MECHANICAL PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 3 n -CZ) Job Address Q $O N e. 97 Tax Folio
Legal Description Historically Designated: Yes
Owner/Lessee / Tenant C (-4 A R ( 1.�' F (4 T) E L y
Owner's Address oC $ O N., C r '7 / c5,' -
Contracting Co. l- V F N A:oc Cm o ro D i- i o m i to of Address / t{ ? 7 3 v .t.v . 6 s I V -
Qualifier A L1) F P-4 A-C
State # (' R c o 1. f a 6 Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor
Permit Type (circle one): BUILDING ELECTRICAL PLUMBIN t' MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION EZ F= 13 la-Ct;` a, S -(-0 tJ
= �J
1LL f I _
•
111 Iu.
Signa
'. f owner an
ondo �'" . 1 VILLA4ate
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC714v3
MY COMMSSION EXP. MAR 1 '� m
Notary to Owner and/or
My C6mmission Expires:
FEES: PERMITA /qF RADON
APPROVED:
Zoning
Mechanical
or on do Presider a te
0
SS #„ Phone (�3n.) -01 a i
Address
No
Master Permit # 'T (v 9y0
Phone G 3oS� - 1g g- 3(,.J
Square Ft. Estimated Cost (value) V t,3, 6
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.
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. F I ermore : 1 I a orize the above -named contractor to do the work stated.
3 -
Signature of C •
/, 3 �apg
Notary ,: to Contrac
My Commission Exp►r O A RYS EAL
GLADY5 VILIAR
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC714103
MY COMMISSION EXP. MAR l 002
C.C.F: NOTARY BOND
Date
TOTAL DUE / 4E)
Building Electrical
■ot , a I
Plumbing Structural Engineer
ITEM
BATH MB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIG-ff OUTLETS
CENTRAL HEATING it k j
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
l
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS A2
.,s4-01..)s
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/ )TER CNANGE
/
REFRIGERATION
GREASE TRAP
APPLIANCE CUTLETS
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 IWP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8— 10 HP
ELEVATORS/ESCALATORS
TEWCRARY 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
LATER 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
SWR 4ING POOL CUTLETS COMMERCIAL
WATER SERVICE SIGN TUBES
:WER CONNECTIONS
SIGN TRANSFORMERS
iILITY— SEVER
"ILITY
SIGN TIME CLOCK
—WATER
FIXTLRES
?TIC TANK
ANTENNA '
.LAY
TELEVISION CUTLETS
AINFIELD, 4' TILE/RES.
VIOLATION
W & ABANDON SEPTIC TANK
REINSPECTION
i
AKAGE PIT CU. FT.
TCH BASIN
SCHARGE WELL
MESTIC WELL
EA DRAIN
)F INLET
.AR WATER HEATER
lE STANDPIPE
-L PIPING
N SPRINKLER SYSTEM
; RANGE
ER SET (GAS)
PIPING
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.)
PLUMBING
ELECTRICAL
MECHANICAL
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Date • 312 /' Z Job Address Zg0 &Jo Tax Folio
Legal Description -
11- 32.64— C15 -04tv /
CL
J
1 {�
Owner Lessee / Tenant r (�
a 'e L y
Owner's Address .2- SD Iv E q ( c1 Phone 7 S? 3 6' 33
fr i t i , rt ea� t 33/6 /
Contracting Co. / - d/, q/11-- A is 1 i ' ( Address f 4)-7 o ■- < s .0 i t, -" (- /a4. .
Qualifier I'L( II E / Sc/Y/: R SS# Phone Rg3e10.5
State # ca Co2; Y 3 ' iunicipal # Competency # / l& r 1 1 h Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING
WORK DESCRIPTION Il `Pp L Q c 1^ r S I/ A c_
i
Square Ft. Estimated Cost(value)
P027? L. - //
Master Permit # 4 3 o'8f5f
MECHANICAL ROOFING PAVING FENCE SIGN
Rpero
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.
OWNER'S AFFIDAVIT:
be done 'n complian
autho th abov i
A
a
/
Si
Date:
a ure of owner
and
e
_ Signature of
Date:
pee
Fire
Zoning Buildin
Mechanicaf \ �� umbing
•
yfr t y p e oc stamp name of Notary PuMIc
'.y known ` J,,OR Produced LD.0
Cont tft`i 'li'l' 4ux1.
ID take an oath, or
e an oath.
ary4as to Cont 9Ft?%17 C �reFt ,Sf ar
h:\
Commission EAMM§IiSSION EXPIRES APRIL 16. 1992
BMW EJ U SIEM8LER ADAMS 8 SWEET
NOTARY .7 t00 TOTAL DUE 35�"
* **
Other
Electrical
Engineering
MIAMI SHORE
Building Inspector
BUILDING INSPECTIO
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
,19./_2
Owner's Name and Address • 24...t.!1. /..Al/.. /..G — No 8..D..— . StreetAZ.E
Registered Architect and /or Engineer.... , cT�.M.e..s ...,._,,
Name and address of licensed contractor.... ../.?f.. ??i S ao. t s..../5 t!'et...e a.....2 X E.,. 7 F ,Sr
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done. ' ! s.? _ s
State work to be done and purpose of building (by floors).f8s 2_ ..f.Z.ovq ai�'.T.tt! en'c" !?Z .,f.L.t. .slGY.IG.. -/���
y ..5.�� z-te t ,.l �G.QkJ L2... �i
and for no other purpose.
New Budding Remodeling 1( Addition Repairs No. of Stories
To be constructed of Kind of foundation vexing
Estimated Total cost of improvements $ s??� Amount of Permit
Zone cubage required _Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Sup plenient,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
pennit, as are licensed by Miami Shores Village.
(Signed).... letZ- i
STATE OF FLORIDA,
COUNTY OF DADE. ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared - -- — -- - and who, being by me first duly sworn, upon oath deposes and says that he is the.
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stn tru3 f
e .
/ (
Permit No.._____ �__ Date Read, Sworn to and Subscribed before me.
Disapproved _......__ Date ____________
Notary Public, State of Florida
( Signed) •���
ILLAGE
J EPARTMENT
y Commission Expires
to me well known,
PLANN 'C BOARD _..- ._....DATE
Chair :nan Member
Member Member
Member �-•_._...
:Member ...... _._._......- -._.._ __.._
Council Approved _ Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
. -
■
, i o . SHORES VILLAGE
f
5
APPLICATION FOR BUILDING PERMIT
BUILDING INSPECTION DEPARTMENT
Application is hereby wade for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. This application is madc in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Date..._..._... ✓__._ _ ..._._.�._ .. , 19�
Owner's Name and Address ....... TA)/ 0 �G��
G I.. ? ._. No.. . &®.._ . Street_. E ... 9. P
Registered Architect and /or Engineer .....
..��
Name and address of licensed contrgctor , ..
Location and legal description of lot to be built on:
Lot Block
Street and Number where work is to be done....sz
Subdivision
S to work to done and urpose f building (by floors)... __...._....
New Building Remodeling
To be constructed of Kind of foundation
Estimated Total cost of improvements $.. r ' 0 Amount of Permit S`
Zone cubage required _Plan Cubage
Permit No..
Disapproved
(Signed)
ate.
Chairman
Member
Member Council Approved Date
Akigi
and for no other purpose.
Addition Repairs No. of Stories
Roof Covering
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the 'Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida. Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only su , ...tractors, wok to be performed under this
pennit, as are licensed by Miami Shores Village.
Remarks .__ _.__ (Signed)
PLA 'INC BOARD
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared ------- - - - - - --
and who, being by me first duly sworn, upon oath deposes and says that he is the.
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
/9P /2 — 7
Date _ TRead, Sworn to and Subscribed before me.
6")
Building I pector M y Commission Expires
Notary Public, State of Florida
.DATE
Member
Member
Member - • - -._ .___
Disapproved Date
NOTE: A ch.trge of $1.00 will be made for making corrections or changes to this application after approval has
the Panning Board.
A re-inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for
materials and /or workmanship.
•
to me well known,
been obtained from
inspection or faulty
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT.
APPLICATION FOR BUILDING PERMIT
Application is hereby uinde for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores village, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Date.. .. J Ut•Y
,. .
Owner's Name and Address .. OMINIG 1 V4 O .__. r . �Z .. 1.
Registered Architect •• -• •••% ���••����•��
Name and address of licensed contractor 01 rNK
New Building Remodeling
Disapproved Date.
(Signed)
Building Inspector
x
Addition
_Plan Cubage
Size of Building Lot
Location and legal description of lot to be built on: /�
v isi io on. POtil r
Lot Block � � QA .. .._ ...
Street and Number where work is to be done.. so �� 91 .�.�{� / .• - . •_
State work to be done and u ose of built (b floors ...- .1��/!IJ `! 1.ON `� 1
IN NON. .;�► l .,.. ` NfU)... Al ��...
60'
My Commission Expires
trookftsti
of epg.e/4
and for no other purpose.
Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering —
eEstirnated Total cost of improvements $. OO Amount of Permit S, $
Zone cubage required
Distance to next nearest building
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and
1
Notary Public, State of Florida
its construction
may
be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the 'Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such subcontractors, on work to . rformed under this
perinit, as are licensed by Miami Shores Village.
Remarks (Signed) lac
STATE OF FLORIDA,
COUNTY OF DADE. j ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the.
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him s ted are true.
Permit No.._._ C7 Date /- ZZ- 7 Read, Sworn to and Subscribed before me.
PL N1NG BOARD DATE
Chairman Member
Mfcrnber Member
Member ...... - - - - - Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has hecn obtained from
the Planning Board.
A re inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection at faulty
materials and/or workmanship.