1177 NE 91 Terr (3)MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Req
Date 1
Type Insp'n ��
Permit No. M. 2W`U
/�lpp II
— 10
Name i os r
Address 1 l N Q I Ie v
Company
1_l ` I
Phone # 305 — 9y 0 - 6111
Inspection Date
Approved / . a .j i3 1
Correction ❑
Re- Insp'n Fee ❑
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT_
305- 795 -2204
Building Inspection Requ
Date o�2
Approved
Correction
Re- Insp'n Fee
Type Insp'n e. X i
Permit No. 1"Ie (aco4-lO
Name ClfQ
Address I' fl 1 € p Q 1 1"e \( (
Company F\4 Ib(CiOb €
Phone # (&)S - q40
Inspection Date a-Jo T/0-1
BUILDING
PERMIT APPLICATION
FBC 2001
Tenant/Lessee Name
Contractor's Company Name
Contractor's Address . 1 �i 1 C b 5l
City r� �" I 1 A-- rI ,� State
Qualifier J Og C` 1
S Value of Work For this Permit
(Continued on opposite side)
c,
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Job Address (where the work is being done) 1 r/ 0 Q )zJl.
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO
1213 1.1112 @ -),A
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $
Permit No.
Master Permit No. Mc y /0
Phone #
Permit Type (circle): Building Electrical Plumbing Roofing
1 L. / K.
Owner's Name (Fee Simple Titleholder)
a rl� L.. i)- Iirl Phone# 126 co fi 3 23Yy
Owner's Address 11 7 N q t J C �
City_ TW A� Iw �� ' State Zip �l � / c�
Phone #
Zip
rtz Zip V2 7q
* * * * * * * * * * * * * * * * * * * * * * * ** *** Fees *** * * * ** * * **** * * * *** * * *** * * ***
7/ •.7-
Submittal Fee '= _ eat Fee $ (G' 6 CCF $
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ Bond $
JAN 130
Architect/Engineer's Name (if applicable) Phone #
Square Footage Of Work:
Type of Work: ❑Addition ❑Alteration New � 0 �j R R ep � air/Repla ac ce ❑ Demolition
Describe Work: 1 S � L T!'7 )-) A / G v∎V / Kw p
xi I/
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 approve �. - einspection fee will be charged.
Ai/
.i ,T
Signature
Chc 10/14/03
Owner or Agent
The foregoing instrument was acknowledged before me this
day of pea . 203, by Mane Dh-h4
o ms perso_Igy_k mofvn to me or who has produced
As identification and who did take an oath.
APPLICATION APPROVED BY:
Signature
//�� (Certificate of Competency Holder)
t%
State Certificate or Registration No. 401
- 4,
( (4• c 4'
Sign -
Print: .
My Commission Expires: My Commission Expires:
Contractor
The foregoing instrument was acknowledged before me this
day of ,i)-e6 , 20 , by 4/7
o is •er
wn to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Certificate of Competency No.
Idosef.
• dAti'
Bpng njy
** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
V
{
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE •
ET
LIGHT OUTLETS
CENTRAL HEATING /agvv
/
HWASt R
RECEPTACLES
A/C (WIND)
;SAL
SERVICE TEMPORARY
A/C (CENTRAL) 4425,r2
NKING FOUNTAIN
SERVICE SIZE IN ASPS
OUCT WORK
CI
CR DRAIN
SERVICE REPAIR/1/MR CRAKE
REFRIGERATION
:ASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
ERCEPTOR
RANGE TOP
UNDERGROUND TANKS
'ATORY
OVEN
ABOVE GROUND TANKS
ROY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
)THES WASHER
MOTORS 0- 1 FP
STEAM BOILERS
ThER
MOTORS OVER 1- 3 FP
HOT WATER BOILERS
a, POT /3 COMP.
MOTCRS OVER 3- 5 FP
MECHANICAL VENTILATION
.K, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
tK, SLOP
MOTORS OVER 8- 10 FP
ELEVATORS/ESCALATORS
.PORARY WATER CLOSET
MOTORS OVER 10- 25 FP
FIRE SPRINKLER SYSTEMS
INAL
MOTORS OVER 25-100 FP
COOLING TOWERS
TER CLOSET
MOTORS OVER 100 FP
VIOLATION
)IRECT WASTES
A/C WINDOW
REINSPECTION
TER SUPPLY TO:
AIR CONDITIONERS
•
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFCRMERS
•
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER- REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIW ING POOL
OUTLETS COWERCIAL
WATER SERVICE
SIGN TUBES
WER CONNECTIONS
SIGN TRANSFORMERS
I L I TY -SEWER
SIGN TIME CLOCK
ILITY -WATER _
FIXILRES
?TIC TANK
ANTENNA
LAY
TELEVISION OUTLETS
AINFIELD, 4' TILE/RES.
VIOLATION
4? E ABANDON SEPTIC TANK
REINSPECTION
AXAGE PIT CU. FT.
TCH BASIN
SCHARGE WELL
MESTIC WELL
EA CRAIN
•
OF INLET t
LAR WATER HEATER `
RE STANDPIPE
0L PIPING
•
—
;WN SPRINKLER SYSTEM
S RANGE
TER SET (GAS)
S PIPING
ADDENDUM TO BUILDING PERMIT APPLICATION
APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
3TAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
Mechanical Permit
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305- 795 -2204 Permit Number: MC2004 -10
Printed: 1/15/2004
Applicant: MARIE DESTIN
Owner: DESTIN MARIE
JOB ADDRESS: 1177 NE 91 TERR
Contractor AFFORDABLE AIR & HEAT
Local Phone: 305 - 940 -0777
Parcel # 1132050010190
Contractor's Address: 515 N. E. 190 St.
Legal Description: WATERSEDGE PB 9 - 141 E1OFT OF LOT 21 ALL LOT 22 & W15FT OF LOT 23
Fees: Description Amount
FEE2004 -464 Building Fee $106.00
FEE2004 -465 CCF $1.80
FEE2004 - 466 Training and Education Fee $0.60
FEE2004 -467 Technology Fee $2.65
FEE2004 -468 Scanning Fee $3.00
Total Fees: $114.05
Total Fees: $11�5
Total Receipts: $O.OU C
CA .05
Permit Status: APPROVED Permit Expiration: 7/11/2004 Construction Value: $2,400.00
Work: INSTALL 4 TON NC W /10 KW HEAT & 9 OUTLETS
Signed:
(INSPECTOR)
Page 1 of 1
JAN 2 0 PAID
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:
t. 445a
t 44