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PL-05-212Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 7/11/2005 Applicant: MAX POLOUKHIN Owner: POLOUKHIN MAX JOB ADDRESS: 10505 NE 3 CT Parcel # 1122310130280 Plumbing Permit Permit Number: PL2005 -212 Contractor PSG PLUMBING SERVICES, INC Contractor's Address: 343 NW 96 ST Local Phone: Legal Description: FIRST ADD TO PASADENA PARK Page 1 of 1 PB 6 -82 LOT 18 Fees: Description Amount FEE2005 - 9406 Building Fee $180.00 FEE2005 - 9407 CCF $1.20 FEE2005 -9408 Training and Education Fee $0.40 FEE2005 -9409 Technology Fee $4.50 FEE2005 -9411 Scanning Fee $3.00 Total Fees: $189.10 Total Fees: $189.10 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 1/3/2006 Construction Value: $189.10 Work: INSTALL NEW DISHWASHER, KIT SINK. INSTALL LAVATORY, TOILET AND SHOWER. iNSTALL NEW WATER SERVICE Signed: (INSPECTOR) JUL 11 PAID c1 IS -15 In consideration of the issuance to me of this permit, I 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: BLK 11 LOT ?hi MIAMI SHORES VILLAGE 0' BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date ,Q Type Insp'n WO1 c e((.) Ca` gaZin Permit No. Pt Q ,1z Name 1 D AX I �� Address 050S NE 2 dr Company PS C9 PI Un Phone # Inspection Date Approved PP Correction Re- Insp'n Fee BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical pg Owner's Name (Fee Simple Titleholder) MVO Padt.,v, Owner's Address 16 N 1P-41 Cit I Y 1, L IAitw Sti State Tenant/Lessee Name Job Address (where the work is being done) la City Miami Shores Vi e 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Is Building Historically Designated YES NO Contractor's Company Name PU tt 1 kJ 6 6 iti2Xic £5 j w e Contractor's Address `� 3 /i9 f,+� 6 j 4 ei City MC Qualifier PC 0 G u a • State l aL State Certificate or Registration No. C I LI LC 2-$7 Certificate of Competency No. Architect/Engineer's Name (if a `ii$ Value of Work For this Perm Type of Work: ❑Addition 'on ❑New A Describe Work: /WA/ 1/ `poi Submittal Fee $ Permit Fee $ Notary $ Training/Education Fee $ Scanning $ 3.00 Radon $ Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ 18a • 10 (Continued on opposite side) Miami Shores Village Building Department �o 2<, Permit No. Master Permit Npa2.009 Mechanical Roofing Phone # � 9Vb 3'LI Zip 3/ t 3 Phone # v ,4' . County Miami -Dade Zip 13 \ ' d Phone # ) ° 7 3 1 Zip ) ,�O Phone # S -1 S Footage Of Work: Repair/Replace ❑ Demolition .5/4 684-7//a4 DM_ e,Lu c ru c * *, * * * * *, * * *** * * * *, * * * * * ** * F * * * * * * ** * * *** ** ** * * * * * * ** ** 0- CO CCF $ (• 2 0 CO /CC Technology Fee $ 4. 50 Zoning Bond $ 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 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 whi h occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be ap it and a reinspection fee will be charged. Signature NOTARYPUBLIC. Sign: ( Print: tiridc.n My Commission Expires: Owner or Agent The foregoin. instrument was acknowledged pp befo me this day of .��/ . , 20 a, by � A 7 who is person lly known to me or who has produced 05/13/03 APPLICATION APPROVED BY: As identification and who did take an oath. k :?)i A0v_ � .. 'I `w pf.., Carlo A Bidon iA i� Q � NOR 14. 2000 1� . °� AaaonNotaty ******* * * * * * * * * * * * * * * * * * * * * *.NW4 * * * *�x .SOa Signature Contractor The foregoing instrument was acknowledged before me this 1 day of Agk ,20d5, who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC. Sign: Print: Cot etc, t .3, 610vLR Zip ,j� .�{� My Commission Expires: 11r'* AB ************************1 ' b� 7/J/j / ` IFir�h�C] bi�ClYlYiF1F1Fi C 'X'ii'�Y'****'* ***iCiFiY�f'hiF vt 1 1 o : Expires NOR 14.2006 liaconllabuy 61 .14 O Q �� * * * * *` * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *'stn° M1 GN�` * * ** *461 * ** .e -%" / - / 0 -` � Plans Examiner Engineer Zoning (AN APLICATION 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.) PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION ELECTRICAL MECHANICAL ITEM BATH TUB UNIT • FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING BISHWASHER 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 (ROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 If STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 I°P MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP Y 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 MOTORS OVER 100 HP VIOLATION INDIRECT WASTES -' A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT ' STRIP HEATER t FIRE SPRINKLER GENERATORS TRANSFERS '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 FIXTURES 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 (AN APLICATION 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.) PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION ELECTRICAL MECHANICAL