O~o{<-) 1111 unlawful tor any Carpenler, Cantraclor, Builder, or other pel1oOnl, 10 cover ar caUM to be covered, any port of the work wllh flooring. lath, earth or other malerlal, until the proper Inlpector hal had ample lime to approve the Inllallatlon. , AFTER CORRECTIONS ARE MADE CAlL INSP'CfO:S8-6611 ~PECTION OfFICE HOURS 8 - 5 MON.-FRI. CITY OF ZEPHYRHILLS "NOTICE" OF ADDITION OR CORRECTION BUILDING DEPARTMENT DO NOT REMOVE I ADDRESS DATE PERMIT." I 59()3 Y~1l On. J~2.~e'"L 0745 THIS JOB HAS NOT BEEN COMPLETED. T~e following additiqns or corrections shall be made before the job , will be accepted. C~-'1 i~~~ ~ (9Q~J) O-Ll~~~~~ trJk~ Cl~ y~ ~ i woJ..t OfFICE HOURS 8 - 5 MON.-FRI. , AFTER CORRECTIONS ARE MADE CAlL 788-6611 FOR RE-INSPECTION (jjp It is unlawful tor any Carpenter, Cantractor. Builder. or other pel1oOnl, 10 cover or caUM to be covered, any port of the work with flooring, lath, earth or olher material. untlllhe proper Inlpector has had ample lime to approve the Inslallatlon. INSPECTOR Ryman Construction 5903 Yorkshire Dr. Lot 40 SQ. FEET PRICE MAIN OR LIVING: 1,436 $ 40.00 OTHER AREA UNDER ROOF: 466 $ 15.00 OTHER: $ - VALUATION $ 64,430.00 FEE SHEET $ 330.00 ADDRESS $ 20.00 DRIVEWAY $ 20.00 .' BUILDING: $ 535.00 CREDIT: $ - BUILDING LESS CREDIT: $ 535.00 ELECTRICAL: $ 82.88 PLUMBING: $ 67.50 MECHANICAL: $ 40.00 RADON: $ 19.02 TOTAL $ 744.40 SEWER: $ 1,278.00 WATER: $ 350.00 IRRIGATION: $ - TOTAL: $ 1,628.00 WATER METER:I $ IRRIGATION METER $ 180~00 I SUB-TOTAL $ 2,552.40 , - I I 8IF'8:1 $ 97.5% $ 2.5% $ T I F '8 :1 $ 99% $ 1% $ TOTAL: $ 2,552.40 I O'rlNER kt'-ll~~~ \ C">\ 40 \4~~\.Llo<;)~.~_, ~CJ-'2.<O - 2.t - 0' 2.<:) - (Xx)f)() - Oq.,oa JOB LOCATION PARCEL I.D. ~ SHOW ALL EXISTING & PROPOSED STRUCTURES qIVING DIMENSIONS & SETBACKS. ,51' II" \302- MoD'tL B91 7/ UTILITY BUILDINGS MUST SHoW SIZE & FOUNDATION INFOR- MATI ON. . 2ci' FRONT PROPERTY LINE (NbTE EXAMPLES 1 & 2) :: '10~U\~ :b~~ STREET 1. SETBACKS FOR Rl, R2 ZONING 601- 2. SETBACKS FOR R3 ZONING 601 , 101 P E- R X 0 I , 101 P S 101 0 T S I E N D G 20' 10' 101 EXISTING 10' 1- PROPOSED i 20'SGL fAM 30'DUPLEX 1 0 I 1 0' FRONT PROPERTY LINE fRONT PROPERTY LINE ~ 'l :$ 'i :. j 1 ... I. f. ~ ~ ii ID .0 I 0 ~.,\n Q::, I ~l :~\ I.~~f' ..,.J;X" "~ ~t,'~\<;?,\-.I,; " ~';:I"I""< Ii: ~..;-:l,.':' -','I', 'i' t 5/:'~'".'~""."l",!?;" ~/;; ":.~~: ,/ .)': "'- '''L 1\ :it 60 '~-<I ~ .. \ I"'~ . 4 " , . ) , " ' . ,,' >- '71";' .v (, ......ii', S9 ~ ~t~' OJ' ~ '.Fl"," ....... "- SI 9 ';ij.P' ..... '0 S., "",~ , o ' .. '"rr k <.? , ~l' '............. S"9 ..... II \I ,. """"" <>........ I seIX~" ..... ,..',:. ,,' ' in cone, ' .' o4..J ,:'.' """ ...... 1 " SI ~ ...,;"., '00 ' ;'If &~I"""" ,..", ,.'.,:,::'.. ~ 1'- . ;~;;; r-.... " ....,..;.~'L .,/ I... ! --........... . J~i.":'-..----- I I 1 / ./ VE \ I ~- 4600' 10 LO 0 o ID "" ID 01 44 46.00' II' \ II' g I o ... o Q:: j2 :::) () (,) co V w ~ .....",l \ , \ " " ..... - - - - - - - - - - - - - - - - --- o 58.00' '.. FIR 1/2" ,11827 ,'..'-, l' :t !2 . 10 42 01 C\J ID 0 r..: 8 ID (f) ,,' \ II' \.y~';1.'J~~ 28 ~~.. \ /~..., I \ I '\ 8 :;~, . -~I ~.}i ID~* ('~ ~.. ' zl '58.00 <81137' J: ,:~, ' .,' :&,;: '~ "~7 'I:'i,,:'~,:,' .Il\' ..~. ~~.44' f:j'~; '!~" ':158 43 N 89 044 '~9" W 91. 31 '}~~r . OlE _ S 890 '!l9 !Ji. I 2.'!l",,;. \ ':>1~" 41 f,~; o o ,.. ....: LO o o ID V N 89044}40. W 89.00' -..;1'; ;t "8 o =0 o N 'k' :':t~':'.' in - 10 o o Co ~ ..,8 q> 1 o ,,' .:.9 1 'I g \ } In' 'I in :,'_' ". ',~ ' I , 8~;qo.. . ".~1";,~:_-- ~(~~~:c.4'40" W iif> l' ::;:;:;' Department of Community Affairs FLORIDA ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION FORM 600A-93 Residential Whole Building Performance Method A CENTRAL PROJECT NAME: WEDGEWOOD MANOR BUILDER: RYMAN CONSTRUCTION CO. , AND ADDRESS: 5"tio3 rorlS~~rf Or. PERMITTIN~/lfor CLIMATE / ZEPHYRHILLS, FL 3354 OFFICEtz~f#Yl"/~ ZONE: 41~ 51_1 61_1 PERMIT NO. Ol\(S'"" JURISDICTION NO. "i i~oo CK ,/ .... OWNER: 1. New construction or addition 2. Single family detached or MUltifamily attached 3. If Multifamily-No. of units 4. If MUltifamily, is this a worst case (yes/no) ~'.', 5. Conditioned floor area (sq. ft. ) ~;6. Predominant eave overhang (ft.) J.:~7. Porch overhang length (ft.) C8. Glass area and type: a. Clear Glass b. Tint, film or solar screen '9. Floor type and insulation: a. Slab on grade (R-value, perimeter) ~10.Net Wall type area and insulation: a. Exterior: 1. Concrete (Insulation R-value) it b. Adjacent: 2. Wood frame (InsulationR-vaiue) )11.ceiling type area and insulation: ~ a. Under attic (Insulation R-value) ]12.Air distribution systems a. Ducts (Insulation + Location) J13.Cooling system ~., ~14 . Heating System: t1 ,/;15. Hot water system: "'.), H16.Hot ,Water Credits: (HR-Heat Recovery, " j, DHP-Dedicated Heat . Pump) ~7.Infiltration practice: 1, 2 or 3 18.HyAC Credits (CF-Ceiling Fan, CV-Cross vent, 'f HF-Whole house fan, RB-Attic radiant barrier, MZ-Multizone) 19.EPI (must not exceed 100 points) a. Total As-Built points b. Total Base points L~\~ SN: 8'132 1. 2. 3 . 4. 5. 1436.00 6. 1. 50 7. 0 . 00 Single Pane 8a. O.Osqft 8b.182.4sqft New Construction Single-Family o Double Pane O.OOsqft O.OOsqft 9a.R= 0.00 , 168.60 ft 10a-1 R= 5.00, 898.44sqft____ 10b-2 R=11.00, 230.40sqft____ 11a.R=22.00 , 1436.00sqft____ 12a. R= 6.00, uncond 13. Type: Central A/C SEER: 9.70 14. Type: Heat Pump HSPF: 6.60 15. Type: Electric EF : 0 . 88 16. 17. 2 18. 19. 90.31 19a. 23633.95 19b. 26168.74 ------------------'------------------------------------------------------------- ------------------------------------------------------------------------------- Review of the plans and specifications covered by this calculation indicates compliance with the Florida Energy Code. Before construction is completed this building will be inspected for compliance in accordance with Section 553.908 F.S. BUILDING I1tICIAL: Bel ~~~ DATE: d I f'l / I Hereby certify that the plans and specifications covered by this calcu- lation are in com~liance with the Flori~~, ,~ PREPA......'C' . , _ DATE: .$ - _ I hereby certify that this building is in compliance with the Florida Energy Code. OWNER~ DATE: ( .., ',- ******************************************************************************* SUMMER CALCULATIONS ******************************************************************************* === BASE === I === AS-BUILT === ~~i:--~;~-~-~;;;-:- POINTS f =============================================================================== ------------------------------------------------------------------------------- TYPE ,SC ORIEN AREA X SPM X SOF = POINTS N 72.58 82.2 5966.1 SGL TINT N 40.2 51.5 .93 1922.4 SGL TINT N 16.2 51.5 .93 779.4 SGL TINT N 16.2 51.5 .91 756.0 E 16.19 82.2 1330.8 SGL TINT E 16.2 107.1 .88 1521.9 S 9.86 82.2 810.5 SGL TINT S 9.9 98.3 .81 788.6 W 83.73 82.2 6882.6 SGL TINT W 13.0 107.1 .84 1175.9 SGL TINT W 13.0 107.1 .84 1175.9 SGL TINT W 13.0 107.1 .84 1175.9 SGL TINT W 13.0 107.1 .84 1175.9 SGL TINT W 13.0 107.1 .84 1175.9 SGL TINT W 18.7 107.1 .84 1688.4 ------------------------------------------------------------------------------- ~ .15 X CON~FLOOR / TOT~~LASS =F~ioR X ~~~S = ~i~~SS I ~~~S ~------------------------------------------~------------------------------------ ~~'.15 1,436.00 182.36 1.181 14,989.99 17,705.88 I 13,336.37 C',r<" ======================::========================================================= lNON G~~--;--B;;~-;; POINTS I TYPE R-VALUE AREA X SPM = POINTS -------------------------------------------------------------------------------- I;~~S-;;;~;-----;~~-- 898.4 Ext NormWtBlock In 5.0 898.4 1. 00 898.4 I,Adj 230.4 .7 161. 3 Adj Wood Frame 11. 0 230.4 .70 161. 3 ~,DOORS---------------- '~\ Ext 20.0 4.8 .4 . 'Y~'Ad ) 1 7 . 6 1 . 6 ~r:: ,; i~EItINGS----_________ 'iUA 1436.0 .6 ~'\ 96.0 28.2 Ext Insulated Adj Wood 20.0 17.6 4.80 2.40 96.0 42.2 861.6 Under Attic 22.0 1436.0 .90 1292.4 , ~' ;' :FLOORS-------________ "Slb 168.6 -31.8 -5361.5 Slab-on-Grade .0 168.6 -31.90 -5378.3 'INFILTRATION--_______ 1436.0 10.9 15652.4 ============================================================================= Practice #2 1436.0 10.90 15652.4 t30,042.28 .37 11,115.64 I 26,100.79 1.00 1.100 .352 1.000 10,106.23 ~============================================================================== v. ! : ( 1 1 ; ) *******************************************************************************' . . ~> WINTER CALCULATIONS *~.**************************************************************************** === BASE === === AS-BUILT === ;(~ , ~ ~., ~;:, i.tf It I'r~" it' ,I ; ,~'~;, ; ~,'; . Ii; I I:' , '" ~ ------------------------------------------------------------------------------- g~~~--~~-~-;;;;-:- POINTS I ================================================~============================= TYPE SC ORrEN AREA x WPM x WOF = POINTS ~:,~~. ~ ------------------------------------------------------------------------------- ~,,'.. .15 x CONDo FLOOR / TOTAL GLASs = ADJ. x GLASS = ADJ GLASS I GLASS t. AREA AREA FACTOR POINTS POINTS POINTS .------------------------------------------------------------------------------- l .15 1,436.00 182.36 1.181 -620.02 -732.36 I 600.03 '1 ",: =============================================================================:: N 72.58 -3.4 -246.8 SGL TINT N 40.2 9.6 1.04 400.4 SGL TINT N 16.2 9.6 1.03 160.6 SGL TINT N 16.2 9.6 1.05 163.6 E 16.19 -3.4 -55.0 SGL TINT E 16.2 -2.0 .34 -11.0 S 9.86 -3.4 -33.5 SGL TINT S 9.9 -10.2 .87 -87.4 W 83.73 -3.4 -284.7 SGL TINT W 13.0 -2.0 .16 -4.1 SGL TINT W 13.0 -2.0 .16 -4.1 SGL TINT W 13.0 -2.0 .16 -4.1 SGL TINT W 13.0 -2.0 .16 -4.1 SGL TINT W 13.0 -2.0 .16 -4.1 SGL TINT W 18.7 -2.0 .16 -5.8 R-VALUE AREA x WPM = POINTS 988.3 414.7 Ext NormWtBlock In Adj Wood Frame 5.0 11.0 898.4 230.4 2.90 1.80 2605.5 414.7 Ext Insulated Adj Wood 20.0 17.6 5.10 5.90 102.0 103.8 861.6 Under Attic 22.0 1436.0 .90 1292.4 Slab-on-Grade .0 168.6 2.50 421.5 ~,)"OTAL WINTER POINTS I G 7,271.90 ~============================================================================== Practice #2 1436.0 4.10 5887.6 'TOTAL x , WIN PTS '=============================================================================== SYSTEM == MULT HEATING I TOTAL POINTS COMPON 11,427.57 ------------------------------------------------------------------------------- x CAP x DUCT x SYSTEM x CREDIT = HEATING RATIO MOLT MOLT MOLT POINTS .I~,.-!"',.,..',,.',.,--- 7,~~~~:~__~~:~=---~~::=9~~:_1_::~~~~~~~_~,~~~_~=.~~~-_--~~~~----:~~~~___~~~~:~~~ ---------------- ------- ---------------------- ------------------------------- { ~i~..,', : ;. 1:.:I'~,,:,',,',',',' . ""," ~~' ~ '1\" { , , **************************************************************************~**** . ,.." WATER HEATING ****~************************************************************************** === BASE === I === AS-BUILT === NUM OF BEDRMS =============================================================================== x MOLT = TOTAL I TANK VOLUME EF TANK RATIO x MULT X CREDIT MULT = TOTAL ------------------------------------------------------------------------------- 2 3527.0 7,054.00 I 40 .88 1.000 3527.0 1.00 7,054.00 I =============================================================================== ******************************************************************************* SUMMARY ******************************************************************************* === BASE === I === AS-BUILT === =============================================================================== COOLING POINTS + HEATING POINTS HOT WATER + POINTS = TOTAL I COOLING POINTS POINTS + HEATING POINTS HOT WATER + POINTS = TOTAL POINTS ------------------------------------------------------------------------------- 11115.6 7999.1 7054.0 26,168.74 I 10106.2 6473.7 7054.0 23,633.95 =============================================================================== ~ ***************** * EPI = 90.31 * ***************** ; " :; ! ~ ' ,:I of .For'~aetailed information 0i-the.EPI rating number OJ'' for any ITEM listed, ask your Builder for DCA Form GOOA-93 or Form 600B-93 ENERGY GUIDE EPI= 90.3 o 10 20 30 40 50 60 70 80 90 100 I---------------------~--------------x----I The maximum allowable EPI is 100. The lower the EPI the more efficient the home ITEM RESIDENTIAL ENERGY PERFORMANCE RATING SHEET HOME VALUE Low Efficiency High Efficiency WINDOWS..................... Single Tint SINGL CLR DBL TINT I------x-------_______I INSULATION. . . . . . . . . . . . . . . . . . Ceiling R-Value......... 22.0 R-10 R-30 I------------x------__I R-O R-7 /--------------x-----_/ R-O R-19 /x------______________/ Wall R-Value......... 5.0 ;t Floor R-Value......... 0.0 AIR CONDITIONER............. SEER. . . . . . . . . . . . . . . . . . . . . . 9 . 7 10.0 SEER 17.0 jX-------_____________1 ;cHEATING SySTEM.............. Electric HSPF............ 6.6 6.8 HSPF 12.0 Ix----------__________/ WATER HEATER.. . . . . . . . . . . . . . . oj Gas EF.............. 0.00 Electric EF.............. 0.88 0.88 0.96 IX-----------_________1 0.54 0.90 1---------------------/ 0.40 0.80 1---------------------1 Solar EF.............. OTHER FEATURES.............. ................... ... ...... I certify that these energy saving features required for the Florida Energy Code have been installed in this house. Address: ~~~~~~~~~._.~ Date: Ci,ty/Zip , ~ Florida Energy Code for Building Construction _ 1993 Florida Department of Community Affairs FL-EPL CARD93 ~:i'~ EJ F'ERFORMANCE BUSINESS PRODUCTS, INC. 813-719-8008 FAX 813-719-7919 CITY OF ZEPHYRHILLS ZEPHVRHILLS, FLORIDA WATER ACCT. NO. DATE II' f S ., c) I OWNER/ n ~. RENTER -'~y r"\ q,., Lol'l.~ +. MAILING .373;j.6 '- -:J (e, 51 &LJ. 7~ phl1( hl {15 I fL: ~35L1 / SERVICE ADDRESS 5 q 0 3 W s i,.: r~ 0 r , Lot If 0 % WATER SHUT OFF SERVICE o TURN ON SERVICE ~ INSTAlL METER r READ METER 0 CHECK METER 0 OTHER 0 o SEWER o GARBAGE fIir- IN CITY o OUT CITY ~ No. OF UNITS _ DEPOSIT AMOUNT -s/yfl _ AMOUNT LAST Bill ~ (\~ _ DATE _ MISC. CHARGE WORK COMPLETED BY & DATE COMPLETED ORDER TAKEN BY Retain white form In office at all times. Send pink & yellow forms to Water Service Dept. Water Service Depl. to sign yellow form & return to office. , ll-I 5 .....0 I