REV-17-1065 Miami Shores Village RECEIVED
Buildinj, APR 17 109
10050142 A�en e i i re , �r d� 8
INSPE I ki PH NE N' -49
FBC 20
BUILDING Master Permit NO. CLC-3 ,17- 627
PERMIT APPLICATION Sub Permit No. F7 ()CoS
F-]BUILDING ELECTRIC ❑ ROOFING [)7] REVISION ❑ EXTENSION []RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
_ P
CONTRACTOR DRAWINGS
JOB ADDRESS:1(2 t)o Il.)r j
City: Miami Shores County: Miami Dade Zip: 3.3161
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: t
OWNER:Name(Fee Simple Titleholder): �'� V (lJ( V4 Q s, 22�( Phone#:
Address: z®U &)C-
City: M(NM I w o�f S State: 1= zip:_ 3 314 1
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: �(��� 1 ti �h�L Phone#: 36S--'?Ji
Address: 12-1 24 S
City: A, k 1 State: F(— Zip: -?, 314 1
Qualifier Name:[20JO !21CJC ,4; (Pj T--&Ljj Phone#: 20S--G 1 - Q700
State Certification or Registration#: —S CJ L Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 3 'r-® Square/Linear Footage of Work:
Type of Work: 0 Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:a y)r)10 t- A �) b { i1 a AJ r 1j ti& c- 7-r� -E
Specify colorof OT
or ru 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$ "
(Revised02/24/2014)
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.
f
SignatureF4R-,/� Signature
OWNER or AG T s CONT R
The foregoing instrument was acknowledged before me this The foregoing instrument as acknowledged before me this
day of Lei, 20 17 by A day of �/ 20 by
who is personally known to L t;1^ who is personally known to
or who has produced as me o&wk>a-lias Ireddee-
identification and who did take an oath. Jdentifica#en and who did take an oath.
NOTARY4PUBL NOTARY PUBLIC:nSign: Sign: IkPrint: Print: b�
91(
SE*,r*,,�:N011r,Ruhtle Sita F1oP1� Seal: o Y DEBORAH SAD GHI
ffry J Yeo a NOTARY PUBLIC
C�nnla w FF 188489pires 11112=18 —STATE OF FLORIDA
Comm#FF171409
s
APPROVED BY ' � /q/��/� I� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
r RECEIVED
' APR
Barry Thompson 230 -'X o c r9
Equipment to structure and cable
Manufacturer Model Quantity Cost Description
Da-Lite 20902 2 $1,002.00 Wall mounted projection screen
Chief CMA115 2 $78.00 Ceiling tile mount w/safety wire
Chief CMS006009W 2 $92.00 Pipe from ceiling mount to projector mount
Chief RPAAIW 2 $334.00 Projector mount
QSC AC-C6T-WH 4 $595.00 Ceiling mount speakers w/safety wire
Belden 1213F 100ft $123.00 CAT5 Plenum cable to room sensor and projector
Belden 63000E 100ft $40.00 18/2 Plenum cable to speakers
Nuetrik NE8FDY-C6-B 2 $50.00 Wall plate RJ45 connector
Nuetrik NL4MP-2 2 $6.00 Wall plate Speakon connector
Nuetrik NC5FD-L-B-1 2 $15.50 Wall plate XLR conncetor
Custom Wall Plate 2 $14.00 Aluminum wall plate
$2,349.50
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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
• 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
erliiicate N ttt;ci 20100108-E135070a e 1 of 2
Rei7,AReferoi':,c E135070, 1997 Septeniber 18
lss(J;Date 2010 January 8 Underwriters
U15L Laboratories 1nc.,11;
Issued to: NEUTRIK AG
IM ALTEN RIFT 143 SCHAAN
9494 LIECHTENSTEIN
This is to certifl,that CONNECTORS FOR USE IN DATA SIGNAL,
representative samplt•y of CONTROL AND POWER APPLICATIONS.
See Addendum Page
Have been investigated by Underwriters Laboratories Inc.` (I-L)or any authorized
licensee of i.:'1_ in accordance;,i,ith the Stanelard(s)indicated ort this Cert{ficate.
*see
Sttdtddard(s)for Safely: UL 1977 - STANDARD FOR COMPONENT CONNECTORS VAR USF_-F4• •.....
DATA, SIGNAL, CONTROL AND POWER APPLICATIONS-*Edition:*** •.?,
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Adddtdwial IJ7re)rinatdt)!9: See UL On-Line Certification Directory at ,vNvw.UL.com f gteadditional.. ••,•�•
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information .. ...�,
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Oul) those products hearing; the UL Recognized Component Mark siTE3ttld be
Considered as being covered by UL's Recognition and Follow-Up Service.
The UL. Recogni cd Coniponent 141ark generally consists of the marnuftcturer'N identiiicat,on and
catalog rrm r be-:, rrodel nun:be: or other product desigatation as specified under 'A-1:i&nu" fol- Clic
p ni�x. crr Recognition rc> publiahed in the appropriate UL. Directory. As a atl:pic:?1rnlar. rncams cel
ideutfyine produr.t� 1.11::11 liavc been producer! under UL.'s Component Rcar nitir;t 1'r, ;rami. LA
Recr ni;cd (ca;morr:ni ?-lark: 9a. may be used in conjuction with ti:e r:.,luired Rc ,;_ni;d Rlztra.
El:c R ( r ,;pc.t.ct:. 'Mark . required when spcciiik�L in the UI. ,).rcclorti p
Iti i+}': ;I;•.'I i..ill ....d Ct .`•i;+;rant' ;i!I,le;ndib dual rc'CQ'�.iil1.E7T 3.
Look for the UL Recognized component Mark on the product
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20100108-E135070 Pace;2 of 2
Re!ererce E135070, 9597 September 18
I. 2010 January 8 underwriters
UO
= 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 followed by
RX for RX series, may be followed by -M3, -H, -V_,,7AU, -B, -BAG, -HE, -HA ,
-L-1 or -0. For RX, X and XX series only: -HD, -14, -CRYSTAL or -SPEC.
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