38238PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ` - Job Address /13c" '' ''1''1'�' 4' Tax Folio
Legal Description
Owner / Lessee / Tenant 6,0 'ec y G�•''vdzs -'-xl/ *- F/-0N 1 4 Master Permit # (3 6 0 E52..)
Owner's Address "130v 'v€ '`'r'�i • 4 ' '`''z"" / 37 ` 1 ck 1- -5 ' -' Phone J Z G /
786. .v40 sr`s
Contracting Co. u''`�' "" ti.•tsi-1 4. 'c-- Address "''i ' .C&4 3 3 it c
Qualifier "''` Z 'v"s .g/ ..../.4.. SS# - - Phone e' 1-4-73
CC - 02/ q / ooaoi3 8S3
State # Municipal # Competency # Ins.Co.
•
Architect /Engineer �' "
Square Ft.
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
Zoning Buildin
Mechanical Plumbin
Address 333D
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION �c'f "1 / '__ F -" , 14:7ce .o .1.*;%-/s, 9 ,•e"
♦ • J 'S 9
Estimated Cost (value/ ° ° °
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO 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). -
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
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. Furthermore, I
authorize the above -named contractor to do the work stated.
Signature of Contractor
Date: 8 /7 /71
Notary as
My Commis i
1
** * * * * * * * * * * * --...
FEES: PERMIT g15( RADON C.C.F. fl NOTARY
APPROVED:
o�r saner- Builder
o • I - - wilder
etherine A. Decesare
Commission Expires
April 29, 1997
Comm. No. CC 281634
* * * **
TOTAL DUE W
Fire Other
Electrical
Engineering
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH CURETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WINO)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
G
/2,
SERVICE SIZE IN AMPS
DUCT WORK
FIOOR DRAIN
p/ 9 .
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
I NTERCPTOR
RANGE TOP
UNOERGRCUPO TANKS
LAVATGAY
e2-
1 1
� OVEN
ABOVE GROUND TANKS
LAUIO(Y TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MIGTCRS 0- 1 HIP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 HP
NOT WATER BOILERS
SINK, POT /3 COMP.
MDTCRS OVER 3- 5 HP
_ MECHANICAL VENTILATION
SINK, RESIDENCE
_ MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, me ",--/®/-'
/
/k
MOTORS OVER 8- 10 HP
ELEVAT0RS/ESCALATCRS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 NP
FIRE SPRINKLER SYSTEMS
URINAL
3
MOTORS OVER 25-100 HP
COMING TOWERS
WATER CLOSET
r
1g;
MOTORS OVER 100 HP
V IOLAT I ON
INDIRECT WASTES Qg' arm
/
g' _
A/C WINDOW
RE I NSPECT I ON
WATER SIPPLY 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
f °IX
AP
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY- WATER
;i
FIXTURES
.
SEPTIC TANK
ANTENNA
'
RELAY
TELEVISION OUTLETS
DRAINFIELO, 4' TILE/RES.
VIOLATION
PUMP &ABANDON SEPTIC TANK _
RE INSPECT ION
SOAKAGE PIT CU. FT.
CATCH BASIN
'
DISCHARGE WELL
'
DOMESTIC WELL
AREA GRAIN
9
ROOF INLET
/®
/�
ii,2,'
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ADDENDUM TO BUILDING PERMIT APPLICATION
ELECTRICAL
MECHANICAL