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PLUMBING PERMITCONTRACTORX Name 1 " '. �Ga.P. 1 r ' A l � t e t! Name �� /. ._, AC - L _ _ /L . License No. /9, .113 R F- y3 a 0 3 Business Telephone 1 Bcv q02_ s 4 i s Address ��`' 4.2. // . eV f 0 74����v �rrJ Cy 3 3 / Telephone3 O$ 4/-•6444 Fax Qualifier Name / l /i�a/tf. .!7�21�1�IJ /1i Iii PROPERTY OWNER Name 1 " '. �Ga.P. 1 r ' A l � t e t! Address 3So c.1 E... ' --sr ant P -, t' ,', , Ore S Pc.._ 35138 Home Telephone Business Telephone 1 Bcv q02_ s 4 i s Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'l Detachment Other Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review 10050 N.E. 2ND AVE., MIAMI SHORES, •1 ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES (sq.ft. = x/1000 x ¢.60) (¢.005 /sq.ft.) $ (¢.01 /sq.ft.) ISSUING OFFICIAL REVIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ CIS 9 d DATE: CONDITION OF APPROVAL Revised July 2001 L • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com Master Permit No. 1.001..- �1 Subsidiary Permit No. PERMIT APPLICATION INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. Folio Number Lot Block Subdivision Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Address Apt. City B PG r� P / A 1M PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Description of Work Zoning Square Feet Flood Zone `a• Value of Work a 000 Tax Assessed/Appraised Value Linear Feet Units Floors Bldg Value Base Floor Elev. ENGINEER Name License No. Address Telephone Fax ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps _ A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE Refrigeration, Tons QTY. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/VVin. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet _ PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 2 IMPORTANT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. 1. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50%) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF FL • RIDA, COUNTY OF MIAMI -DADE Signature Print ame Sworn to and subs bed before me this day of Signature of No. Pu is - State of Florida +d','@4 Carla Datorre * *My Commission CC733829 � Expires April 14. 2002 SEAL: Personally known OR, Produced identification Type of Identification Produced: Sworn t SEAL: 1 subscribed before me this PERMIT APPLICATION STATE OF FLORIDA, COUNT OF MIAMI -DADE day of Signature 1 Notary Public - State of Flon. RENE TUMA Notary Public - State of Florida My Co^nmis :dn E p es Aix 25, 2003 Cc - nT' -;n C ' 1 ' x CF911 ti 1 Personally (mown _ OR, Produced Identification Type of Identification Produced: Page 3 QV) 4"" PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: Permit No Nature of Water Supply: City —Well Amount of Permit $_3.00L_ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (S ed) - - (_ (Signed Date 5-6-63 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 work. Owner's Name and Address Street N - - -� , -- fit- - -__ -_ Registered Architect and /or Engineer Employing Plumber's Name____ AB( a Seerbtr -T-a ik- S8 ''t^e° - -_ No.-- - - - - -3 23_ Street_ - Location and Legal Description Lot _ _ _ ,__ Block__ _ Subdivision Street and Number where work is to be performed— No._____ __ __ _ __ —___ _ Street State work to be performed and purpose of building (By Floors)_ New Building Remodeling Addition_ Repairs No. of Stories. Size Septic Tank Type of Tanl Capacity Gals. Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well _Size of Soakage Pit The undersigned applicant for this building permit does hereby certify that he understands and accepts his . `igations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida P . anent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contract 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 sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. My Commission Expires Notary Public, State of Florida PPuumbing Inspector. Master Plumber. STATE OF FLORIDA, COUNTY OF DADE. j Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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 stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY Toss URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'N6 TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW MVO POOL CONTR. LIST - CHECK Permit No Nature of Water Supply: City —Well Amount of Permit $_3.00L_ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (S ed) - - (_ (Signed Date 5-6-63 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 work. Owner's Name and Address Street N - - -� , -- fit- - -__ -_ Registered Architect and /or Engineer Employing Plumber's Name____ AB( a Seerbtr -T-a ik- S8 ''t^e° - -_ No.-- - - - - -3 23_ Street_ - Location and Legal Description Lot _ _ _ ,__ Block__ _ Subdivision Street and Number where work is to be performed— No._____ __ __ _ __ —___ _ Street State work to be performed and purpose of building (By Floors)_ New Building Remodeling Addition_ Repairs No. of Stories. Size Septic Tank Type of Tanl Capacity Gals. Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well _Size of Soakage Pit The undersigned applicant for this building permit does hereby certify that he understands and accepts his . `igations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida P . anent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contract 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 sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. My Commission Expires Notary Public, State of Florida PPuumbing Inspector. Master Plumber. STATE OF FLORIDA, COUNTY OF DADE. j Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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 stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or workmanship. Permit No. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in complianez 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 work. Owner's Name and Address 1 7 '1h/ t ' Registered Architect and /or Engineer Employing Plumber's Name ` ) t �'" t sj--' No Street Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No .o":t t i �° t- 1 i___ Street State work to be performed and purpose of building (By Floors) STATE OF FLORIDA, COUNTY OF DADE. ss. Y , ! ! ( Signed) No Street New Building . Remodeling Addition Repairs Size Septic Tank -t---' Type of Tank Capacity Gals. Feet of Drain Tile f' - Dist. Feet of Tani or Drain Field from Well Nature of Water Supply: City-.Well Size of Soakage Pit Date_ -- - - -- t. No. of Stories._ Amount of Permit $ t (Si Plumbing Inspector. The undersigned applicant for this building permit does herby certify that he ungerstands and accepts his obliga ons as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled Genetal Laws of Florida Permane Supplement, and has com- plied with the provisions thereof, and will require similar compl:ance 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 sub - contractors, on work to be performed under this permit, as arc licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon )ath deposes and says that he is the of the above described construction, that he has carefully real the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida Master Plumber. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS / LAVA- TORIES SINKS . / SLOP SINKII LAUNDRY TUBS / URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS t� J, 1 ' . '„yl / -' +T (. TOTAL .FIXTURES CONT STR CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST 4 !..O - Al, CHECK Permit No. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in complianez 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 work. Owner's Name and Address 1 7 '1h/ t ' Registered Architect and /or Engineer Employing Plumber's Name ` ) t �'" t sj--' No Street Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No .o":t t i �° t- 1 i___ Street State work to be performed and purpose of building (By Floors) STATE OF FLORIDA, COUNTY OF DADE. ss. Y , ! ! ( Signed) No Street New Building . Remodeling Addition Repairs Size Septic Tank -t---' Type of Tank Capacity Gals. Feet of Drain Tile f' - Dist. Feet of Tani or Drain Field from Well Nature of Water Supply: City-.Well Size of Soakage Pit Date_ -- - - -- t. No. of Stories._ Amount of Permit $ t (Si Plumbing Inspector. The undersigned applicant for this building permit does herby certify that he ungerstands and accepts his obliga ons as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled Genetal Laws of Florida Permane Supplement, and has com- plied with the provisions thereof, and will require similar compl:ance 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 sub - contractors, on work to be performed under this permit, as arc licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon )ath deposes and says that he is the of the above described construction, that he has carefully real the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida Master Plumber. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. BUILDING ELECTRICAL PLUMBING PERMIT N° 9905 yet Work to be performed under this Permit Architect Contractor , or Builder - «- Legal Lot Description Address of Building e` MIAMI SHORES VILLAGE, FLORIDA DATE 195 Bl. Subdi- vision Value of Project $ Contractor's License No Amt. of 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 application 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 responsibility for work done by his agents, servants or employees. Signed e; 1 BY INS CTOR In consideration of the issuance to me of this permit I agree to per[orm the work covered hereunder in compliance with all Ordinances and regulation 1 pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY