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MECHANICAL PERMITDate Type Insp'n Permit No. Name MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Address ji (p a 9 Sr Company Ac:4, 1 -re Phone ,o_5 J09 ' ,gze La For Inspector: Name & Date Approve o / f\ / c .6 - Correction ❑ Re- Insp'n Fee ❑ O ✓1 P tv 3 Ur '5).a� 48°( ( a - e R x ( aim / 2 . / C ? CONTRACTOR New Construction Name i . Name A _ ' 1 ._ License No. . e.. ® 3 c .2 e " Address,,, , Ai e 9 7 ...- s -r t '` 41 /A4'l' s /10 406S„ F 3 Address l® ` `l s - A ) 1 / , G. , fi , . -.P> 3 3d s ,, ,,•O T 9� o X0 /9 7469 Fax g /9•34L4 9 Qualifier Name PROPERTY OWNER New Construction _ : — Name A _ ' 1 ._ Address,,, , Ai e 9 7 ...- s -r t '` 41 /A4'l' s /10 406S„ F 3 311 Home Telephone!f6ce 9 p �7,� 03 6 9 o 6 O 6/.- Business Telephonne3 co g. y e t , Y B Fal j® f S ' 6 /- X TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'l Detachment Other 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. APPLICATION Job Address: // / / We Si /17/Am / SA /Z S Address Apt. City Folio Number Description of Work( Lot Block A/c, Subdivision PB PG Zoning Linear Feet Current Use of Property / –0 Square Feet Units Floors Proposed Use of Property r. .:Q Value of Work 2 0 0. 0 "a Bldg Value Tax Assessed/Appraised Value Flood Zone Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Rooting Fence Other PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. 14- ( State PERMIT APPLICATION X 3 13 e Zip Base Floor Elev. ENGINEER Name License No. Address Telephone Fax Page 2 IMPORTANT NOTICES 1. 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. 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, P' 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. w,m to a d subscribed before me this STATE • FLORIDA COUN XOF MIAMI- •_ = ! . ignature o Owner L AL: Personally known blic - Sta Florida Angela M Becker My Commission DD150048 de Expires November 15, 2008 OR, Produced Identification Type of Identification Produced: E 0 N ORIDA, COUNTY OF MIAMI -DADE gn atetrt Contractor / Qualifier /7/ 2 /w1 Print Name Sworn to and subscribed before me this 2 7 day of hc.006 zp Signature of Notary Public - State of Flo SEAL: Personally known PERMIT APPLICATION STEVEN P. WAGNER C My Comm Ems. 6124/05 No. DD 019759 I 1 PersonaHN Norm I 1 Other I.D. OR, , ,uuu .eu Iuenuncauon Type of Identification Produced: ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE. Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Cooling Tower Fan / Outlet, Wall A/C Wall/Win. Tons Service, Temporary A/C Central 4 -7 Ton - Paint Booth Fire Pump Ventilation, Cost Outlet, Switch Signs Ductwork, Cost of A/C Central 8 -15 Ton Fixture - Fluorescent Barbecue Oven Space Heater (kw) Process/Pressure Piping A/C Central 16 -20 Ton Fixture Light Parking Lot Lights Fireplaces, Number of 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. QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. 'I'YI'E QTY. Refrigeration, Tons A/C Central, Tons ' / Cooling Tower - Heating Strips, each >O / Vent Hood, Cost A/C Wall/Win. Tons Solar Water Heater Dryer Vents, Number of - Paint Booth Filter Replace Ventilation, Cost Air Handler, Tons Sprinkler Repair Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Pump and Abandon Fire Sprinkler System Process/Pressure Piping Cap - Water Bath Fan - Vented, # Pump, Domestic Fireplaces, Number of Pressure Vessel Cap - Sewer 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 Denta] Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well 'Ice Maker . Pump, Sump Utility - Water Dishwasher IIndirect Wastes elay Repair Vacuum Pump Gis;msal IInterceptor "; ouff 'Inlet Water Closet Dal- testic Well Laundry Tray Septic Connection Water Heater Hied, 4" Tile/Res. Lavatory Septic Tank Water Heater New Grains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Grains, Floor Minimum IFee Shower Water Service Grains, IFrench Miscellaneous Equipment Sink Well, Supply Page 3 v. PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY DATE Zoning Electrical Mechanical . , �n /L. d ?. Plumbing Fire Public Works Structural Building Official Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) Miami Shores Village Bond Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) (9 $ Metropolitan Dade County (C.C.F.) $3 , j a $ Sr (¢.005 / sq.ft.) (¢.01 /sq.ft.) (sq.ft. = x/1000 x0.60) REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL 6 c� ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2"° AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com CHECK NO. Security leonine back Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed:12 /2/2002 Applicant: AMY Owner: SALZVERG JOB ADDRESS: 1116 Contractor BRANDON AC Local Phone: Parcel # 1132050270420 NE 92 Mechanical Permit Permit Number: ME2002 -164 Legal Description: BAY LURE s YS_oD S o0 G 3. k■v u 0 Total Fees: Total Receipts: $0.00 Permit Status: Approved Permit Expiration: Work: CHANGE OUT 5 TON A/C SYSTEM BRANDON AIR CONDITIONING SERVICE CORP. 6175 N.W. 167 STREET, G -25 MIAMI, FL 33015 (305) 819 -2669 PAY D TO THE ORDER OF i SunTrust Bank/Miaml, N.A. MIAMI WEST OFFICE 702 MIAMI, FLORIDA 33155 5/31/2003 DATE IPO L L 295 ':066000604': 0 70 200089 5 50 3e SALZVERG AMY ST Contractor's Address: DATE INVOICE AMOUNT n WA y.un? PB 44-63 LOT 3 Construction Value: $5,200.00 GROSS AMOUNT DISCOUNT _202;,x4/,, 11295 63 -60 660 CHECK AMOUNT NP Page 1 of 1 BLK 3 LOT SIZE 75.000 X 125 OR Iections. Re- inspection sd in the application herefor in strict compliance with all lents or specifications that may have been submitted to ch ordinances or if the plans are changed without umes the responsibility for a thorough knowledge of the fications and that he assumes responsibility for work done and regulations pertaining thereto and in strict conformity mit I assume responisibility for all work done by either APPROVED: FEES: PERMIT 3 RADON PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 4 Address /2 t /t' 7 2 / Tax Folio Legal Description Si5a /f p� ,y Owner / Lessee / Tenant �' /�< .. . /1 1 7 Z`''/Z Master Permit # 37/3 4 Owner's Address // //6 ///47 9 ( Phone /• Zz/ST? contracti.: / A k WeaAddress Qualifier ( c/ ( C /C_ SS# Phone 2/ State # #e4C(J3tA nicipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING EEELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION c C%Kd ( 4-/c?./ Lei )/ 2 4 Square Ft. Estimated Cost(value) Lir 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 one in compliance with all applic - =1e laws regulating construction and oning. Furthermore, I authori = the above -named o do the work stated Signature of owner and or Condo o President Date: dZi' y ,c- -v,a �� / .rte:, /d � /�C( Notary as to Owner a id Eores t SEA p' Fie pFI 6 DARBARA ANN FUGAZZI My Commission Expire -4.1? aII r <* COMMISSION NUMBER '' Q CC360191 r "v QU O MY COMMISSION EXP. ** * * * * Q p F\: * ulA . 29 f998 C.C.F. No a,y My db:. . � <±" VI i/ y / $ . . w OQ MY COMMISSION .EXP. * o I* AUG. 1►1998* re of Contra/ or igna Da te' NOTARY er- Builder CenteaaaumaRecs r- Builder * MI A s ti MONTIEL SSION NUMBER CC401261 * ** TOTAL DUE 1 //6 Fire Other Zoning Building Electrical Mechanical Plumbin En ineerin ' � R B K PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) /� y ^ Job Address J/ /4 // 924/ V,,y� Tax Foliof/ _P-4 7 f9 rtIV Legal Description j Of Ay iL Master Permit # j,' )7q5" Owner / Lessee / Tenant Owner's Address / /I& /Vt. V/, , ` "df00 1" phone Contracting Co. )4//f; . _, " end ee. '/ ' �'`� Address 74/(,) /121:2:- c=7. Qualifier �'_ ✓ � �� _' � � `a �� d� �r'' SS# . phone State# (('(% Competency # Csile /997 Ins. Co . Pica, 4 > /Zvi Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING (. CHANICAL ) PAVING FENCE SIGN WORK DESCRIPTION 7 �0'(9E �' /s sAJ� Uc Sib er /e Al/P4v s20 47 )0er ) ir" 16 /� /S 1/ �1 ��> a� r s i 6Y/s!i NF's Rao P6571/61,9)4oAiS • Square Ft. Estimated Cost / 14,50':- -*--- 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. 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. Furthermore, I authorize the above -named contractor to do the work stated. N3 ary a. is Own and /or Condo President My Com1 issi3n Expires: 'At * * * PERMIT FEE: APPROVED: ( C r< �C QMechanica 144 i +c }l /6L 6A Lz66 — e r and /or Condo President Zoning NOTARY PUBLIC. STATE OF FLORIDA. MY COMMISSION EXPIRES: APRIL 26. 1994; BONDED THRU NOTARY PUBLIC UNDERWRITERS. * * Fire Building Signature $$ C ntractor or Owne :.'lder Date s /� / 2_g/ otar My Comm ion Expires: * * * * Other Electrical * uilder * * q 7 441umbing Engineering