REV-17-1062 p g RECEIVED
i e
nt APR 17 2017
es- 6*f2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 *
FBC 2014
BUILDING Master Permit No. ' - 3-I1 -63v
PERMIT APPLICATION Sub Permit No. [2f,417—�0Qoq—
❑BUILDING EgELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
/ CONTRACTOR DRAWINGS
JOB ADDRESS: t ! 3�� N r-= 2 — f 5E/�-j T f-z
City: Miami Shores County: Miami Dade Zia:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):_ U y ( V c SPS (I V Phone#: 7 66- .2c) -2- �(Z
Address: �j
City: M(j�'M 1 M G2 FS State: FL Zip: 33 (6 l
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name:_ aLsoi r Kj C Phone#: 3o5--€j
Address: 3 7 5 `J Z 12 C LuA S
City: 6 LT7T7j !�,( Aid State: E c- Zip: 3 316 Je
Qualifier Name: (Q C 2�Cl� �( IU -(7� Phone#: }
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ /�� Square/Linear Footage of Work:
Type of Work: W Addition El Alteration 1:1 New EJRepair/Replace ❑ Demolition
/
Description of Work: D D((,3 ( Pi,-� 11U) 1 DU/u a::k= (-o N AL c'-TU 0c'
( 1z P 6,PPt.-)c i 2l<
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ C�
(ReAsed02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as 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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC.....
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 approved and a reinspection fee will be charged.
Signature Signature
w U,
OWNER or 4ENT CONTRALTO
The f re . instrument AMU
acknowledged beforeeyme this The foregoing instrument was acknowledged before me this
B daay�p ofn
�A1 U .20 a d by day of r 1 20 ` � by
who is personally known to I 11J, who is personally known to
Wg or who has produced as me or--w as PF9dwGed
identification and who did take an oath. -i l€reat(=and who did take an oath.
NOTARY PUB : NOTARY PUB C:
Sign: Sign:
06Print: Print:
�� Y s�
al: Seal: °° NOTARY PUBLIC
Notary Public State of FloAda
;� Jeffry J Y80 STATE OF FLORIDA
MY Commission FF 168481 Comm#FF171409
�dgpd� Exphea 11/12/2018 �i/yc 0 xn fAc �ry,'A�p
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Barry Wiegand 132 Project# 17078.7 APR 17/n2017'
Equipment to structure and cable 94�
Manufacturer Model Quantity Cost Description
Da-Lite 70292 1 $432.00 Wall mounted projection screen
Crestron GLS-OIR-C-CN 1 $125.00 Room sensor for turning off equipment
Chief CMS440 1 $89.00 Ceiling tile mount w/safety wire
Chief CMS006009W 1 $46.00 Pipe from ceiling mount to projector mount
Chief RPAAIW 1 $167.00 Projector mount
QSC AC-C6T-WH 4 $344.00 Ceiling mount speakers w/safety wire
Belden 1213F 100ft $123.00 CATS Plenum cable to room sensor and projector
Belden 63000E 100ft $40.00 18/2 Plenum cable to speakers
Nuetrik NE8FDY-C6-B 1 $25.00 Wall plate RJ45 connector
Nuetrik NL4MP-2 1 $3.00 Wall plate Speakon connector
Nuetrik NC5FD-L-B-1 1 1 $7.75 Wall plate XLR connector
Custom lWall Plate 1 $7.00 Aluminum wall plate
$1,408.75
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4/10/2017 NC5FD-L-B-1-Neutrik
NC5FD-L-B-1
5 pole female receptacle,solder cups,black metal housing, gold contacts
Universal D-size metal body XLR panel mount series.UL recognized component.
Features&Benefits
• Robust•D"metal shell lit
Standardized D sized 24 mm panel cutout
• Solder cups on 3-7 pole version
Technical Information show
Accessories
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Certificate of Compliance
iicate ttiutri[;c:r 20100108-k i 35070 a^e s of t
Re-oilefe.,,er-c E1350i0, 1997 Septeniber 18
lssil-:Da?:' 2010 January 8 Underwriters
V L Laboratories
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Lvned to: NEUTRIK AG
IM ALTEN R1ET 143 SCHAAN
9494 LIECHTENSTEIN
This IS 1O i'eN %that CONNECTORS FOR USE IN DATA SIGNAL,
representative samples of CONTROL AND POWER APPLICATIONS. •.•.
See Addendum Page • • +••• •••••
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Have been invesnguted by Undertiwiters Laboratories Inc. !({0L•).or ant, prized` ••+
.� ltJsr
licensee of UL in accordance with the Vandard(s)indicatectbAlhis Ceftifrcate.
Statrdarrl(v)for Safi.,q,: UL 1977 - STANDARD FOR COMPONENT CONNECTORS FOR USE'A
DATA, SIGNAL, CONTROL AND POWER APPLICAMW-Edition*2
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Additional Information: See UL On-Line Certification Directory at ,vww.UL.com for additional
information
Onh those products bearing the UL Recognized Component Vlatrk sbault9 br-
considered as being covered by UL's.Recognition and Follow-Lip:Service.
71e UL Recognized C'on;ponent Mark een:rally consists of the ntanu(tcturt.r's idetttitira!,tn: sua
c,talo" ntimber, model number or other product designation as specified andel "Marking." fir flit,
p nicui:+r Rccet!?ition as published in the appropriate UL Director}. As a sul;pieme nary ntr;tr: of
i.fen1il'.0ng products that have bt-en produced tinder UL' Component Recorariti:n Prorrrun. 4. L''
Rect,enired C.cmiron-I Mark: 911, tnav be t-ised in cimjuction with the re,Jtiucd Reoo2nir;d N011k'.
reouh-ed when sixcit ed in ili(' 1;1. ')J'�C'alrt !. t r : Y !h'
lbr..i:;ndivi(Jual reco-Ynitic?n .
Look for UL Recognized Component Mark or, the produci
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E935070. :99?SepteMber 18
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UO L Laboratories Inc,..;
This is to verify that representative samples of the product as specified on this certificate were tested
according to the current UL requirements.
Component Connectors, Series DL, Series DLX, Series RX, Series XX
and Series X, Cat. Nos. with prefix NC followed by 3, 4, 5, 6 or 7 followed
by F or M, may be followed by S, followed by D for DL series or D-LX for
DLX series or followed by X for X series or XX for XX series or followp•by
RX for RX series, may be followed by -M3, -H, -VAU, -B, .BAG. -HE,'e-j"•, 0000•.
-L-1 or -0. For RX, X and XX series only: -HD, -14, -CRYSTAL?, ;SPEC. 0000 ••.`
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