MECHANICALdC5 75 fie
BUILDING
PERMIT APPLICATION
FBC 2001
Miami Shores Village
Building D ep artment
RECEIVED
AUG w1 2003
Permit Type (circle): Building Electrical Plumbing
Owner's Name (Fee Simple Titleholder) Rc\ i() A.\ f > r Phone #
Owner's Address '7 3 N• '. 93 `s • 3 v
City �I 1 5 L v-Q S State F L. Zip 5. 2 Jf ✓ v
Tenant/Lessee Name Phone #
Job Address (where the work is being done) 3 3 /v' C. 73
City Miami Shores Village
Is Building Historically Designated YES NO
City t , Vvt / State F
" L
Qualifier M o, lr 1 4 , :� � t f °■
$ Value of Work For this Permit
Number of: Bays Stories Families
Type of Work: ['Addition ['Alteration ❑New
Describe Work:
A� 1 C v Cam,
Permit Fee $
County Escrow Fee $ )
Education/Training Fee $ Tech $
Code Enforcement $ Bond $
Minus Plans Check Fee $ Total Fee Now Due $
Permit No. M e aDo3 ' /too
Master Permit No.
County Miami -Dade Zip 3 ,313 i
Contractor's Company Name G ` `, AI C C C' - Phone # (5c) 6, 61 ` 9 8 Ter
Contractor's Address 7 1 g C S L 4
. c.) 7 3
Zip
?J 3�.�i�
Architect/Engineer's Name (if applicable) - — - Phone #
Architect/Engineer's Address
City '` State Zip
Square Footage Of Work:
Bedrooms
Repair/Replace
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPlicalion Fee. 4 3000 Check
Notary $
Scanning $ Radon $
Struct. $
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Baths
❑ Demolition
(Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
Signature
APPLICATION APPROVED BY:
Chc7// /03
State Certificate or Registration No.
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
Owner or Agent
The foregoing instrument was acknowledged before me this
day of . 200 , b
who is personally kn
agfrico (eV7
/ti /14_
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
NOTARY PUBLIC:
Sign:
Print: A H
Zip
NOTARY PUBLIC:
Sign:
Print:
My Commi
Contractor
The foregoing instrument was acknowledged before me this //
day of 20Q5, by te_o ' 1 -i>
who is perso ly known to me or who has produced
TJLJ O''1 4L has identification and who did take th
" . /COVIS�ION D 084130
�""
PTAES ebrua 2 2006
Plans Examiner
Engineer
Zoning
an oa .
My CommissiUn Expires: 6 .. 2 y -. 2.6 it `
(Certificate of Competency Holder)
Certificate of Competency No.
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
**
•
ITEM
BATH T10
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
i
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE MOUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
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 If
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 If
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS
'"6 -Vt) e1 - f a C sZ 3 r
_
A/C UNIT
STRIP HEATER
6 H' 0 CO "7d .
FIRE SPRINKLER
GENERATORS TRANSFORMERS
'HEATER -NEW INST.
GENERATORS TRANSFORMERS
I
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIM1ING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
..
UTILITY -WATER
FIXTLRES
SEPTIC TANK
ANTENNA '
RELAY
TELEVISION OUTLETS
DRAINFIELD, 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL ,,_.:
DOMESTIC 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 B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
uone item rtegaraing Date Type
SideACT!
- '='='T RR!TTO 33 NE 93RD STREET (MIAMI SHORES 8/11/03
rL1 1 t.rlNniGE OUT
2
3 SUPPLIER: PO#
4 SUPPLIER:
5 SUPPLIER:
6 * * * * *** * * *** * * * * * * * * * * * *MARCOS & JULIO * * * * * * * * * * * * * **
7 LUNCH:
I ft)
1 S�j A- E.
PO#
PO#
8/11/03
8/11/03
8/11/03
8/11/03
8/11/03
8/11/03