825 NE 91 Terr (3)Date e t DD Job Address D oJ V v Tax Folio
Legal Description
/ Tenant T \ Lam,
Owner's Address WD-S W ` Z (Z -�
'OD WC (
Qualifier \_k) `Pty l/v � Sti Q Y)I iQ ( SS#
State # G 3 Z 7 Municipal # Competency #
Architect/Engineer Address
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING
Contracting Co.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and
construction and zoning. Furthermore, I authorize the above -named contractor to do
Signature of owner
My Comi}}ission Expires:
"r.7- JC Shawn Crow
MY COMMISSION # CC910817 EXPIRES
February 15, 2004
BONDED THRU TROY FAIN INSURANCE, INC
/v
FEES: PERMIT fi , RADON
APPROVED: e,
Zoning
Lkf
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
d/or Condo President Date
.ii ✓% !� - 4 -
as to • t er and/or Condo President
Nn1-tab ��lQ
0
e
Historically Designated: Yes No .7
Address
Address
C.C.F. p '99 NOTARY
Building
Master Permit # 7
Phone 305 7 3 £•Q. `
WORK DESCRIPTION (1 LQ\t. (9 �9`T � j ,)
Square Ft. Estimated Cost (value) LA 60 1)
ti S RA) V11
Phone 365— (O S AS () I/
Ins. Co.
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.
all work will be done in compliance with all applicable laws regulating
ork -t )
Ji
Signature offontractor or Owner- Builder
No •. as to Contract.r or Owner- Builder
My Commission Expires:
�M'•Py''. JC Shawn Crow
ci MYCOMMISSION # CC910817 EXPIRES
Ins
February 15, 2004
BONDED THRU TROY FAIN INSURANCE, INC.
Electrical
ROOFING PAVING FENCE SIGN
BOND l
TOTAL DUE D7 i7 l U
Date
Mechanical • 7 ( ( '� 09i Plumbing Structural Engineer
ITEM
3ATH T16
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
3IOET
LIGHT OUTLETS
CENTRAL HEATING
1d
DISIWASNER
RECEPTACLES
A/C (WIND)
0ISPOSAL
SERVICE TENQCRARY
A/C (CENTRAL)
3,C
DRINKING FOUNTAIN
SERVICE SIZE IN AlrPS
DUCT WORK
;LOCK DRAIN
SERVICE REPAIR/METER MANGE
REFRIGERATION
:REASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
_AVATORY
OVEN
ABOVE GROUND TANKS
_AUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
:LOTHES WASHER
MOTCRS 0- 1 FP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 FP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTCRS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 FP
ELEVATORS/ESCALATORS
iEWCRARY WATER CLOSET
MOTORS OVER 10- 25 PP
FIRE SPRINKLER SYSTEMS
JRINAL
MOTORS OVER 25-100 FP
COOLING TOWERS
iATER CLOSET
MOTORS OVER 10O FP
_
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
iATER 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
SNIMSIING POOL
CUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
EWER CONNECTIONS
SIGN TRANSFORMERS
TILITY -SEWER
SIGN TIME CLOCK
TILITY -WATER
FIXTURES
EPTIC TANK
ANTENNA
_LAY
TELEVISION CUTLETS
3AINFIELD, 4' TILE/RES. --
VIOLATION
AP & ABANDON SEPTIC TANK
REINS?ECTION
JAKAGE PIT CU. FT.
“CH BASIN
;SCHARGE YELL
:MESTIC WELL
ICA CRAIN
OF INLET
;LAR IUTER HEATER
RE STANDPIPE
CL PIPING
IN SPRINKLER SYSTEM
S RANGE
TER SET (GAS)
S PIPING
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
BUILDING ❑ MIAMI SHORES VILLAGE FLORIDA r ,: � ..
ELECTRICAL El Date `' 19'x'
PLUMBING ❑ PERMIT N? 10305 Contractor's
ROOFING El License No.
y a
l% �t . `mac._-?- ❑
Owner of
Building
Architect
Contractor
or Builder
Legal Lot
Description 11 B1.
Address of - ; - �, ,
Building ,'i, Y ii P ,
CONTRACTOR or BUILDER
A
U v /
Work to be performed under this Permit
Subdi-
vision
Sq. Ft. 7 C:,
Value of r, ' � Am ount of i ,
Project $ I I Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Signed c (INSPECTOR) BY
��n consideration of the issuance to me of this permit I.; agree to perform the work covered hereunder in compliance with all ordinances and regulations
'g thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
this permit I assume responsibility for all work / done by either, myself, my agent, servant or employee.
Y
1,,-,�:,_„ A /6-
BY AUTHORITY
Zone cubage required
Distance to not nearest building
STATE OF i pr i I i)A,
COGNIY t, 1)A . SS.
pears•:
Pern-I,t •`:.i . � ;59 Date
Disap ;ro•-cd tT�l �C Date
(Si gned)
Ci.
N1.
ti.,
Illdt. r... ..
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Ap;` 111, n 1 i.l made for tlic approytl of the detailed statement of the plans and specifications herewith submitted for the build
ing or 1'I 1'1 sh i;soli hri.in des(Id∎ed 'Iles atlphcation is made in compliance and conforrnity with the Building Ordinance of Miarni
Shores \'1i1,9 ', I i. r:;ln. ,u.d .111 provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the riulhlulg Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specIIrcations must be kept at budding during progress of the work.
Date.
l Cq - -•_- _...__ _ ,1 4-
qq
$ r
Uvncr's Name and Address . A�� zee, .. NO. .. ,. . Street.. p) .r.E..:.. " 'r Tz.e.
Registered A.r.hitect and'or Engineer
Name and address of licensed contractor.. . Ps. 1 . 5 ...Z5O4's t. , W 2. 56 5 7— , 3 3 1 2- 16 "'
Location and lei,' description of lot to be built 94:_
cD.
Lot.. .Lei( 4 ..1 9.. Block A5.. ..I.. d .�l.0
ivision. -P G�T _... a <.......m1.. P.0 ...•
Street and Number where work is to be done ` e • .—.—
State work to be done and purpose of building (by floors) .357.3 vo .... w "_l_c teL CUE ....L. :e: J,
e-P t. Ace JE Ca■-'T 2®. k.. � I ItC'5:1—E fvi •
NC ' Bun :ding Remodeling Addition.. Repairs No. of Stories.
To be constructed of ... . .... Kind of foundation Roof Covering
Estimated Total cost of improvements $ 2, -(= Amount of Permit $. ii--- 5
.Plan Cubage
Size of Building Lot
Maximum live load to be home by each floor...
1 heiohy submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be se; l; to
i•e ,:: , i- i I:. •:.i 1. r iln` Iwildnit; permit dues hereby certify that he understands and accepts his obligations as an employer
of 1.1 or n,,.l r i . r:J 1 \\ „i knlcn s Cul.tpcln.uluu Act, bang Section 5966, Compiled General Laws of Florida, Permanent Srrplllrulent,
and has o. :..;.;.t a the tilosio ons thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in 11.c %stir'.. to te.: :soil.. :n,der this permit, and will post or cause to be posted for inspection on the site of the work such public notice
or nciu'es .0 ac: t :,. •ieol i,.. !fie A t. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, • s are l.:: tired b; Ni . n i Shores Village.
(Sig
ti.: ; : : :•it d ,I a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
and v i,n, i.• r.; i.. ; :r fu,t duly sworn, upon oath detic.ses and says that he is the .
of t! t. •.e d. ,. ;.! . 1 • . ,etruruon, that lie Las carefully read the foregoing application, and that he did sign the same, end that all facts
thcre,n h/ i :.;;; st..tcd arc Inie
i. :.i•.I.t h 111 . 1 1 My Commission Expires
1'1.AN; ,;(; ROAM)
DATE
Member ..........
Member .. .... .
Member
Date Uisapprovod .... ..
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
and for no other purpose.
2 'E D
to me well known,
DAte
t l: (,r ni..l:mg corrections or changes to this application nfter approval has been obtained Irmo
° I i:1) %,.il b , h, r when such re inspection is made necessary by improper notice for inspection co faulty
1 ... •,..,1.,,.:1,1;;