PL2003-283 NIIAMII SHORES VIILLAGE
BUILDING DEPARTMENT
305-795-2204
Builth/ng spection Request
Date l 2—(d Time !/
Type Insp'n 2
Permit No.
Name
Address
Company
Phone# 50s
For Ins tor: (� 7e ,
a
Approved
Correction ❑
Re-Insp'n Fee ❑
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305-795-2204
Building Inspection Reques
Date Time
Type Insp'n uc Y 9f G Y
Permit No. ?I X065- 2.93 .
Name 1"�1JG2 r
Address Il 6
Company 60�F
Phone#
For Inspector: ���a� N to
Approved
Correction ❑
Re-Insp'n Fee ❑
1
y
�EC I ED Miami Shores Village
CT 4 2003 Building Department
10050 N.E.2nd Avenue
- - -------m Miami Shores,Florida 33138
Tel:(305)795.2204
Faa:(305)756.8972
BUILDING. Permit No. PQW2)'a�-�53.
PERMIT APPLICATION Master permit No.�' 2¢Q358
FBC 2001
Permit Type(circle): Building Electri. �Plumbin echanical Roofing
JZOwner's Name(Fee Simple Titleholder)',
Phone# .3 cL 5' 3
Owner's Address t t g 3 4-4- t 9 3
City M Alw .�'i{p s State a-,,(S.t.- Zip
Tenant Name �'N'^�- Phone# ^
Job Address(where the work is being done) ' 3 t O 3
city NEW Shores Village County HaminDadep. Zip
Is Building Historically Designated YES NO
sr S Q,- Ur`. Phone# 3 Q 5'- 2 z� -°t R 3 Z-.
Contractor's Company Name 'h �('
contractor's Address "�Q 5 4;' ��� `' 1,✓ -
,,
city � ' state 5�
ArchitecdEngineer''s Name(if applicable) Phone#
Archbect/Engineer's Address
as
$Value of Work For this Permit 113 Qo Square Footage Of Work:
Number of:Bays Stories � Families Bedroo Baths
Type of Work: OAddition ClAlteration []New W;;;;lReplace ❑Demolition.
Describe Work: 2A
" f , wr�ttsir�r�r�t�tsir�ew*�*its,t�ttsst�,t�ttF��t�t�t�t,t�tstr�w*,t*s,ts�t,ts,t*�tttt�rss�t�t .
County Escrow Fee$ Permit Fee$ �,`� Notary$
Educationfrmining Fee Tech$ Scanning$ Radon$
Code Enforcement$ Bond$ Strad$
mus Plans Cbeek Fee$ Total Fee Now Due$ �� (Continued on opposite side)
j# ► -3ro
Bonding Company's Name(if applicable) '
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
CityState 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 permft must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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.
"WAwMG TO OWNER YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR 1WROVEMENTS 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.
ibL
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The forego' instrument was acknowledged before me this•
day of ,20_,by day of 20i�,by r 1OV)n
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUB C:
Ic—
sign: Sign:
Print: Print:. ' ' mmisdon k 1984
Expo :Jul
13,20
My Commission Expires: My Commission Exp. .' g Ttnn
' �
�,.*sr:s:rs,xss,�ss�.,xAr�*�rsr�.*,t,��,r,�•.s,r,�.s.:,�,�:,x,..��e,�r:**::#*���esa.,.,.*.,►,��,x,.••�*,x*•�*�r��t�t,.;�*t ,�a
( ertificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
*************************** * *** ******************************************************************
APPLICATION APPROVED B Plans Examiner
Engineer
Zoning
Cho 10!0M
, . ADDENDUM TO BUILDING PERMIT APPLICATION
APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
:AINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING ELECTRICAL MECHANICAL
UNIT FEE ITEM . UNIT FEE ITEM UNIT FEE
TUB SWITCH OUTLETS SPACE HEATERS
LIGHT OUTLETS CENTRAL HEATING
{ASIIER RECEPTACLES A/C (WIND)
]SAL SERVICE TEMPORARY A/C (CES•
(INS FOUNTAIN SERVICE SIZE IN AMPS arT WORK
T DRAIN SERVICE REPAIRWER CHASE REFRIGERATION
SE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING
;CEPTOR RANGE TOP mumm TANKS
TORY LR J OVEN ABOVE GROX TANKS
JRY TRAY WATER HEATER U.F. PRESSURE VESSELS
AS WASHER MOTORS 0- 1 HP STEAM BOILERS
n MOTORS OVER 1- 3 HP HOT WATER BOILERS
POW COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION
RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEWLIES
SLOP MORS OVER 8- 10 HP ELEVATORS/ESCALATORS
MY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS
RAL MOTORS OVER 25-100 HP COOLING TOWERS
A CLOSET ! i MOTORS OVER 100 W VIOLATION
RECT.WAR S A/C WINDOW REINSPECTION
:R SUPPLY TO: AIR CONDITIONERS
/C UNIT STRIP HEATER
IRE SPRINKLER GENERATORS TRANSFORMERS
EATER-NEW INST. GENERATORS TRANSFORMERS
CATER-REPLACE GENERATORS TRANSFORMERS
AWN SPRINKLER-WELL SPECIAL PURPOSE
'RIMMING POOL OUTLETS COROCIAL
ATER SERVICE SIGH TUBES
:A CONVECTIONS SIGN TRANSFORMERS
_ITY-SE18 SIGN TIME CLOCK
:ITY--WATER FIXTURES
TIC TANK ANTENNA
AY TELEVISION OUTLETS
INFIELD, 4' TILE/RES. VIOLATION
P & ABANDON SEPTIC TANK REIIRSPECTION
KAGE PIT W. FT.
CH BASIN
OIARGE WELL
ESTIC WELL
:A DRAIN
IF INLET
.AR WATER HEATER .
X STANDPIPE
IL PIPING
IN SPRINKLER SYSTEM
R RANGE
'ER SET GAS) s
> PIPING