1275 NE 93 St (13). 'PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
10050 N.E. 2nd Avenue • Miami Shores, Florida 33138.305- 795 -2204
Date.3'7 Z Job Address a 7.S/' e !a S) Tax Folio
Legal Description Historically Designated: Yes No
Owner /Lessee/Tenet h )-1
Owner's Address / /2 TS ' c= 2 S j Phone
Contracting Co. ". G 7 "" 6 Address 5
Gc�, c
Phone-
State # GA-'o 2s/3/
' ft SION # CC 832514
; EXPIRES: June 25, 2003
.,„84 .d'`, Bonded Thru Notary Public Underwriters
Signa of owner and/or Condo President
Notary as to Ow
My Commission E
FEES: PERMIT 7 ��_ RADON
APPROVED:
Municipal # Competency #
Master Permit #
Ins. Co.
ate Notary as to Contractor or Owner Builder
My Commission Expires
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOT ECTION.
Permit Type (circle one): BUILDING ELECTRICAL ROOFING
WORK DESCRIPTION: 4 (7) S 703/ S / / Z- S q l /J
3 s,e-i � s 7Z ??/
Square Ft. Estimated Cost (value • ( % 2 ) 190
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 ANY 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 all disciplines.
OWNERS 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 sated.
Date Signature of Contractor or Ow >,.:r elder Date
Date
C.C.F 1 ' NOTARY BOND
TOTAL DUE
Zoning Building Electrical
Mechanical .'u• a t ° `�� Plumbing Structural Engineer
UNIT
Tl8
FEE ITEM UNIT
SWIMS CUTLETS
FEE
ITEM • . - • . FEE
SPACE NEATERS . '
A/C (WINO)
':,ScER
-- l!Grf' CUTLETS
IMEMSEINIIIMMMHIMI
RECEPTACLES
SAL
SERVICE TESFt .*RY
A/C (CENTRAL)
:ING FOUNTAIN
SERVICE SIZE IH ASPS
DUCT WCRX
t GRAIN
SERVICE REPAIR/k€TE MAXI
REFRIGERATION
;E TRAP
_' APPLIANCE CUTLETS
PROCESS AND PRESS PIPING
:CEPTCR
1 RA`IGE TOP
1111341G ROM TANKS
(CRY
OVEN
ABOVEGROUND TANKS
NY z
�� WATER HEATER
U.F. PRESSLRE VESSELS
4 ES WASFER
�' IGTCRS 0- 1 FP
STEAM BOILERS • •
ER
-_ MOTORS OVER 1- 3 FP
HOT WATER BOILERS
. POT/3 COMP.
IOTCRS OVER 3- -5 FP
ICNA(I CAL VENTILATION
. RESIOENCE
I POTCRS OVER 5- 8 FP
TRAtSPCRTIbt ASSE'IBLIES
. SLOP
'_ MOTORS OVER 8- 10 FP
ELEVATORS/ESCALATORS
CAARY WATER CLOSET
%0TCRS OVER 10- 25 FP
FIRE SPRINKLER SYSTE}S
a1
_' MOTORS OVER 25-1C0 FP
COOLING TOPERS
IR CLOSET
MGRS OVER 100 FP
VIOLATION
ERECT WASTES
A/C WINDOW
RE I NS?ECT ION
SLFPLY TO:
AIR CONDITIONERS .
•
fC UNIT
1 1 STRIP HEATER
IRE SPRINKLER
GENERATORS TRANSFCRS€€RS
I
EATER -FLEW IFST.
GENERATORS TRANSFCR.I€sS
EATER - REPLACE
-_ CENERATCRS TRAISFCA4ERS
;nN SFR I XLER -7iELL
=_ SPECIAL RSPOSE
f IMANG POOL
• CUTLETS CCt ERCIAL
I
ATER SERVICE
• SIGN TUBES
:R CONNECTIONS
SIGN TRA'SFCR.4fRS
_ITY- SEWER
SIGN TIkE CLOCK
_ITY -WATER
FIXTERES
TIC TAN(
_' ANTENNA
AY
-' TELEVISION CURETS
IN'rIELO. 4' TILE/RES.
'_ VIOLATION
. & 18ANE]ON SEPTIC TANK
'_ REINS?ECTICN
KALE PIT CU. FT.
GI BASIN
CHARGE WELL
ST
A
'F INSET
AR RATER HEATER
tE STANDPIPE
:L PIPING
• • . .
I
IN SPRINKLER SYSTEM
�_ 1
-'
RAND
;ER SET (GAS)
I
i PIPING
__ 1
- '
APPLICATION FOR BUILDING PE ".IT MUST ACCOMPANT THIS ADDENDUM. IF A MASTER PERMIT HAS 3.
AIMED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
0-
PLUMBING
ELECTRICAL
MECHANICAL
The Sunshine State
UCENSE KAMER
K520-901-54-246-0
WALTER A KONG
52811 NW MG LN
MIAMI FL 33055-16116
BIRTH DATE SEX HOT. REST. ENDORSE
07-0644 M 6-07
1141 ISSUED EXPIRES OUFUCATE
•P' 06.11.00 074646 00-26-01
09240033
Opendion al a motor vehicle constitutes consent to any sobriety test required by law.
SAFE DRIVER
APPLICATION FOR BUILDING PERMIT
Application is hereby made for thcI approval of the detailed statc,,,enc ur one plans and specifications herewith submitted for the build •
ine or other structure herein described! This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida. and all provisio',ns 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..._..._... � O .. _ .__ .....__ ........ ,19.
Owner's Name and Address Q 4 -`•' '' S� ..._ _ No.- .._ ... . StreetL7 C 10 _ g 3 `` D
Registered Architect and /or Engineer i
Name and address of licensed contracto
Location and legal description of lot to be built on:
Block Subdivision
It
State work to be done and purpose of building (by floors)
STATE OF FLORIDA,
COUNTY OF DADE. ss •
Chainnan
Mcrr,ber
Member .. ... _....._......_..._.,...._
Council Approved Date
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re- inspection fce of $1.00 w 11 be charged
materials and /or workmanship.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
H,. t•t,tt,.,t,,,a.,
Street and Number where work is to be done 1 1- l'" 3_124-- ` � L ._ .
and for no other purpose.
New Bui!ding Remodeling Addition l/ Repairs No. of Stories `').----•
1
To be constructed of ( Kind of foundation R vering
Estimated_Total cost of improvements 1 $..�J 0 0 Amount of Permit S. t
I
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 nndispecifications 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, Pennanent Sup clement,
and h,is complied with the rovisionsithereof, and will require similar compliance from all contractors or sub - contractors employed by hips
in the work to be performed under this permit; and will post or cause to b osted for inspection on the site of•the _ ic notice
or noticcs as arc required by the Act. The undersigned agrees to employ on ch subcontractors, on wo ' • rforme • u . • er this
pcnnit, as are licensed by Miami Shores Village.
Remarks __._-__ (Signed) _
i
.Before me, the undersigned authi p ity, 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, hat he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated e.. 1 '
Permit No.. " 1 Date (e j ! t Read, Sworn to and Subscribed before me.
Disapproved Date
(Signed)
Building Inspector
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Member
Member
Member ...._
Disapproved Date
ri
( _7 I 1 3 3/ ��s
to me well known,
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