REV-17-1068 Miami Shores Village
M Building Department
De
p
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 S�VI
FBC 201H
BUILDING master Permit No. SLC -- 3 -17 -6
PERMIT APPLICATION Sub Permit No. Re'j 1- - 1 c-uy
❑BUILDING Z ELECTRIC ❑ ROOFING ® REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
[� CONTRACTOR DRAWINGS
JOB ADDRESS: ( 13SCO �+ 1 -J-kJ (W 'jb n r a-S
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):_ N U l� d/rZ� ( I Y Phone#: 7&46 ` ;�'W - 3,(z
Address: II 1Soo N ra / yr=--
City: 'I r \LNMk J y State: Zip: 3 3
Tenant/Lessee Name: Phone#:
Email: (�
CONTRACTOR:Company Name: C— Phone#: 05--0 [ ®0()
Address: I 3 75 N t-d S
City: A)c-an-1 State: Pc Zip: S 3(6(
Qualifier Name: (NJ 1:?2LLJ Phone#:
State Certification or Registration#: r S CSC) ( ` 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: [X Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:�-D�(�11(a- 12(J )A-0,D(77G &J L L 03 L O ELIZ EL 7-6
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$ � 'W
(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.
Signatur Signature
OWNER or AG T I CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument N�as acknowledged before me this
day of s 20 Q� .byd, ,::,
day of � � 20 by
who is personally known to l� / C� who is personally known to
{ me or who has produced as me or_wrho has oroduced - -
0
identification and who did take an oath. ideo6fleatrotrand who did take an oath.
NOTARY P C: NOTARY PUBL C:
Sign: _ Sign:
9
PrinPrint:
;� Jeffry J Yao o *9VSeal: Seal: NOTARY PUBLIC
My� COMMMW FF 168"1
� —STATE OF FLORIDA ppo� Expires itH9J2018
Comim�#FF,1�77114409r Q
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
RECEI VE®
' APR 7
19
Barry Andreas 105 o� 3U ,Y
Equipment to structure and cable ;''
t,
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 $7.75 Wall plate XLR connector
Custom lWall Plate 1 1 $7.00 Aluminum wall plate ••••
$1,408.75
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s efi ficate tiur;t}eP 20100108-E135070 .age 1 of g
Repoil Reference E135070, 1997 Septentber 18
Essi e Date 2010 January 8 Underwriters
U0 L 'Laboratories Inc.,
Asued to: NEUTRIK AG
IM ALTEN RIET 143 SCHAAN
9494 LIECHTENSTEIN
sees
This is to certify char CONNECTORS FOR USE IN DATA :S16NAL,;•••� ••••:•
representative samples of CONTROL AND POWER APPLICATIQ s.
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See Addendum Page see:e s
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Have been investigmted by Underwriters Laboratories Inc.,ef4 j.,or an,�-atftlirizede
licensee of 1.11, in aecoralance.>with the Standard(s)indicate drwatdtis Certificate. .'
e seeeei
Slarttlarrl(s)for Safely: UL 1977-STANDARD FOR COMPONENT CONNEGTOAS FORx1SM
DATA,SIGNAL,CONTROL AND POWER APPLICA?IDNS -Editioq 2: :
!;additional 1pformation: See UL On-Line Certification Directory at www.UL.com for additional
information
Only those products bearing the UL Recognized Component M arh should be
considered as being covered by UL's Recognition and Follow-Up Service,
The 111- Recos2ntred ('oniponent hark gen rt l onsists of the nranufteturer's iderttifrcat.ion and
catalot, number, 1-o el number or other pri�dtrct designatkm as specified under "110arkints-' for the
ptn-neuEar Rcuo}rt 11 n as published in the appropriate LT Director}. As a supplementary tnians of
dentii�ir.L procUtd,; that hate beat produced tinder UUL Component Recognitiott l'ros_ranT.
Recoenved (omno-rcnt '.lark:511'. mav be rued in co imdon with the required Reco_nnizQd Marks.
The R e ,,.:rice. C, ir , ; ;.k Mark -coo red v,hen sixcified in til [ L Directory t 1ecccdi;ts the'
recotn.i.an,01 d1 lor h ndib idwil recotn'.ic on .
Look; for the UL Recognized Component Mark on the product
WiltLim lib:';trtac•Y
Nmrth Aizaerietttt e:.�a z �t? a rogr amts
T,ttts.r,'tittss Laboratories lnt.'-
20100108-EI35070 of
Rc;: it Reieicr;ce E135070, 1997 September 18
ks-U ua°e 2010 January 8 Y
Underwriterss
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 foffowad
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by F or H, may be followed by S, followed by D for DL series or -LX f*•r••
••
DLX series or followed by X for X series or XX for XX series or followaa'ty •
RX for RX series, may be followed by -M3, -H, -_V _,,7-AU, -B, !hl&•• -HE,'
• °SAA , °•°°•.
.••! . •
-L-1 or -0. For RX, X and XX series only: -HD, -14, -CRYSTAL or -SPEC. :sees*
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Vifflani R,Carney
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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SCDX SCF SCCD-W
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