402 NE 93 St (8)®
CLOiETB
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS{
LAUNDRY
TUBE
UR
CATCH
BABIN
FLOOR
DRAIN
DRINKING
FOUNT' NB
TOTAL
FIXTURE6
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
• 0
� � �
` --
CHECK
_
^
-
Permit N
Street
State work to be performed and purpose of building (By Floore) _______ _,A4X_
New Building ___._ --- Remodeling------ -....- -- -___ _ Additior__•- -- -._` Repairs .
Employing Plumber's Name No._
Location and Legal Description Lot
Street and Number where work is to be performed —No
Amount of Permit $
STATE OF FLORIDA, 1
COUNTY OF DADE. j
MIAMI SHOR[;S VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR FLUMBING PERMIT
lick
Street__
(Oigned) �%
Dat
Application is hereby made for the approval of the detailed statement of fle plans and specifications herewith submitte for the building 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 Misr ii Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address
Subdivision____ __________
c 6
No. of Stories. .... ............. .......
e/
Size Septic Tank Type of Tank_____
Feet of Drain Tile____.__ ........... - -- -_- .... ___-__.-_Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well._____ _.--_- __- ______- ___________ She of Soakage Pit
Capacity Gals
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that lie 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 com-
plied 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 sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
My Commission Expires Notary Public, State of Florida
Master Plumber.
NOTE: A re- inspection fee of $$1.00 will be made when st ch re•insix etion is made' necessary by improper notice for inspection, or faulty
materials and /or workmanship.
[27
Amount of Permit $____
STATE OF FLORIDA, t
COUNTY OF DADE.
SS.
)
Permit No. t
Application is hereby made for the approval of the detailed statement of the
structure herein described. This application is made in compliance and confor
and all provisions of the Laws of the State of Florida, all ordinances of Miami
of Miami Shores Village shall be complied with, whether herein specified or
building during progress of work.
MIAMI SHORE; VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
, r
Street and Number where work is to be performed—No
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition
Size Septic Tank
Feet of DraM Tile ./ „
Date \ 7 .•*• - . C';
plans and specifications herewith submitted for the building or other
pity with the Building Ordinance of Miami Shores Village, Florida,
Shores Village and all rules and regulations of the Building Division
not. A copy of approved plans and specifications must be kept at
Owner's Name and Address • 7 No.
Registered Architect and/or Engineer_
Employing Plumber's Name 1 No
Location and Legal Description Lot Blot k Subdivision
Repairs
Type of Tank__
Dist. Feet of Tank or Drain I ield from Well.
00
Nature of Water Supply: City—We — Sizt of Soakage Pit
Street
Capacity Gals.
----- ------ ----
Street
Street
No. of Stories
( S .gned )
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify t hat he mhderstands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Comp led General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from :11 contractors or sub-contractors employed by him in the work to he
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 sub-c mtractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
( igned )
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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 fore l. oing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re-inspection fee of $1.00 will be made when such re-inspi ction is made necessary by improper notice for inspection, or faulty
materials and/or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOU NT• NS
At s k
TOTAL
FIXTURES
CONTR.
LIST
"2.
../
(
,..-.
,
,
i
t
CHECK
2 0
1
—
c c'
I
'-- •':
1 '.rf
/.--, 3
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW I M 'G
POOL
1..Y0
CONTR.
LIST
.
..;
CHECK
.-
[27
Amount of Permit $____
STATE OF FLORIDA, t
COUNTY OF DADE.
SS.
)
Permit No. t
Application is hereby made for the approval of the detailed statement of the
structure herein described. This application is made in compliance and confor
and all provisions of the Laws of the State of Florida, all ordinances of Miami
of Miami Shores Village shall be complied with, whether herein specified or
building during progress of work.
MIAMI SHORE; VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
, r
Street and Number where work is to be performed—No
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition
Size Septic Tank
Feet of DraM Tile ./ „
Date \ 7 .•*• - . C';
plans and specifications herewith submitted for the building or other
pity with the Building Ordinance of Miami Shores Village, Florida,
Shores Village and all rules and regulations of the Building Division
not. A copy of approved plans and specifications must be kept at
Owner's Name and Address • 7 No.
Registered Architect and/or Engineer_
Employing Plumber's Name 1 No
Location and Legal Description Lot Blot k Subdivision
Repairs
Type of Tank__
Dist. Feet of Tank or Drain I ield from Well.
00
Nature of Water Supply: City—We — Sizt of Soakage Pit
Street
Capacity Gals.
----- ------ ----
Street
Street
No. of Stories
( S .gned )
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify t hat he mhderstands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Comp led General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from :11 contractors or sub-contractors employed by him in the work to he
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 sub-c mtractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
( igned )
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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 fore l. oing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re-inspection fee of $1.00 will be made when such re-inspi ction is made necessary by improper notice for inspection, or faulty
materials and/or workmanship.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of -�
Building
Address of
Building
n
MIAMI SHORES VILLAGE, FLORIDA
DATR
PERMIT N? 11164
n Work to be performed under this Permit
Architect
"ontractor
or Builder. . :j a� �' • j _ i ,.� ; • 4"_ i
Legal Lot I Bi.
Description 1 t
) N4AC O OR BUILDER
S, tbdi .
t ision `\
' •
VI due of
PrDject $
i
' :L. 1 s
r
This permit is granted to the contractor or builder named above to construct he building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the un lerstanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approver 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 ch inged 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 i1. the statements or specifications and that! tt: es responsibility for work
done by his agents, servants or employees. r'
� }
Signed ' " � , ,, .. 'Li BY ; '.1
k
SPE
In consideration of the issuance to me of this permit I agree to erform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or si ecifications submitted to the proper authorities of Miami Shores Village.
l accepting this permit I assume responsibility for all work done by ether, myself my agent, servant or employee.
Contractor's
License No
Amt, of ' # , -
Permit
BY AUTHORITY
1 95
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR ' LUMBING PERMIT
/emit No. -. ..._
��� - -- -- Date
Application is hereby made for the approval of the detailed statement of he plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and con:'ormity 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 work.
Corner's Name and Address - ! % f / _ / '{ / / - / -_- - - - -- -- -- -- •---- .------ .- - - - - --
Registered Architect and /or Engine
Employing Plumber's Name - Street.
Location and Legal Description _ B. ock Subdivision
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)_4 4.
New $uilding____.-- _- .- _.-- ..... -. Remodeling_-_ -_ - Addition Repairs No. of Stories
Amount of Permit $-
STATE OF FLORIDA, }
COUNTY OF DADE.
(S. Strad)._
Str
Street
7
Size Septic Tank
Feet of Drain Tile_ f r- list. eet o ank or Drain :Field from Well
Nature of Water Supply: City — Well.-----_---_-- .-- .- .._. ..... of Soakage Pit
Capacity Gals
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Comp'_•led General Laws of Florida Pennanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from a ll 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 sub - contractors, on work to be performed under this permit, as are
lid by Miami Shores Village.
My Commission Expires Notary Public, State of Florida
_1
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized '.o administer oaths and take acknowledgments, personally appeared
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 foregt ing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLoorrei
OATH
TUBS
SHOWERS
LAVA•
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
LICr
.11.1gC:S
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IN •G
POOL
C6RiTW.
tin
CHECK
CHECK
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR ' LUMBING PERMIT
/emit No. -. ..._
��� - -- -- Date
Application is hereby made for the approval of the detailed statement of he plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and con:'ormity 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 work.
Corner's Name and Address - ! % f / _ / '{ / / - / -_- - - - -- -- -- -- •---- .------ .- - - - - --
Registered Architect and /or Engine
Employing Plumber's Name - Street.
Location and Legal Description _ B. ock Subdivision
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors)_4 4.
New $uilding____.-- _- .- _.-- ..... -. Remodeling_-_ -_ - Addition Repairs No. of Stories
Amount of Permit $-
STATE OF FLORIDA, }
COUNTY OF DADE.
(S. Strad)._
Str
Street
7
Size Septic Tank
Feet of Drain Tile_ f r- list. eet o ank or Drain :Field from Well
Nature of Water Supply: City — Well.-----_---_-- .-- .- .._. ..... of Soakage Pit
Capacity Gals
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Comp'_•led General Laws of Florida Pennanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from a ll 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 sub - contractors, on work to be performed under this permit, as are
lid by Miami Shores Village.
My Commission Expires Notary Public, State of Florida
_1
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized '.o administer oaths and take acknowledgments, personally appeared
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 foregt ing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
lUILDING
LECTRICAL
'LUMBING
)wner of
3uilding
u chitect - --
-: ontractor
nr Builder
.egal Lot B�
Description
=iddress of ,.Ar
; uilding_ _
This permit is granted to the contractor or builder named above to construct t
,ation herefor in strict compliance with all ordinances pertaining thereto and with th(
clans, drawings, statements or specifications that may have been submitted to and ap
t any time if the work is not done in compliance with such ordinances or if the plan
.ermit is granted is the understanding that the contractor or builder named above as
egulations pertaining to the work covered hereby whether shown on the plans or d,
ibility for work done by his agents, servants or employees.
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT ■2 4339
Work to be performed under this Permit
Sul: di-
visi >n
Val ie of
Pro:ect
DATE
Contractor's
License No.
Amt. of
Permit
194
le building or to install the equipment or device described in the appli-
understanding that the work will be performed in compliance with an
iroved by the proper m authorities. This Permit may be revok
are changed without authorization. A further condition upon which is
;times the responsibility for a thorough knowledge of the ordinances d
awings or in the statements or specifications and that he assaw. re on-
,
1 Y AUTHORITY
Signed: By
INSPOR
•
In consideration of the issuance to me of this permit I agree to perform the w irk covered hereunder in compliance with all ordinances and regulations
)ertaining thereto and in strict conformity with the plans, drawings, statements or pecifications submitted to the proper authorities of Miami Shores Village.
n accepting this permit I assume responsibility for all work done by either myself, n y agent, servant or employee.
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 tc: 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 F 2OM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIFMENT 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 fron- 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 instz.11ation 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 fie 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 th.: 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, Pt 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.
ST T FLORID O Y OF MI y I DARE STATE O1 ORI , ' O 7FMIAMIDADE
9 r
Signature of Owner
Print Name ' 7)�,,
Sjo and subscribed before me this ' of DZ��
..l1 ,17U�
B Lit
Signs e t1ir - Gc -,State of Florida
SEAL:
2
111
ter Ae
�� Fly
LESTER ER E. CROCKErT
MY C *IM SSION # DD 014762
EXPIRES: May 20, 2005
Bonded lin Budget Notary Services
Personally known OR, Produced Identification
Type of Identification Produced:
Sil;aCctorTalifier —
�L� E koC,/'L -
Print Name
S and subscribed before me this /
Avit
1.A _ �.
nature of Pry Public - tate of ' on
SEAL:
` 4: re,
!, f , l
PERMIT APPLICATION
Per O y � Old; Prod ced Identification
c. te e• ._.� . ,y
Type of Identification4Produced:
PROPERTY OWNER
New Construction
Name e/✓LV
al,-)71„
Address
$ ca. A
'935
Home Telephonee T ^7 . S1 1 j'D
J [/
Business Telephone
Fax
ENGINEER
New Construction
_
Name
. i �
, A .
License No.
Repair
Address
Demolish
Telephone
Relocation of Structure
Fax
Foundation Only
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.
Step 2.
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.
Job Address:
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
Folio Number 1/
Lot / 1, / - Block 3
Subdivision /4//111n/ 9/00Z PB PG Zoning Linear Feet
Current Use of Property R CS /DtWee- Square Feet
Proposed Use of Property XZ 1( Value of Work 42 0 0 • 00
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Address Apt.
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
PERMIT CHANGE (✓ )
ARCHITECT
Name
License No.
Address
Telephone
Fax
Description of Work
l
City
PERMIT APPLICATION
Master Permit No. -5 0 / 3 ,
Subsidiary Permit No.
Flood Zone
State Zip
Pza-e-e-
Units Floors
Bldg Value
Tax Assessed/Appraised Value
Base Floor Elev.
CONTRACTO
License No.
Address
Telephone
Qualifier Name
PAY
TO THE
ORDER OF
FOR
lt�)
LLOYD NORTH DADE SEPTIC
750 NW 107TH ST.
MIAMI, R. 33168
V,_g_
c-21 ( 044S
Washington Mutual
Washington Mutual Bank, FA
North Miami/7th Avenue Financial Center 1746
12600 NW. 7 Avenue 1.800- 788 -7000
North Miami_ Ft iA168 44 hmu Custmier Senna
,,, r+c gas, „c ,,,Msb3 +3��Z
u'00 2 L04u' 1:26 7084 L 3 LI: L9 3111 200 9 2 3111 E0'
DATE
-d/
DOLLARS
210.
63- 8413/267
6
ELECTRICAL
TI'1'E
Minimum Fee
QTY.
'TYPE
Dryer
QTY. TYPE.
Outlet, Appliance
QTY.
TYPE
Service Repair
QTY.
A/C Central 1 -3 Ton
A/C Central, Tons
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
1 Posts
Gas - Propane
Swim Pool, Commercial
Pump, Re- circulate
Air Conditioners
Temporary Water Closet
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Pump, Replace - Pool
Generators, etc.
Receptacles
Dental Chair
Switchboards
Grease Trap
_Chiller
Clear Violations
Pump, Sprinkler
Pump, Sump
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Dishwasher
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Interceptor
hoof Inlet
Demolition
Low -volt, Intercom/Teleph.
f
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
f
Service, Number of Amps
Water Heater New
Water Re -pipe
Water Service
MECHANICAL
TY
Minimum Fee
QTY.
TYPE
Condensate Drain
QTY.
TYPE
Generator
QTY.
TYI'I':
Refrigeration, Tons
QTY.
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wallin. 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
Supply, AC Well
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Temporary Toilet
PLUMBING
TYPE:
A/C Condensate
QTY
TYPE
Drains, Roof
QTY
'TY
Miscellaneous Fixture
Q
TYPE
Soakage Pit
TI
Bath Tub
Drinking Fountain
:Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
:'ump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
:'ump, 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
Pump, Sump
Utility - Sewer
Utility - Water
Discharge Well
Ice Maker
Dishwasher
Indirect Wastes
1lelay Repair
Vacuum Pump
Water Closet
Disposal
Interceptor
hoof Inlet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Meter Set (Gas)
Septic Tank
Sewer Connection
Water Heater New
Water Re -pipe
Water Service
Drains, Area
Drains, Floor
Minimum Fee
Shower
Drains, French
Miscellaneous Equipment
S nk
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:
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.)
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)
‘
o
(sq.ft. = x/1000
x0.60)
$ (¢.005 / sq.ft.)
$ (¢.01 /sq.ft.)
�1 vV
REVIEWED AND PREPARED BY:
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
DATE
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
TOTAL $ 3,14 4
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