EL-04-295BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building
Owner's Name (Fee Simple Titleholder) eVilrl4 0 ( Phone #
- Owner's Address J 130° NG �, „ 0 c ��JJ
Cit Mont.; 3 hcrc' State r� lO1�1d,
Tenant/Lessee Name
Job Address (where the work is being done) bariLl ()AA itCr3
City Miami Shores Village County Miami-Dade
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address c 2c)Cr)
City
Qualifier
Type of Work: ❑Addition ❑Alteration
Describe Work: \la Q Ck Q1
Submittal Fee $
Notary $
brol
i •C'Ln1 A5
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
118
State
Plumbing
Permit Fee $ f "r 'too
Training/Education Fee $ O.
Master Permit No.
Zip 33 I co
Phone # -
Phone #
Zip o
****************************Fees******************************
OCT 1 9 2D04 /
Permit N. . (O l 2
Mechanical Roofing
& OY * .e1
Zip 35
qty - 445 r7 7 7
State Certificate or Registration No. EA - cy3r4 55 / Certificate of Competency No. q r2 E OC
Architect/Engineer's Name (if applicable) 4,4 Phone #
$ Value of Work For this Permit O • Q Square Footage Of Work:
❑ Repair/Replace ❑ Demolition
CCF $ 1 7 • CO /CC
Technology Fee $
Scanning $ Radon $ '"°- Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Bonding Company's Name (dapplicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State'
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
Owner or Agent
The foregoing instrument was acknowledged before me this / 9 tk The foregoing instrument was acknowledged before me this
day of Alb 6e � , 20 vq by u / LG -e rg S , day of 200H, by
who is personally known to me or who has produced Fl • who is personally known to me or who has produced
C) Rnv • a C. As identification and who did take an oath. — as identification and who did take an oath.
NOT %ij/�UBLIC:
Sign: etsc,o..
Print:
My Commission Expires:
Chc 05/13/03
_ - - -� ---
VERONICA A. GALLI
Notary Public - State of Florida M
.1 My Commission Expiate May 9, 20D8
Op als ,aohreD0084895
lay 14a olitif
APPLICATION APPROVED BY:
— CAMPUS SERVICES —
PAUL CARSTENS
Facilities Director, Barry University
Higher Education Services, 11300 NE 2nd Avenue, Miami Shores, FL 33161
Telephone: 305 -899 -3791 • Fax 305 - 899 -3794
e -mail: pcarstens @mail.barry.edu
NOTARY PUBLIC•
Si
:***.
Sodexho
Member of Sodexho Alliance
1A3
Print: 0 2.4tAg i g Zunibun
,.t La Bunbury
My Commission EXJ ^ commission CC979842
* * * * * * * * * * * * * * * * * * * **
****************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
. Plans Examiner
Engineer
Zoning
PUMP & ABANDON SEPTIC TANK
REINSPE
SOAKAGE PIT CU. FT.
r•}qT? 4- 74I.t. L
u�
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
ITEM
PLUMBING
BATH TUB
BIDET
DISHWASHER
•DISPOSAL
DRINKING FOUNTAIN
FLOOR DRAIN
GREASE TRAP
INTERCEPTOR
LAVATORY
LAUNDRY TRAY
CLOTHES WASHER
MOWER
SINK, POT/3 COMP.
SINK, RESIDENCE
SINK, SLOP
TEMPORARY WATER CLOSET
URINAL
WATER CLOSET
INDIRECT WASTES -
WATER SUPPLY TO:
A/C UNIT
FIRE SPRINKLER
HEATER -NEW INST.
HEATER- REPLACE
LAWN SPRINKLER -WELL
SWIMMING POOL
WATER SERVICE
SEWER CONNECTIONS
UTILITY -SEWER
UTILITY -WATER
SEPTIC TANK
RELAY
..M .rt A T•. P Tr
ADDENDUM TO BUILDING PERMIT APPLICATION
r
"a•
}
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
ELECTRICAL
MECHANICAL
UNIT
FEE ITEM
SWITCH OUTLETS
MOTORS OVER 10- 25 HP
LIGHT OUTLETS
RECEPTACLES
SERVICE TEMPORARY
SERVICE SIZE IN AMPS
SERVICE REPAIR/METER CHANGE
APPLIANCE OUTLETS
RANGE TOP
OVEN
WATER HEATER
MOTORS 0- 1 HP
MOTORS OVER 1- 3 1•P
MOTORS OVER 3- 5 HP
MOTORS OVER 5- 8 HP
MOTORS OVER 8- 10 HP
MOTORS OVER 25-100 HP
MOTORS OVER 100 HP
A/C WINDOW
AIR CONDITIONERS
STRIP HEATER
GENERATORS TRANSFORMERS
GENERATORS TRANSFORMERS
GENERATORS TRANSFORMERS
SPECIAL PURPOSE
OUTLETS COMMERCIAL
SIGN TUBES
.SIGN TRANSFORMERS
SIGN TIME CLOCK
FIXTURES
ANTENNA
TELEVISION OUTLETS
UNIT FEE ITEM
SPACE HEATERS
CENTRAL HEATING
A/C (WIND)
A/C (CENTRAL)
DUCT WORK
REFRIGERATION
PROCESS AND PRESS PIPING
UNDERGROUND TANKS
ABOVE GROUND TANKS
U.F. PRESSURE VESSELS
STEAM BOILERS
HOT WATER BOILERS
MECHANICAL VENTILATION
TRANSPORTING ASSEMBLIES
ELEVATORS/ESCALATORS
FIRE SPRINKLER SYSTEMS
COOLING TOWERS
VIOLATION
REINSPECT ION
UNIT FEE
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 10 /26/2004
Applicant:
Owner: UNIVERSITY
JOB ADDRESS: 11300 NE 2
Parcel #
Electrical Permit
Permit Number: EL2004 -295
UNIVERSITY
AVE
Contractor DOUG HEDDEN ELECTRIC, INC. Contractor's Address: 2200 N. W. 118 AVE.
Local Phone: 888 672 - 7177
Page 1 of 1
Legal Description: 36 52 41 40 AC SE1 /4 OF NE1 /4 LESS E35FT & LESS W4OFT LOT SIZE 1740400
Fees: Description Amount
FEE2004 -10500 Building Fee $150.00
FEE2004 -10501 CCF $1.20
FEE2004 -10502 Training and Education Fee $0.40
FEE2004 -10503 Technology Fee $3.75
Total Fees: $155.35
Total Fees: $155.35
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 4/17/2005 Construction Value: $2,000.00
Work: VOICE AND DATA
.00T 2 6 PAID
Signed: (INSPECTOR)
In consideration of the issuance to me of this permit, 1 agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict
conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY: