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1037 NE 91 Terr (7)MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305 -795 -2204 Building Inspection Request Time Ttif �`�-�• Permit No: L ^ P / 5-2/ Date Type Insp'n Name Address / - 2 /\i 9/7 Company Phone # For Inspector: /4/7 Correctio ❑ / Approved/ Re- Insp'n Fee ❑ -R)y- :/ Passed Ins P • r �' • mmen Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until 1 h nspection Number: INSP -4336 Inspection Date: 05/10/2006 Inspector: Levrack, James Owner: Job Address: Project: <NONE> HARKE, LANCE AND ALLISON 1037 91 Terrace NE Miami Shores Village, FL 33138- Contractor: E H WHITSON PLUMBING Building Department Comments Tuesday, May 9, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Number PL- 12-05 -1333 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number (305)528 -5870 Parcel Number 1132050010050 Lot: Phone: 954- 929 -3599 Page 1 of 2 4 BUILDING PERMIT APPLICATION Master Permit No. FBC 2001 Permit Type (circle): Building Electrical ( Mechanical Roofing Owner's Name (Fee Simple Titleholder) A LI Sc A) Phone # -3 �i �j � ) CA Owner's Address 1 Q'3 % Ki I f CI k `C- Cit}H fAt`4 1 SHO/J., 5 State it— Zip 2 ) ^j( 3F) Tenant/Lessee Name Phone # Job Address (where the work is being done) /(J 'j 4 A) (E City Miami Shores Village Is Building Historically Designated YES NO Contractor's Address L J t ) S - :_4 / AV bk) i✓I i; Citv1-V . I (2v1 ,iO State Qualifier C) S / 1 r/�� Code Enforcement $ Structural Plan Review. $ Training/Education Fee $ Total Fee Now Due $ 1 60. C.J O (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 County Miami -Dade DEC a 8 2 Permit No. I2 f33 zip 33 i 3c) Contractor's Company Name \ RI 14)1 Phone # q G f - f C C1-- � t5c cj Zip 3 hl-U State Certificate or Registration No.0 "EC 14 . Certificate of Competency No.0 Architect/Engineer's Name (if applicable) Phone # at G . $ Value of Work For this Permit r ('C,'C_ Square Footage Of Work: Type of Work: ['Addition ❑Alteration EINew ❑ Repair/Replace ❑ Demoliti n Describe Work: 1) P t) 1. 1 () 2 i i C- r l [ x-n Q 0(_Ytt. ****************************F**************************** , Submittal Fee $ Y Permit Fee $ 4. CCF $ Notary $ Scanning $ Radon $ Zoning Bond $ Technology Fee $ CO /CC 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 perfornied 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 exc' -ding $2500, the appl promise in good faith that a copy of the notice of commencement and construction lien law broth ' e wil be dh ivered t ust • • posted such po whose property is s for th t inspe' inspection wi n' Signature The foregoing instrument wa ackn day ofT ? . C , 206_6 by AL-1 S0 I■.' who is personal ,i kno^+�own t..o me or who has produced NOTARY PUBLIC: Sign:" 1 My Commission Expir Chc 05/13/03 rest to attachment. Also, a certified copy of the recorded notice of c.mmen on which occurs seven (7) days after the building permit is is e approved and a r inspection fee will becharged. Owner o As identification and who did take an oath. dged before me this f(, ************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * ** APPLICATION APPROVED BY: Signature ant must he person the 1 b site ice, the actor The foregoing instrument was acknowledged before me this /� day ofTla C . , 2005, by 4-t 1•-- S who is personall known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: My Commission ******************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 2- `0,fr- Plans Examiner Engineer Zoning 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 MANGE 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 MOTORS 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 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 1 METER SET (GAS) GAS PIPING 3 PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION (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 Survey Sheets / Plans Customer Name: Address: /417 Pit c 7 City, State, Zip: /P/#0,/), Phone #: 3o 5 8— 6 All Work to Comply With N.F.P.A. Code #: 1 (f Estimated Job Cost: j reete? ///1//30 7 ;9c 44? Description of Work:, 7p7%e- 4 7 44, ,y4 Piping ISO E.H. Whitson Plumbing 421 South 21st Avenu Hollywood, FL 33020 - ? f ) /r , &fR 4474r/P Customer Name: E.H. Whitson Plumbing 421 South 21st Avenue Hollywood, Ft 33020 Survey Sheets / Plans Address: /047 / / , ' ‚ / 7 City, State, Zip: �i >/Pv (-3 %/e: Ph #: - 306 ,Q 5 c All Work to Comply With N.F.P.A. Code #: ���' / vL� ` 7 ' O Estimated Job Cost: Description of Work: ft' 1 5- 0,7400 g,5 i40 redge/2_ 6-4/, Piping ISO 0 /6/ ,,p oit/ 4--09a Issue Date: 12/30/2005 Owner's Name: LANCE HARKE Permit Type: Plumbing - Residential Work Classification: Gas Job Address: 1037 91 Terrace NE Contractor(s) E H WHITSON PLUMBING Miami Shores Village, FL 33138- Phone 954 - 929 -3599 Comments: RUN GAS TO SUPLY W /H, 1 RANGE, AND 1 DRYER Additional Information Type of Work: GAS LINE Additional Info: Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Type of Piping: Bond Return : Permit Expires: 12/28/2006 Primary Contractor Yes 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 responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Fees Due CCF Education Surcharge Miscellaneous Fee Permit Fee - Additions /Alterations Scanning Fee Technology Fee Total: Building Department File Copy Applicant Signature Amount $1.20 $0.40 $60.00 $100.00 $3.00 $4.00 $168.60 Invoice Number Amt Due PL - 12 - 05 - 23313 $168.60 Total: Parcel #: Block: Section: Permit Status: APPROVED Permit Number: PL -12 -05 -1333 Phone: Total Square Feet: Total Valuation: Required Inspections 'IAN 0 A. PAID 1132050010050 Lot: PB: 0 $ 2,000.00 Press Test ROW Final Amt Paid 4 1 .6° NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. ...3 ,--- 2,...- a ‘ Passed In pect r • • mer (` / Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until 'Inspection Number: INSP -6540 � Inspection Date: 03/29/2006 Inspector: Levrack, James Owner: HARKE, LANCE AND ALLISON Job Address: 1037 91 Terrace NE Miami Shores Village, FL Project: <NONE> Contractor: TECO PEOPLES GAS SYSTEM Building Department Comments Tuesday, March 28, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Number: PL -1-06 -148 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number (305)528 -5870 Parcel Number 1132050010050 Lot: Phone: (305)957 -3857 Page 2 of 2 BUILDING PERMIT APPLICAT FBC 2001 Job Address (where the work is being done) Architect/Engineer's Name (if applicable) $ Value of Work For this Permit Submittal Fee $ Permit Fee $ Notary $ Training/Education Fee $ Scanning $ Radon $ 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 Permit Type (circle): Building ` Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) A l 1 (5 t7 N 1 Phone # j �Z 7 U Owner's �''t Address 1© 3 7 R� q ( `'.e /'t irk City MAX ( S lry ij State Zip 3 3 ( Tenant/Lessee Name Phone # /U Ale c l/ •42i City Miami Shores Village County Miami -Dade Zip Is Building Historically Designated YES O V 'r Contractor's Company Name c p CS � G ' , c� IIIJ(c ( Phone # Contractor's Address / � �� ' p '7 , 77 in) Cit /Vl - ��yr`-{ t State _ L_ Zip c> 4 Z Qualifier State Certificate or Registration No. Certificate of Competency No. Type of Work: ❑Addition ['Alteration w � ❑ Repair/Replace ❑Demolition Describe Work: '1 L `'V 2 < 1 l LX 64 /1/A-c ti (' o n! N br-H R1.14) tyr- (1, cfi et - e R4- • * * * * * * * * * * * * * * * * * * * * *.f Vic**** FM*:k * * * * * * * * * * * * * * * * * * * * * * * * * ** Zoning Code Enforcement $ Structural Plan Review. $ Permit No. Master Permit No. Phone # CCF $ Technology Fee $ Square Footage Of Work: Bond $ 14 so CO /C ?mil 17(7 , { 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 NOT Sign: Print: The foregoing instrument was acknowledged beef? re me this day of () " tr °, - 20 %, by 7 +-f / &J tiev who is personally known to me or who has produced BLIC: My Commission Expires: APPLICATION APPROVED BY: chc 05/13/03 Signature ontractor The foregoing instrument was acknowledged before me this 16 A , day of �( \ 20 b(p by t} vl A � who is personally known to a or who has produced As identification and who did take an oath. as identification and who did take an oath. a.•. ``' - ' 0%,,.. 6 ' . 9OTARY PUB I — r�r,,, Luis i4JhTERO , ,uuu State of Florida Sign: � r:^. E iec Jan 27, 2006 ,tics, 4 50084905 Print: Floiic y r.:a' ::;n:.l Notary Assn. yo'f My Commission Exp e ***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** LU;S t. +ONTERO 1. Notary Pubhe - State of Florida • E My Cornmrrion Ex*es Jan 27, 2006 Commission # AA0849Q5 ;t; Bonded By National Notary Assn. Plans Examiner Engineer Zoning ' • T . f^ ^ • •• • • • • ••• • • • • • • • • •• V i v : • 1711: _._...„ L . • f 0. •I • 1 • • I I 1 N,R/W SIDEWALK SWALE GRASS . c N E 91 ST TERRACE TIE IN TO p GAS MAIN cn . N. o O SWALE GRASS E O.P SIDEWALK CONSRUCTION E., V cz) NOTES: S. R/W � : RED El , `;ED JAN. , . HS I R_Ob - 445 I. ALL CAS PIPELINE CONSTRUCTION TO FOLLOW TECO PEOPLES GAS STANDARDS. 2. TRAFFIC CONTROL SHOULD BE MAINTAINED AND COORDINATED WITH THE APPROR/ATE GOVERNMENTAL AGENCY. 48 HOURS BEFORE DIGGING 3. ALL DISTRUBED ASPHALT /CONCRETE /SOD AREAS TO BE RESTORED TO PRIOR CALL SUNSHINE 1- 800 - 432 -4770 CONDITION. UNLESS OTHERWISE SPECIFIED. ATLAS: 1 CO PE 4C) PLE AS DATE: 1/16/06 SCALE: NTS SHEET: 1 1 NEW 1 /2 " PLASTIC GA S SERVICE 1037 NE 91ST TERRACE. MIAMI SHORES, Fl DRAWN BY: LM JO: 12233 1 N • • I I • • : ... 7/d'3 . . . • • • • • • N,R/W A • .. • C .... • .. �Q►• Q _. • • 1 . __ CO •• .. • SIDEWALK t SWALE GRASS . E,O.P N. NE 91ST TERRACE TIE IN To Q") CAS MAIN co N. o O SWALE GRASS EO.P h O C.. O NOTES: SIDEWALK -4770 CONSRUCTION S. R/W CAS STANDARDS. WITH THE RESTORED TO PRIOR 48 HOURS BEFORE CALL SUNSHINE DIGGING 1- 800 - 432 1. ALL CAS PIPELINE CONSTRUCTION 2. TRAFFIC CONTROL SHOULD . APPRORIATE GOVERNMENTAL 3. ALL DISTRUBED ASPHALT CONDITION. UNLESS OTHERWISE TO FOLLOW TECO PEOPLES BE MAINTAINED AND COORDINATED AGENCY. /CONCRETE /SOD AREAS TO BE SPECIFIED. ATLAS: TE CO PE PLE AS DATE: 1/16/06 SCALE: SHEET: 1 1 NTS NEW 1/2" PLASTIC GAS SERVICE 1037 NE 91ST TERRACE. MIAMI SHORES, FI DRAWN BY: LM JO: 12233 So r- 9 •• • • • • • • • • • • • • • . .• • • • • • • • • • • • • • • • 7 ••• • 37 - ,a3 . 4r'. • • • ••• ••• /0 • • •'• • • • • • • • • • // • • • • • •• . • •• • • • • lig' 413 /2 1 J /3 845 • /4 4 / /S 849 4 043 1D$S z i .3 -.79 •dei -i tdr - VerbillW 41E N. E. 3 13 - 905 VI - co / o o/ 39- o// • 6/4 3 a N.E. 0 4 o/ 6 S 6 -4 S 0 c 2 7 so • / /00 4 q 64 l� 24 99 O17 O/9 02/ OlS 4 5 6 7 6 So • q -3^1 6 9 1; 4 I CCU 8 0 . 8 9 /0 // /Z /3 \ /7 is / . ,eel x'86 8 S e.. 114 G Pi 9, MN So r- 9 •• • • • • • • • • • • • • • . .• • • • • • • • • • • • • • • • 7 ••• • 37 - ,a3 . 4r'. • • • ••• ••• /0 • • •'• • • • • • • • • • // • • • • • •• . • •• • • • • lig' 413 /2 1 J /3 845 • /4 4 / /S 849 4 043 1D$S z i .3 -.79 •dei -i tdr - VerbillW 41E N. E. 3 13 - 905 VI - co / o o/ 39- o// • 6/4 3 a N.E. 0 4 o/ 6 S 6 -4 S 0 c 2 7 so • / /00 4 q 64 l� 24 99 O17 O/9 02/ OlS 4 5 6 7 6 So • q -3^1 6 9 1; 4 I CCU 8 Issue Date: 1/19/2006 Expires: 01/18/2007 Owner's Name: LANCE AND ALLISON HARKE Permit Type: Plumbing - Residential Work Classification: Gas Job Address: 1037 91 Terrace NE Miami Shores Village, FL Contractor(s) Phone TECO PEOPLES GAS SYSTEM (305)957 -3857 Comments: NEW 1/2 PLASTIC GAS SERVICE FROM GAS MAIN LOCATED ON THE NORTH R/W OF NE 91 TERRACE TO THE PORPERTY AT 1037 NE 91 TERR Additional Information Type of Work: RUN GAS LINE Additional Info: Classification: Residential Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Type of Piping: Bond Return : Permit Primary Contractor Yes 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 responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Fees Due CCF Education Surcharge Permit Fee - Additions /Alterations Scanning Fee Technology Fee Total: Building Department File Copy Applicant Signature Amount $0.60 $0.20 $160.00 $3.00 $4.00 $167.80 Invoice Number PL -1 - 06 - 23528 Total: lM42OPAID Parcel #: Block: Section: C-K- 2 Amt Due $167.80 Permit Status: APPROVED Permit Number: PL -1 -06 -148 Phone: (305)528 -5870 1132050010050 Lot: PB: Total Square Feet: 0 Total Valuation: $ 600.00 Required Inspections Press Test ROW Final Amt Paid 416 , C) NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. ANID THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. MARIA 305 - 944 -8886 i Passed Inspect . r Co y ents , Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Project: <NONE> 7 h nspection Number: INSP -78 Inspection Date: 12/20/2005 Inspector: Levrack, James Owner: HARKE, LANCE Job Address: 1037 91 pE S r Miami Shores Village, FL Contractor: A ARON SUPER ROOTER Building Department Comments Thursday, December 15, 2005 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miiami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 0 Permit Number: PL -11-05 -1016 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Block: Phone Number Parcel Number 1132050010050 Lot: Phone: 305 - 944 -8886 Page 1 of 2 DATE TIME S,R -TIME DISTANT STATION ID 12/21 12:06 00'18" 9549678433 M M M M M M M M M M M M M M M . . . . . 1111 . . . . . . . IN IN MESSAGE CONF I EMfT I ON MODE TX 12/21/2005 12:06 ID =MIAMI SHORES UILLAGF PAGES RESULT 001 OK D.CODE S.C. 0000 MARIA 305 - 944 -8886 Passed I s ec Comments ; Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until nspection Number: INSP -78 Inspection Date: 12/20/2005 Inspector: Levrack, James Owner: HARKE, LANCE Job Address: 1037 91 Project: <NONE> Miami Shores Village, FL Contractor: A ARON SUPER ROOTER Building Department Comments Thursday, December 15, 2005 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Number: PL -1 1-05 -1016 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Block: Phone Number Parcel Number 1132050010050 Lot: Phone: 305 -944 -8886 Page 2 of 2 Issue Date: 12/2/2005 Owner's Name: LANCE HARKE Permit Type: Plumbing - Residential Work Classification: Addition /Alteration Job Address: 1037 91 Contractor(s) A ARON SUPER ROOTER Additional Information Miami Shores Village, FL Fees Due CCF Education Surcharge Permit Fee - Additions /Alterations Plan Review Fee (Engineer) Scanning Fee Technology Fee Total: Phone 305 - 944 -8886 Building Department File Copy Applicant Signature Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Amount $0.90 $0.30 $100.00 $50.00 $3.00 $3.75 $157.95 Perrnit Expires: 11/29/2006 Primary Contractor Yes 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 responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Invoice Number PL - 12 - 05 - 22861 Total: Parcel #: Block: Section: Permit Status: APPROVED Permit Number: PL -11 -05 -1016 Phone: 305/525 -1427 1132050010050 Lot: Amt Due $157.95 PB: Total Square Feet: 40 Total Valuation: $ 1,500.00 Required Inspections Underground Rough Water Main Top Out Main Drain Lavatory Water Service Re Pipe Heater Final DEC 05 PAID Amt Paid NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Owner's Name (Fee Simple Titleholder) LC4 nC6 Owner's Address City pao ry\t Shetae R, Tenant/Lessee Name Is Building Historically Designated YES Contractor's Company Name Contractor's Address City Qualifier Submittal Fee $ iO31 !E 911 Ter Permit Fee $ Total Fee Now Due $ -` ' 'T' • (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 NO Co r--e r S REL. 'iNI`~ii7 1 NO 2d76 Electrical Job Address (where the work is being done) , a 31 NEE' dl) Te r 21 S\ ?)S c State )`L G Notary $ l Training/Education Fee $ O • (Dc Scanning $3 , 00 Radon $ Code Enforcement $ Zoning Structural Plan Review. $ Permit No. PLUS - /0 Master Permit No. 'lu n 11 4 113hho # Zip Zip 33 Phone # Mechanical City Miami Shores Village County Miami -Dade Zip 331 'i Phone # �" M r+ T ra c n e$-e State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit "k 1'5 - fie. Footage Of Work: Type of Work: ❑Addition ['Alteration ❑New Repair/Replace ❑ Demolition Describe Work: .e AD) (Ice, \ +yr ****************************F 32 Roofing CCF $ • aC /CC Technology Fee $ 3 • - 7.6 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 r /• 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 comm• r ent must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. the .bsence of such posted notice, the inspection wil qt be approved and a r'inspection fee will be charged. Signatur Owner,or • gent The foregoing instrument was acknowledged before me this day of /ti ON/ , 20 0.5 by A t Q who is personally known to me or who has produced L 1 CQrfr-sc As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expi s , p ` ' 9 ' 4 ) r " ` +''1N It .37 ***************** * * * * * * * * * * * * * * * * * * *Kit19t * ** I- 800- 3dJUY:'a FL Notary Discount Assoc. Co. Chc 05/13/03 Signature Contractor The foregoing instrument was acknowledged before me this t day of Nov' , 2(P S , by .A 1 { -Q gnPPe who is personally known to me or who has produced I NOTARY PUBLIC: Sign: Print: ** as identification and who did take an oath. new SM 10 Win' ap zyr °� [ h.h i:`AJ. S. . My Com isAi epines:oNA )r,, it uL)250437 * * * * * * * * * * * * * * * * * * * *( * * i ** * * *� * * * * *�t * * **•* ** * ** icy * * * * ** t- 800.3 -NoTpr ..,ar Discount Assoc. Co. ************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** c lans Examiner APPLICATION APPROVED BY: Engineer Zoning 1037 NE 91 TERRACE FINAL DRAINFIELD Passed Inspe C • m = nts Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until 'Inspection Number: INSP -69 Inspection Date: 11/14/2005 Inspector: Levrack, James Owner: HARKE, LANCE Job Address: 1037 91 Terrace NE Project: <NONE> Miami Shores Village, FL 33138- Contractor: A ARON SUPER ROOTER Building Department Comments Tuesday, December 13, 2005 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL hone: (305)795 -2204 Fax: (305)756 -8972 cL Block: Permit Number: PL -11-05 -1015 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number Parcel Number 1132050010050 Lot: Phone: 305 -944 -8886 Page 1 of 2 1037 NE 91 TERRACE FINAL DRAINFIELD Passed Insp • • r / nts Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until nspection Number: INSP -69 Inspection Date: 11/14/2005 Inspector: Levrack, James Owner: HARKE, LANCE Job Address: 1037 91 Terrace NE Project: <NONE> Miami Shores Village, FL 33138- Contractor: A ARON SUPER ROOTER Building Department Comments Tuesday, December 13, 2005 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Number: PL -11 -05 -1015 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number Parcel Number 1132050010050 Lot: Phone: 305 -944 -8886 Page 2of2 Issue Date: 12/1/2005 Owner's Name: LANCE HARKE Permit Type: Plumbing - Residential Work Classification: Drainfield Job Address: 1037 91 Street NE Contractor(s) A ARON SUPER ROOTER Additional Information Miami Shores Village, FL 33138- Phone 305 - 944 -8886 Type of Work: DRAINFIELD Type of Piping: Additional Info: Expires: 11/29/2006 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 responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Fees Due Bond Type - Contractors Bond CCF Education Surcharge Inspection Fee Permit Fee - Additions /Alterations Scanning Fee Technology Fee Total: Amount $300.00 $1.47 $0.49 $75.00 $100.00 $3.00 $4.40 $484.36 Finance Copy Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Primary Contractor Yes Invoice Number PL - 12 - 05 - 1113 Total: Parcel #: Block: Section: Permit Status: APPROVED Permit Number: PL -11 -05 -1015 Phone: Total Square Feet: Total Valuation: Required Inspections Rough Landscaping Final DEC 0 5 PAID Amt Due $484.36 1132050010050 Lot: PB: 450 $ 2,450.00 Amt Paid $484.36 $484.36 NOTCCE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. BUILDING PERMIT APPLICATION f --- -- ne ster Permit No. FBC 2001 Permit Type (circle): Building Electrical (Pi u i Mechanical Roofing Owner's Name (Fee Simple Titleholder) a(- Lon Ce... Al F hone # Owner's Address \ C)31 N E rt 1-12)( City f�Sk'lO State ter zip - 3 - 31 - t' Tenant/Lessee Name Job Address (where the work is being done) IaS1 N £ `l 1 'Le/C City Miami Shores Village County Miami-Dade Zip 331 %P' Is Building Historically Designated YES NO 1/ Contractor's Company Name A it von C'ontractor's Address C.02 2 (S%-4-) 3 S Ct City M Ct 1^■1Q r Qualifier G4:3 ' \ 't - State Certificate or Registration No. ( g� G4-8 Certificate of Competency No. Architect /Engineer's Name (if applicable) 10050 N.E.2 Tel: (3 Total Fee Now Due $ 4134 .80 (Continued on opposite side) Miami Shores Village Building Department _ • r. . 15) ' .► �Q ,r State 1 L NOV 2 _ c ,_'cL5 -$ ur, - F orida 33138 rdhc l 59- Y548972 f.c0 -1-er Phone # Phone # zip 'sue 23 Phone # $ Value of Work For this Permit Square Footage Of Work: �J Type of Work: DAddition ❑Alteration ❑New 031 Repair /Replace ❑ Demolition Describe Work: 1,f) 5+4 t 1 ij» ca is .P (� * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ 17S. C CCF $ 1 - 80 CO /CC Notary $ Training /Education Fee $ 0 . GC) Technology Fee $ 4 .40 Scanning $ 3 . Radon $ Zoning Bond $ 3C0 . CO Code Enforcement $ Structural Plan Review. $ NOV 2 9 PAID t1 4.8 33 Permit No. 1© if Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City Signature NOTARY PUBLIC: Sign: Print: My Commission Exp * * * * * * * * * * * * * * * * * ***** * * * * * * * * * * * * * * * * * * * * * * * * * *li' ** APPLICATION APPROVED BY: Chc 05/13/03 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, BEATERS, 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 comme !ement must be posted at the job site for the first inspection which occurs 'even ) da s after the building permit is issued. In absence of such posted notice, the inspection will not be approved and u y coon f will be charged. The foregoing instrument was acknowledged before me this30 day of ■Sb• , 20D S, by r Ke_. who is personally known to me or who has produced As identification and who did take an oath. ,J‹ Signature NOTARY PUBLIC: Sign Print Zip Zip My [ 1 1'0 . 0 ' EXPIRLS: September 16, 2007 QIN11145 ExplC4&,*n� Discount Assoc. Co. e Contractor The foregoing instrui ent was acknowledged before me this 19 day of 3 AV ,20 3, by Jour (u who is personally known to me or who has produced as identification and who did take an oath. y 'I ow ';.: 4 " `" ° 'r. TERES/ !. `Otf'viON 1 .800-3- NOTARY FL Notary Discount Assoc. Co. e Iffr" O * ***************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning ONSTRUCTION PERMIT FOR: ]New System [ ]Existing System [ X ]Repair [ ]Abandonment PPLICANT: Harks, Lance & Alison ROPERTY STREET ADDRESS: 1037 NE 91 Ter Miami Shores FL 33138 DT: 4 BLOCK: 1 SUBDIVISION: Watersedge [Section /Township /Range /Parcel No.] IOPERTY ID #: 11 - 3205 - 001 - 0050 [OR TAX ID NUMBER] (STEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC FPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME 3RIOD. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, QUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS 'sRMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM )MPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT. .'STEM DESIGN AND SPECIFICATIONS STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT 1200 ]Gallons SEPTIC TANK 0 ]Gallons 0 ]GALLONS GREASE INTERCEPTOR CAPACITY 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS [ 450 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM [ 0 ]SQUARE FEET SYSTEM TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED CONFIGURATION: [ N ]TRENCH [ N ]BED LOCATION TO BENCHMARK: EFF ELEVATION OF PROPOSED SYSTEM SITE [ BOTTOM OF DRAINFIELD TO BE FILL REQUIRED: [ 0.0 ]INCHES HER REMARKS: CIFICATIONS BY: Andre, 'ROVED BY: Andre, Paul 'E ISSUED: 11/28/05 ]Holding Tank [ J Innovative Other ] Temporary [ NA ] AGENT: SR091112, Tuffy John El..10.10'NGVd 2.1 ] [ FEET ] 4.6 ] [ FEET ] EXCAVATION REQUIRED: [ 30.0 ] INCHES CENTRAX #: 13 - - 27149 DATE PAID: FEE PAID : $ RECEIPT : OSTDSNBR : 05 - 3716 - - MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] [ N ]MOUND [ N ] [ N [ BELOW] BENCHMARK /REFERENCE POINT [ BELOW]BENCHMARK /REFERENCE POINT .- Install 450 sf of drainfield in trench configuration. .- Existing 1200 gal. septic tank , certified by " A Aaron Super Rooter on 11/21/2005." to emain. .- Invert elevation of drainfield to be no less than 6.00' NGVD. .- Bottom of drainfield elevation to be no less than 5.50' NGVD. HIS PERMIT IS NOT FOR " ADDITION(s) ". TITLE: TITLE: Professional Engin Dade EXPIRATION DATE: 2/26/06 CHD Scale: Each block represents 5 feet and 1 inch = 50 feet. • :e Plan submitted In Approved b STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSETE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT d.5 37/4 A • 4 1 P - a -e 1 1 f J E ' Permit Application Number PART II SITE PLAN Signature i 1 Y 2 i ._� _ , t - • «-- s....r..r �-r + • �. T I t ! r - ; } y I:- Y , Ha f e - 10 3- ME ` 1 - T-Q -4 33 1,'38 ay n-r-wi V ✓ -4 ava ; r\ 'g-to . g U Sl a1c33 deN4 vs. 21,6 x2 t 4 - 1) 53 F4- encCe �rG ►of c • Title Not Approved _ Date County Health Department ALL -CHANG MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT C REV Issue Date: 12/1/2005 Owner's Name: LANCE HARKE Permit Type: Plumbing - Residential Work Classification: Drainfield Job Address: 1037 91 Street NE Contractor(s) AARON SUPER ROOTER Additional Information Type of Work: DRAINFIELD Additional Info: Miami Shores Village, FL 33138 Applicant Signature Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Phone 305 -944 -8886 Expires: 11/29/2006 Type of Piping: Fees Due Amount Bond Type - Contractors Bond $300.00 CCF $1.47 Education Surcharge $0.49 Inspection Fee $75.00 Permit Fee - Additions /Alterations $100.00 Scanning Fee $3.00 Technology Fee $4.40 Total: $484.36 Permit Primary Contractor Yes 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 responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Building Department File Copy Invoice Number PL - 12 - 05 - 1113 Total: Permit Status: APPROVED Permit Number: PL -11 -05 -1015 Phone: Parcel #: 1132050010050 Block: Lot: Section: PB: Total Square Feet: 450 Total Valuation: $ 2,450.00 Required Inspections Rough Landscaping Final DEC 0 5 PAID Amt Due $484.36 Amt Paid $484.36 $484.36 NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. ANID THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. Date 6c1 Job Address 1037 N.E. 91st Terrace Tax Folio Legal Description Historically Designated: Yes No PERMIT APPLICATION FOR MLAMI SHORES VILLAGE Owner/Lessee / Tenant Alison Harke Master Permit # 92 6 Owner's Address 1037 N.E. 91st Terrace, Miami, Fl 33138 Phone 305 - 758 -3614 contracting Co. Coastal Plumbing Co of Miami Address 285 N.E. 185th Street, Miami, F1 33179 Qualifier Robert E. Brincefield SS# Phone 305- 651 -4429 State # CFCO -19042 Municipal # 6264 Competency # 6264 Ins. Co. Collinsworth, Alter, et al. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL LUMBIN)MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Replace existing electric water heater Square Ft. Estimated Cost (value) $200.00 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 COMMENC'EMENT.) 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. • 6 -25 -01 o President Date Signature . owner d/or Con Notary as to Owner and/or • ondo President Date My Commission Expires: Patricia Stover MY COMMISSION # CC839914 EXPIRES June 28, 2003 ry? BONDED THRU TROY FAIN INSURANCE, INC APPROVED: Zoning Building Mechanical Plumbing Of Signature of Contractor or r -B ilder Notary as to Contractor or er- Builder D ate My Commission Ex;, Patricia Stover �:� MY COMMISSION # CC839914 EXPIRES ` " "' ' June 28, 2003 BONDED THRU TROY FAIN INSURANCE, INC FEES: PERMIT I QV RADON C.C.F. h U NOTARY ( BOND Electrical TOTAL DUE 6 -25 -01 Date ) 6 0/ Structural Engineer ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT CUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN MPS 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 MOUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTCRS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTCRS OVER 3- 5 I-P MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTCRS 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 FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE t 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 PUMA & 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 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.) PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION ELECTRICAL MECHANICAL