EL-05-26Miami Shores Village
Buildirig Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATIO
FBC 2001
Permit Type (circle): Building
Owner's Name (Fee Simple Titleho der)
Owner's Address
City intdS , jig tate
Tenant/Lessee Name
l ECElVED
Permit No.
aster Permit No
g
Mechanical Roofing
one #
Zip ize
Phone #
Job Address (where the work is being done) -Q Ng�• 0 / �'(".e 0131
City Miami Shores Village
is Building Historically Designated YES
Contractor's Company Name
Contractor's Address
City �K[a 1
Qualifier
County Miami-D de Zip 3 / 3e
NO
.2tSGOT rGicirci l d
Gjjf State
fTCrt?�T/
Phone # /177
Zip ;a_ tal
State Certificate or Registration No. sM 6 /3 OO /,5J/,O Certificate of Competency No.
Architect/Engineer's Name (if applicable)
Phone #
Value of Work For this Permit (p.5-6 o' 0
Square Footage Of Work:
Type of Work: ❑Addition teration a ew ElRepair/Replace Demolition
Describe Work: fL, Ze riero 31?:)RiC 1 sitz 1 ri 9�
2)
Submittal Fee $ • Permit Fee $ l
' CCF $ CO/CC
Notary $ Training/Education Fee $ Technology Fee $ /T
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Han Review. $
Total Fee Now Due $
c908
(Continued on opposite side)
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 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.
"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
Owner or Agent
Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this /+-I
day of
,20_,by , day of ,.-.., ,20d.5",by
who is personally known to me or who has produced
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 PUBLIC:
Sign: Sign: ,, 1
Print: Print: �p}- ►/ s i) o tJ
My Commission Expires: My Commission Expires:
Y P . c9g T40
;Yr MY COMSMISSION # D0004259 � RES
March 31, 2005
BONDED THRU TROY FAIN INSURANCE INC.
************************************************************************************************************
APPLICATION APPROVED BY:
Chc 05/13/03
Plans Examiner
Engineer
Zoning
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION, FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, L: OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN •
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT/3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTCRS OVER 100 HP
VIOLATION
INDIRECT WASTES-
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
,_..
GENERATORS TRANSFORMERS
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER -REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
.SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTLRES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
DRAINFIELD, 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING