MECHANICAL PERMITDate 1 Job Address
Legal Description Historically Designated: Yes No X
Owner/Lessee / Tenant ROBERT GROSS Master Permit # y 93 9
Owner's Address
Qualifier WILLIAM CLARK
State# CACO36781
ignature of owner an
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
T Folio d
1051
NE 92 ST.
1051 NE 92 ST. MIAMI SHORES 33138
Contracting Co. BRANDON AIR CONDITIONING
Condo President b ate
Notary as to Owner and/or ondo President
My Commission Expir
o
FEES: PERMIT/ 6 ` RADON
c -o �
Date
SS#
Phone 305 - 751 -6555
Address 6175 NW 167 ST. # G -25
ph 819 -2669
Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBINgECHANICA)ROOFING PAVING FENCE SIGN
WORK DESCRIPTION DIRECT CHANGE OUT OF TWO TON A/C
Square Ft. Estimated Cost (value) $ 3,200.00
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 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 constructibn 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.
Signature of Contractor or Owner- Builder
eJ -4--" 6 — .24 —o /
Notary as to Contractor or Owner - Builder Date
My Commission Expires:
C. C.F. NOTARY
APPROVED:
Zoning Building Electrical
gt 0? 5.0(
/ /ems
Date
BOND m
TOTAL DUE4 * Li V
Plumbing Engineering
ITEM
BATH TLB
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) 24,./
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/VETER CHANGE
REFRIGERATION
GREASE TRAP
-
APPLIANCE CUTLETS
PROCESS ANC PRESS PIPING
INTERCEPTOR
RANGE TOP
1 UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE GRCUND TANKS
-
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
_
MOTORS 0- 1 FP
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 FP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER • 100 FP
1 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
I-
SKIMMING POOL
CUTLETS COMt,ERC I AL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCX
_
_
UTILITY-WATER
1
FIXTURES
SEPTIC TANK
ANTENNA '
RELAY
TELEVISION CUTLETS
.
CRAINFJELD. 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
RE INSPECTION
SOAKAGE PIT CU. FT.
_
_
.
CATCH BASIN
DISCHARGE WELL
-
CC.IIESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
"
METER SET (GAS)
GAS PIPING
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
rfr
6 -22 -2000 2 FROM GROSS, R. /C. 751 -5006 305 751 5006
I WU I6t Ut LUMMCNCEMENT
A ItECORDED tOI MiiUSt Si . MOO Oil nit jail SITE At TIM OF FIRST INSPECTION
PERMIT NO. TAX FOLIO No. r/ 3.141S" a// Oc' a
STATE OF FLORIDA:
COUNTY OF DADE:
0'1R326261 2001 AM 22 11:06
kit
THE UNDERSIGNED hereby gives notice that improvements will be Made to certain real property, and in accordance with
Chapter 713. Florida Statutes, the following Information is provided in this t40llce ot•Gommencement,
1. Legal description of property and street address: • 1051 NE 92 ST,
0 , 0$ $ s r.2 'S a 3313
AIR CONDITIONING CHANGE OUT
2. Description of improvement:
3.OJMnor(slhaMtb a a ROBERT GROSS, 1051 NE . 92 ST., MIAMI SHORES, FL. 33138
Interest in property:
Name and address of fee simple titleholder:
4. Coniractot'S name and address: BRANDON AIR CONDITIONING, 6175 NW 1:5T/ST. G -25
MIAMI, FL. 33015
5. Surety :(Payment bond required by owner from contractor. If any)
Name rr.nd address:
Amount of bond $
B. Lender's name and address:
5 nature of Owner
' Print Owner's Name
Sworn to and subscribed before me this /J day of
7. Persons within the State o; Florida designated by Owner upon whom notices or other documents may be served as provided
by Section 713.13(1)(8)7.. Florid* Statutes,
Name and address:
8. In addition to. himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in
Section 713.13(1)(b), Florida Statutes.
Nam. and address:
9. Expiration date of this Notice of Commencement: (the expiration date Is f year from the date of recording unless a
different date is specified
*NIS
, 200' /
• / ti
'dotary Public .. to
'rint Notary's Name STEVEN P. WAGNER 1 Na 00019759
My Commission Expires 4 - 4 - :.'
STEVEN P. WAGNER
22 w.
t' :
P. 1
Preparedby WAGNER
Address:
6175 NW 167 ST . G-
MIAMI, FL. 33015
• Buildin
}
MIA I\SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
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.
nspector
Date
Owner's Name and Address.. " At-A0i ees.t_oN
Registered Architect and /or Engineer
Name and address of licensed contractor..4'Et9T — C cU. lN.( O I .M# dip 'VC /444 ,75 -rid /$,f 7 - /ERR, /21,41",
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done /051 A/ 9a '/
State work to be - done and purpose of building (by floors) To ,9 d 2°A i3 2
/k... 70 N A1/2 C ow 4, /A r6 $742 cp% /N AA/ ,rrl' /S7 /."6 64 U.ST
4 ,r /N P° .Rfa..."1:c ' ' • and for no other purpose.
New Building Remodeling. X Addition.X Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $..._ 7,90, Amount of Permit $ •2__ x/_.._ ,3.4"
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
No /07° NFc Street. ..`?_..3._-- . .51�•
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 rovisions thereof, and will require similar compliance from all contractors or sub - contractors employed by bins
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
permit, as are licensed by Miami Shores Village.
Remarks ( Signed)
7 / 2 / 19.7
7a" d' /4
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
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.
Permit No I S Date - 2 . Read, Sworn to and Subscribed before me.
Disapproved , f____ Date
Notary Public, State of Florida
( Signed)
My Commission Expires
PLA ! NING BOARD DATE
Chairman 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- inspection 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.