526 Gran Concourse 6.AM I SHORES Vi LLAG E
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida, and all provision the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of i. ti Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept t ilding during progress of the work.
Iinte�.__
Owner's Name and Address
Registered Architect and/or Engineer —
Name and address of licensed contractor--_ e�err.��_
Location an-dlegal description of lot to be built on: N
,It _0 [ 7 Block _11 SubdIiv�ision
Street and N ber where work is 'to be done___ 4p
State work e t ne d purpose of build (by floors)_ ..__�i,-y.�--�-� '��
New Building ------------------------------
To be constructed of—-— Kind of fottndatigm _---_
Estimated Total cost of improvements $ ----- 72--&-o-_l_�_i_-_d__0----------- Amount of Permit
Zone cubage req
pe
for no other4ptirpose.
No. of
Covering------------------------------------------------
Distance to next nearest building ....... —__-_ _Size of Building
Maximumlive load to be b by each floor-------------------------------------------------------------------------------------------------------------------------------------------------------------
I hereby submit all 1 s an seeifiea ' ns for sal b ing. All notices with reference to the building and its construction may
be sent to_—
The undersigned applicant for this building permit does hereby certify that he understands -and accepts his obligations as an employes
of labor wader the Florida Workmen's Compensation Act, being Section 5966, Compiled Gener l haws of Florida, Permanent Supplenient,
and has complied with the provisions thereof, and will require similar compliance from al�.•to ctors or sub -contractors employed by him
in the work to be performed under this permit; and will post or cause to be pasted for i e on on the site of the work suelti uhlic notice
or notices as are required by the Act. The undersigned agrees to employ only such s actors, on work to a perforn under this
permit, as are licensed by Miami Shores Village, J J
Remarks----------------------------------------------------------------------------------------------- (Siened)_ Z,4c f!f2 G- 3'%
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared— ....................... - - -
- m me well known,
and who, being by me first duly sworn, upon oath
of the above described construction, that lie has cc
therein by him s 'tted are tru
Permit No.
Disapproved
( Signed) —
sand says that he is the ----------------------------------------------------------------------------------------------
read the foregoing application, and that he did sign the same, and that all facts
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires--------------------------------------------------------
PLANNING BOARD -------------------------------------------------------- DATE
Chairman Member--- - -----
----------------------------------------------------------------------------------------------
Member -------------------------- Member --....._..._.._.
Member-------- ....---------------------- ...- Member .-________......._.
Council Approved -------------------------------------------------Date Disapproved - — —
NOTE: A charge of $1.00 will be made for makip-
the Planning Board.
A re -inspection fee of $1.00 will be charged wl-
materials and/or workmanship.
,changes to this application after approval has been obtained from
made necessary by improper notice for inspection or faulty
�l
MIAW SHLi DIES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
�
Permit Nol, a Date.��� .�
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith stsbmiued for the building
structure' herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, ,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Div
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept
building during progress of work.
Owner's Name and Address ..� 'G o•_. ,e?----------- Street.__. ................
Registered Architect and/or Engineer —_----- _—........
..--- --
Employing Electrician's Name __�_ � - --- -----
�T S/ - --- - —
Location and Legal Description Lot. ----------- __.._____.Block --------
Street and Number where work is to be performed—No.Street___—__.__-.-.__..�...�__
State work to be performed and purpose of building (By Floors) f u..........:....._----- ------- _— .....
_...___._.�
New Building__________________________________ Remodelir__g-.........-...._- _.-..-.._ Addition.---... f...___ Repairs___. ................... —... No. of Stories_...--
SWITCH
OUTLETS
I LIGHT
I OUTLETS
III
PLUG
RECE'P'T's
FIXTURES
NO.LAMPS
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT-
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
2—
LIST
CHECK
ENT.
SW.
DIST.
CAD.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0-1 HP
MOTORS
1-5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
Service Overhead '—Size Feeders ________________ ConduitMain Sw........._ . Am Main Fuses ---- — -------- —_ Amps.
L�IIe3ergra�.., ._____________ .........- Amps. ----- ----
Type of Installation —Conduit________________ Tubing____ B.X.L----------------- Metal Moulding __________-- .......
Amount of Permit �--------- --- - (Signed)
Electrical Inspector•
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub -contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The under signed agrees to employ only such sub -contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. may,
(Signed) .._..-.: i!..-.._:`'____ c� W.
Master Electrican.
CT ATV nl= rT rlV TnA 11
MIAMI SHORES VILLAGE, FLORIDA
WILilING DATE ' 2" 7 1942--
LECTRICAL V PERMIT N° 5631 Contractor's ,
TUMBING License No.
Work to be performed under this Perna
)caner of
I�
luilding ,�,�-• - r''
Lrehitect
contractors _~
r Builder t
regal Lot Bl.
)escription
tddress of . zt, ( f
iseilrlinsr ;4 C l lF
Subdi-
vision
Value of
Amt. o6 G�
Perna
This permit is granted to be contractor or builder named above to construct the building or to install the equipment or device described in the appli-
ation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
may•laps, drawings, statements or specifications that may have been submitted to and approved by the proper. municip4l, authorities. This Permit may be revoked
t any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization'. A further condition upon ► which this
-ernut is. granted is the understanding that the contractor or builder named above assumes the responsibility for a thoroulgh knowled a of the ' 'nances and
agulations pertaining to the work covered hereby whether shown on the plans wingthe stn nents qmpecificatio he sumes respon-
ibility for wo done by his agents, servants or employees.
Signed Hy 1
INSPE OR
cons' eration of the issuance to me of this permit I agree to perform the work covered her under in compliance w� ordinances apo��lakions
ert ' g tl ato and in' strict conformity with the plans drawings, statements or specifications submitted to the proper a es of Miami fhjPt..3, illaae.
n AC this permit I assume re nsibility for all work done by either myself, my agent, servant or employee.
CONTRACTOR OR BUILDER BY AUTHORITY
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Coastal Shutter Systems, Inc.
NOTICE OF ACCEPTANCE: EVIDENCE SUBMITTED
A. DRAWINGS
1. Drawing No. 05-331, titled " Bertha HV Accordion Shutter System ", sheets I
through 14 of 14, prepared by Tilteco, Inc., dated November 02, 2005, signed and
sealed by Walter A. Tillit Jr., P.E.
B. TESTS
1. See Association's generic approval under 05-0227.
C. CALCULATIONS
1. See Association's generic approval under 05-0227.
D. QUALITY ASSURANCE
1. By Miami -Dade Building Code Compliance Office.
E. MATERIAL CERTIFICATIONS
1. See Association's generic approval under 05-022Z
F. STATEMENTS
1. Release letter issued by the American Shutter Systems Association, Inc., dated
November 7, 2005, certifying this product to meet the criteria of product tested
and approved, and allowing Coastal Shutter Systems, Inc. to use the test results
approved under Dade County Approval No. 05-0227, signed by Ms. Legny
Santana.
2. Acknowledgment letter by Coastal Shutter Systems, Inc., dated November 7, 2005,
signed by Mr. Tom Buchholz
3. Letter by Tilteco Inc., dated November 04, 2005, certifying that the drawing (No.
05-331) prepared for Coastal Shutter Systems, Inc., signed and sealed. by Mr.
Walter A. Tillit, Jr., P.E., is engineering wise identical to ASSA's generic drawing
(No. 05-072).
dt"Z�
Helmy A. Makar, P. E.
Product Control Examiner
NOA No 05-1114.03
Expiration Date: 12/29/2010
Approval Date: 12/29/2005
E-1
MIAMI-QADE
BUILDING CODE COMPLIANCE OFFICE (BCCO)
PRODUCT CONTROL DIVISION
NOTICE OF ACCEPTANCE
Coastal Shutter Systems, Inc.
8500 N.W. 72' Street
Miami, Florida 33166
MIAMI-DADS COUNTY, FLORIDA
METRO-DADE ELAGLER BUILDING
140 WEST FLAGLER STREET, SUITE 1603
MIAMI, FLORIDA 33130-1563
(305) 375-2901 FAX{305) 375 2908
www.buildin eodeonline:com
SCOPE:
This NOA is being issued under the applicable rules and regulations governing the use ofconstruction materials.
The documentation submitted has been reviewed by Miami -Dade County Product Control Division and accepted
by the Board of Rules and Appeals (BORA) to be used in Miami Dade County and other areas where allowed by
the Authority Having Jurisdiction (AHJ).
This NOA shall not be valid after the expiration date stated below. The Miami -Dade County Product Control
Division (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade County) reserve the right to
have this product or material tested for quality assurance purposes. If this product or material fails to perform in
the accepted manner, the manufacturer will incur the expense of such testing and the AHJ may immediately
revoke, modify, or suspend the use of such product or material within -their jurisdiction. BORA reserves the right
to revoke this acceptance, if it is determined by Miami -Dade County Product Control Division that this product or
material fails to meet the requirements of the applicable building code.
This product is approved as described herein, and has been designed to comply with the High Velocity Hurricane
Zone of the Florida Building Code.
DESCRIPTION: " Bertha HV " Aluminum Accordion Shutter System
APPROVAL DOCUMENT: Drawing No. 05-331, titled " Bertha HV Accordion Shutter System ", sheets 1
through 14 of 14, prepared by Tilteco, Inc., dated November 02, 2005, signed and sealed by Waiter A. Tillit Jr.,
P.E. bearing the Miami -Dade County Product Control Approval stamp with the Notice of Acceptance number and
approval date by the Miami -Dade County Product Control Division.
MISSILE IMPACT RATING: Large and Small Missile Impact
LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and the
following statement: "Miami -Dade County Product Control Approved", unless otherwise noted herein.
RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been no
change in the applicable building code negatively affecting the performance of this product.
TERMINATION of this NOA will occur after the expiration date or if there has been a revision or change in the
materials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of any
product, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to comply
with any section of this NOA shall be cause for termination and removal of NOA.
ADVERTISEMENT: The NOA number preceded by the words Miami -Dade County, Florida, and followed by
the expiration date may be displayed in advertising literature. If any portion of the NOA is displayed, then it shall
be done in its entirety.
INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its distributors
and shall be available for inspection at the job site at the request of the Building Official.
This NOA consists of this page 1, evidence submitted page E-1 as well as approval document mentioned above.
The submitted documentation was reviewed by Helmy -A. Makar, P.E.
Il ]9• % NOA No 05-1114.03
Expiration Date: 12/29/2010
Y
12-4 n s Approval Date: 12/29/2005
Page 1
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MIAMI SHORES VILLAGE, FLORIDAd:--__
DATE
WILDING
:LECTRICAL tP---*-1,�PERM1T N? 6526 Contractor's
License Via. -
)LUMBING
Work to be performed under this Permi ---
p,, iner of
B- 'ding a(,�L
Architect
ContraLer
or BuiiIl
Legal Lot ` Bl.
Description ll,�
Address of
WIFA
Subdi-
vision
Value of
06.
Building p equi vice. scribed in the
This r rujitris gra np]iao t w th else rOr dinances. pertaining thernamed eto and with ve to the understhe dtmdingor t hat the work wilI be per thl ineconhpliay b with
cation p
is Permit x
plans drawings, tstatements
ta me is
o don ifi compliance ►ay have
eedi ancestor if the plansrarechan8 d widlout authomunicrizatioal authorities. kf�rrthenccondition upon wl icl
at any ordinance
permit is granted is [he un erstanding that the contractor or builder named above assumes the responsibili for a thorpug]h knv dge
regulations g antedpertain s t e the work covered hereby whether shown on the -pl b a - gs or a ents or spec ieativns an at assumes r�
,sibility, for work done by his agents, servants or employees. By
t in Consideration of the issuance to me of thus permit I agree
pertaining thereto and in strict conforrnity with the plans, drawini
In accepting this permit I assume responsibility for all work done l
Ville work covered hereunder in compliance with,%* ordinances andjW
eats or specifications submitted to the proper authorities of Miami Shores
myself agent, servant or emp oyeo.
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