1268 NE 93 St (8)MIAMI 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.
Owner's Name and Address ��� - - �'- ,
Registered Architect and /or Engineer
Name and address of licensed contractor
C.
f
Date
, 19
No Street
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done �� /� ��_
State work to be done and purpose of building (by floors) ,
(y AJ
and for no other purpose.
y
New Building f' Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof r <' -
� .- o o E. 6 •
Estimated Total cost of improvements $ �' �, Amount of Permit $ u
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 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 such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks ( Signed) ar-'
1
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 Date Read, Sworn to and Subscribed before me.
Disapproved Date
. \
(Signed) �f
Building Inspector My Commission Expires
Notary Public, State of Florida
PLANNING 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.
STATE OF FLORIDA,
COUNTY OF DADE. ss
Permit No 4
Disapproved
(Signed)
MIAMI 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.
Date- ,'"j' y 19
` �. .. lsa_ ' n
/ � 1
f 4' ..... . . �''- % i
Owner's Name and Address .� /._� :, ._ % _�>1����z� :';� No ../ � � � % Street � ).•-:, -'
Registered Architect and /or Engineer ...... ...... ....__
ri° • �� , ,tom -
Name and address of licensed contractor..,..��
�._..: u /,'"'' ;.. -
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done ` �/.
State work to be done and purpose of building (by floors) : -: ! -2% "-- i
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stones
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ • • � � 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 pennit 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 such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
1 ..
Remarks (Signed).: f—A- -'- / ' /;';
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
Date Read, Sworn to and Subscribed before me.
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.
Date.
Notary Public, State of Florida
Building Inspector / My Commission Expires
PLANNING 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 heen 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.
of
t
or
,
Lot Bl, Subdi-
Lon vision
of Value of Amt. of
Project $ — Permit $ y
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner
Building
Architec
Contrac
or Build
Legal
Descript
Address
Building
I
MIAMI SHORES VILLAGE, FLORIDA
PERMIT IN? 13471
DATE
Work to be performed under this Permit
195
Contractor's
License No
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.
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this /permit I assume responsibility for all work done by either, myself, my agent, setyant or employee.
/
1 ■ ...�►
CONTRACTOR OR BUILDER
Signed: ` " �.BY
INSPECTOR
BY AUTHORITY
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner
Building
Architec
Contrac
or Build
Legal
Descript
Address
Building
I
MIAMI SHORES VILLAGE, FLORIDA
PERMIT IN? 13471
DATE
Work to be performed under this Permit
195
Contractor's
License No
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.
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this /permit I assume responsibility for all work done by either, myself, my agent, setyant or employee.
/
1 ■ ...�►
CONTRACTOR OR BUILDER
Signed: ` " �.BY
INSPECTOR
BY AUTHORITY
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the builii-
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.. - 4 , 19
Owner's Name and Address a: •-_ - - . No 9 �‘ . _ - ---- Street ,
Registered Architect and /or Engineer _
Name and address of licensed contractor ' /_f-ak __ L A,
Location and legal description of lot to be built on:
Lot_ Block Subdivision
Street and Number where work is to be done L2 1'�f' °° t�_ __ _d- e = - •_{�
t fl State work to be done and - purpose of building (by floors)
_____- ___ ___ "____ and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To lie constructed of Kind of foundation Roof Covering__ ! - 2( V /r i -•;
Estimated Total cost of improvements $ - �c n(. 4 Amount of Permit $ 7 e9 6
_Plan Cubage
_Size of "Building Lot
Zone cubage required •
Distance to next nearest building
Maximum live load to be borne by each floor___ . .
I hereby sub it all the plans an specifications for said building. All notices with reference to the building and its construction may
-,r be sent to 6 '� iLf f 1 - E I- `e, y a-( » L
The undersigned applicant for this buildin 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 Gener., " a of Fl ida, Pennanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all con ntractors employed by 1 'm
in the work to be performed under this permit; and will post or cause to be posted fo ec on a :ite of the work such ubli ice
or notices as are required by the Act. The undersigned agrees to employ only sue subco a' ✓ to be perfo this
.
permit, as are licensed by Miami Shores Village. — —
Remarks _- -_ _ _ (Sited) ....
STATE OF FLORIDA,
COUNTY OF DADE. d 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.
16 r
Permit No._____X ✓_ �L Date Read, Sworn to and Subscribed before me.
Disapproved __ _ _.... ,_ Date
(Signed) - x� "' f . t$ " p! A!
Bding Inspector / My Commission Expires_
Chairman -
Member
Member ._
Council Approved
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re- inspection fee of 51.00 will be charged
materials and /or workmanship.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
PLANNING BOARD_
__Date
J065O,Le
to me well known,
Notary Public, State of Florida
DATE
Member
Member
Member -
Disapproved
Date
making corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
•
Date
Legal Description
Owner / Lessee / Tenant
Owner's Address
Contracting Co. S A' l / 4 Address
Qualifier Ora--M/V) %3 1 hen(a ril SS #k
State #0770/0 Municipal #e / w Competency # Ins.Co.6 . a -� `s��'�i% Pf '% t '
Architect /Engineer
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFI Q) PAVING PENCE SIGN
WORK DESCRIPTION V - i.l /If /) . by_oTC1 1601, 1/ 3 , Q < (ter✓'( / .. f ' `;
Estimated Cost(value) B• //0 786. cr,
Square Ft.
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. Furthermore, I
authorize the above -named contractor to do the work stated.
Signature of owner and /or Condo President
Date:
** *
FEES: PERMIT " 06 RADON
APPROVED:
1
/1 AE 9 13vd Tax Folio 11 3 ;O5 00, ;.7 0,. Y-O '
U ' 0 G'O
YYM • AtfitjAid :
��
/c N � 3 � Phone
Job Address
459
OFFICIAL NO'11.11Y 51.
Aiotary as to Owner and/ 'Cd
My Commission Expires: MY_C3IV.1..iiSEIC2:d %2. A:1.12_2t. r,
Address
Mat d .we
Master Permit #0y1.2,
�tr
'73 5? /WI) t /i'je- i;2 J (f
Phone - -6 /
gnature of Contractor or Owner - Builder
ate:
Notary as to Contr ctor er_ W0in'E'Btii'lder
My Commission Expi4'e r p =
tltl 1` :.. IooN , XI'. MAR. 12; cc
* * * * * * * * * * * * * * **
C.C.F. f NOTARY TOTAL DUE . l',l
Fire Other
Zoning Building Electrical
Mechanical Plumbing Engineering
v
•
NOTICE OF COMMENCEMENT
9 3 8 2 Ca 9 7 1 1993 APR 26 15:37
PERMIT NO. TAX FOLIO NO. f -- 2 ` OS o) 7 O °/, �CJ
STATE OF FLORIDA:
COUNTY OF DADE:
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 Notice of Commencement.
1. Legal description of property and street address: %)(rY /Ur `/ 3Y` "Jr 126-2z,
2. Description of improvement: PE
3. Owner(s) name and address: ,IL.9. X0 :1j Ley , _e
Interest in property:
Name and address of fee simple titleholder.
4. Contractor's name and address:
6. Lender's name and address:
( rrc-£L-1 C L f_E v a 5
it, 'l.0 « 410:2 , /l . /S6
5. Surety:(Payment bond required by owner from contractor, if any)
Name and address:
Amount of bond $
/ / //
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be sere 'd:as provided ,
by Section 713.13(1)(a)7., Florida Statutes,
Name and address: , !
'73 7 A-'L4.1 / -n, ( 1
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.
Name and address:
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
different date is spe ified)
Sworn to and subscribed before me this f day of C(/),/ ( ' , 19 7
Notary Public
Print Notary's Name _ , &) ��r r'
My Commission Expires:
0 ; -
Sign 1 tur- Owner T.a, /'r
Prepared by_. r
Fl /t t��
Print •wners Dame A a ( i l V ee J - v t e.
Address /''TL /Lt /Cj ''
/4 Z l , Ai ;'C'.s
j
1230152 2/93
0
CONTRACTOR ,/ / q' 4 L,,',, jT j
vim°
Name . ,hdo ` o,
License No. o/y43/
Q
/976 6 /C /3 jf
//47/,,q ' &
Address
Telephon f y /3ec� 9f Fax
a,,
— r23 -0
Qualifier Name i A /
?------
PROPERTY OWNER
New Construction
Name � n
j
Q
/IA)9.-j `
Address
Home Telephone
Business Telephone
Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'1 Attachment
Other
Add'1 Detachment
Other
Step 1.
Job Address: /'O AJt Sr
Address
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Apt.
Folio Number 1/3 La b 50 �.) 6 a Description of Work
Lot Block WL
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
City
Master Permit No.
•
State
PERMIT APPLICATION
Subsidiary Permit No. b P • O (D • Co
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores 'Village:
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must he 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
3er
Zip
5 / /
Subdivision PB PG l�-� Zoning Linear Feet
Current Use of Property Square Feet Units Floors
Proposed Use of Property Value of Work tr-5 Bldg Value
Tenant Information
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
PERMIT CHANGE (✓ )
ENGINEER
Name
License No.
Address
Telephone
Fax
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 FLORIDA, CO7 OF MIAMI -DADE
Signature of 9ldvner
C/,ey
Print Name
Sworn to and subscribe
SEAL:
Signature of Notary
Personally known
d before me this
day of j Q
MICHAEL IWASKEWYCZ
MY COMMISSION # CC 721000
''-E1 ft8ES'ApiiI 10, 2002
OR, Produced Identification
STATE OF FLORIDA, C�� OF MIAIVII -DADS
Signature of Contr ctor / Qualifier
2 /> j
Print Name
Sworn to and subscribed before me this _( day of
gnature o
SEAL:
PERMIT APPLICATION
Personally known -� OR, Produced Identification
Type of Identification Produced: Type of Identification Produced:
SECTION
BY
D TE
Zoning
ato 62-1
/ 5 /Da.
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
,r - 1/ 1 F —
Page 4
OFFICE USE ONLY
CI IE'C(LIST
❑ 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
Metropolitan Dade County (C.C.F.) $
O PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
O OTHER
(Specify & Attach)
$ �C P
Inspector State Educational Fund $ (0.005 / sq.ft.)
State DCA (Radon) $ (0.01/sq.ft.)
Code Enforcement Fine $
Zoning Review
(sq.ft. = x/1000
x ¢.60)
REVIEWED AND PREPARED BY:
PERMIT APPLICATION
CONDO ASSOCIATION APPROVAL
(Attach)
0 BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $ S- °
ISSUING OFFICIAL
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -_8972 • http : / /www.miamishoresvillage.com
4
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
Disposal
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Domestic Well
Dishwasher
Low -volt, Television
Service, Number of Amps
Drainfield, 4" Tile/Res.
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/Win. 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
Cap - Water
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Cap - Sewer
PLUMBING
TYPE QTY.
TYPE
QTY.
TYPE
QTY.
TYPE QTY.
A/C Condensate
Drains, Roof
Miscellaneous Fixture
Soakage Pit
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 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
Village of Miami Shores
10050 NE 2nd Avenue
Miami Shores, FL 33138
Phone: 305 - 795 -2204
Printed: 1/9/2002
Applicant: HARVEY GLEN
Owner: IVIE
Contractor
Local Phone:
Building Permit
Permit Number: BP2002 -64
Address:
Cellular:
IVIE
HARVEY GLEN
Parcel # 1132050270220 Legal Description: 5 53 42 BAY LURE
Job Address: 1268 NE 93 ST
Fees:
FEE2002 -185
FEE2002 -186
FEE2002 -187
Description Amount
Building Permit Application Fe$60.00
CCF
Notary Fee
Total Fees:
Permit Status: Approved Permit Expiration: 7/8/2002
$0.60
$5.00
$65.60
Construction Value:
Work: EXTERIOR PAINTING AS PER AGREEMENT (ONWER BUILDER PERMIT)
If there is no permit package accessible on the job -site for in
fee is $50.00, which must be paid in advance before calling for
This Permit is granted to the contractor or builder named above to construct the bt
ordinances pertaining thereto and with the understanding that the work will be perforr
and approved by the proper municipal authorities. This Permit may be revoked at an
authorization. A further condition upon which this permit is granted is the understand
ordinances and regulations pertaining to the work covered hereby whether shown on
by his agents, servants or employees.
Signed: (INSPECTOR)
In consideration of the issuance to me of this permit, I agree to perform the work cc
with the plans, drawings, statements or specifications submitted to the proper authori
myself, my agent, servants or employes.
Signed: (Contractor or Builder)
063E
S?I V11Ot1
BY:
PB 44 -63 LOT 10
$850.00
6 // S 31Va
£tts£9c1£9
OL9Z /£1t'9-£9
Page 1 of 1
BLK 2 LOT SIZE 75.000 X
Total Fees: $65.60
Total Receipts: $0.00
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