PLUMBINGBUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electri
Owner's Name (Fee Simple Titleholder)
Owner's Addr9ss 4 S (Y 3 E '72'
City t;,64,14, CD (Q S State L
Tenant/Lessee Name
Job Address (where the work is being done)
City
Miami Shores Villa •e
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Address Z�
City A.) , rn- i- GtASA/I„
Qualifier
Architect/Engineer's Name (if applicable)
Notary $ Training/Education Fee $
Code Enforcement $
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Plumbing
/ ( . y 2 . g
County Miami -Dade
NO X
State f
State Certificate or Registration No.0 s.54 7 ( /
Structural Plan Review. $
Permit No. PL d — 1
Master Permit No. C (( ' /(P Q 4
Zip
Mechanical Roofing
Phone # (309 7 2 ( 7 5 (
i 3
Phone #
Phone #
Zip
Zip 3 311v )
Certificate of Competency No.
$ Value of Work For this Permit 2 1 066' Square Footage Of Work: s
Type of Work: Ly' Additi ❑Alteration New
❑ ❑ Repair/Replace El Demolition
Describe Work: Y V y bi c.t. (,C CQ C (} .Q C fp C ) Qc L L.
cre Submittal Fee $ � Permit Fee $ U : CC CO /CC
Technology Fee $
Scanning $ Radon $ Zoning Bond $
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State 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 a proved and a reinspection fee will be charged.
Signature
Chc 05/13/03
Owner or Agent
APPLICATION APPROVED BY:
My
Signatur Il/ - 4i1.
Contractor
The fore oing instrument was acknowledged before me this The The foregoing instrument was acknowledged before me this esr
day o 20 (Gby ac I C 5 / ?flay of t■l , 20 y 1N u
who is personally known to me or who has produced
( 1)
NOTA Y PUBLIC: � As identi nY and PUBUC who • d STA id TE OF take FL anORIDA oath. as identification and who did take an oath.
1 ∎' I Yo e 1 Y • I'Mandez NOTARY PUBLI
Sign: `7 . Comm ; � I h . Sign:
� scri �% _ __ 7 2009
Print: • Print:
��;.F .•, nc.
My Commi sion Expire Ali
* * * * * * * ** *************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
who is personally known to me or who has produced
1.
I -01) q,upu71111111'' • • nn{ L Papuo
l 1 O Z ` LZ _,� .
::.:etin - 6 11 '4 f `11111111111)
sion d0
************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ****************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
i • - DPlflfl.
‘' Plans Examiner
Engineer
Zoning
Issue Date: 6/1/2005
Owner's Name: RODNEY & FRANCES ROLPH
Permit Type: Imported Permit
Work Classification: Addition /Alteration
Job Address: 453 92 Street NE
Additional Information
Miami Shores Village, FL
Building Department File Copy
Applicant Signature
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Expires: 03/12/2006
Contractor(s)
PRONTO PLUMBING INC
Phone
305 - 892 -2255
Primary Contractor
Yes
Comments:
INSTALL NEW MASTER BATH, ONE SHOWER, TUB, TWO LAVATORIES AND ONE
TOILET
Perm Type: Plumbing
Alpha Four:
Alpha Six:
Pay Amount: 204.35
Bond Return :
Alpha Two:
Alpha Five: Residential
Pay Date: 6/10/2005
Pay Comments: PD CK 3854
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, servants, or
employes. I understand that separate permits are required for ELECTRICAL,
PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING
POOL work.
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. Futhermore, I authorize the above -named contractor to do the work
stated.
Parcel #:
Block:
Section:
Permit Status: APPROVED
Permit Number: PL2005 -166
Phone: (305)762 -6756
1132060140260
Lot:
PB:
Total Square Feet: 0
Total Valuation: $ 2,000.00
Required Inspections
Plumbing
Fees Due
Revision Fee
Total:
Amount
$35.00
$35.00
Invoice Number
imp -1 -06 -23450
Total:
(JAN 3 0 PAID
Amt Due Amt Paid
$35.00 - 00
NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be found in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
BUILDING 1 5 '915
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building
Owner's Name (Fee Simple Titleholder) nik,-0/1,1.A
3 k eriz
City j L4A &U_ Mate ijti Zip
Phone # '-‹
Owner's Address
Tenant/Lessee Name
Job Address (where the work is being done) C
City Miami Shores Village County
Is Building Historically Designated YES
Contractor's Company Name Pf,.� Reit/}'vV/ -Gs
Contractor's Address . 3 00 /1 _
City Mate f C� Zip 3 !�'
Qualifier - - -- if/y_.) - - -- /,
State Certificate or Registration No. _ 5_S l t Certificate of Competency No.
Architect /Engineer's Nanie (if applicable)
$ Value of Work For this Permit
Type of Work: ❑A'ddition Alteration
-
Describe Work:
Submittal Fee
Notary $
Scanning $
Code Enforcement $
Total Fee Now Due $
(Continued on opposite side)
* * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit Fee $
Training /Education Fee $
Radon $
Miami Shores Village
Building Department
10050 N.E.2nd Avenu mi Shores, Florida 33138
Electrical
Structural Plan Review. $
x: (305) 756.8972
Phone #
Permit No.
Master Permit No.
Phone #
Phone #
Square Footage Of Work:
Mechanical Roofing
3D — 25
zip -- 3 3/3
3e - 9, 77 S
❑Ne ❑ Repair /Replace • Demolition
�O r CCF $ CO /CC
4 C Technology Fee $ 4
Zoning Bond $
Bonding Company's Nanie (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State 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.
Signatt
My Commission Expires:
Owner or Agent
The foregoing instrument was acknowledged before me this
day of
who is personally known to me or who has produced
NOTARY PUBLIC:
Sign:
Print:
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** **
APPLICATION APPROVED BY:
Chc 05/13/03
As identification and who did take an oath.
, 20 , by , day of
who is personal
. o -wy . produced
o ►. take an oath.
NOTARY PUBLI
S
My Commissi
known
**e, * * * * * * * * * **
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
t_ d ''2- C •-‘, ' Plans Examiner
Engineer
Zoning
PLU- iING
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.)
ELECTRICAL
MECHANICAL
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
ITEM
BATH TLB
UNIT
j
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKIt FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/ME CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
2
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER I
i
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 I-F
MECHANICAL VENTILATION
SINK, RESIDENCE
MDTCRS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
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 FP
1
VIOLATION
INDIRECT WASTES- (
I
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
(
{
AIR CONDITIONERS
A/C UNIT
(
I
I STRIP HEATER
1
FIRE SPRINKLER
I
I
I GENERATORS TRANSFORMERS
I
HEATER -NEW INST.
(
I
I GENERATORS TRANSFORMERS
I
I
HEATER - REPLACE
I
GENERATORS TRANSFORMERS
I
I
LAWN SPRINKLER -WELL
I
SPECIAL PURPOSE
SWIMMING POOL
OUTLETS COWERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
I
SIGN TIME CLOCK
UTILITY -WATER
FIXTURES
SEPTIC TANK
I ANTENNA
RELAY
TELEVISION CUTLETS
DRAINFIELD, S' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK,
REINSPECTION
SOAKAGE P1T CU. FT.
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
{ t
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
I
^UC PIDIM•
PLU- iING
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.)
ELECTRICAL
MECHANICAL
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: PL2005 -166
Printed: 6/1/2005
Applicant: FRANCES ROLPH
Owner: ROLPH FRANCES
JOB ADDRESS: 453 NE 92 ST
Contractor PRONTO PLUMBING INC
Local Phone: 305 - 892 -2255
Parcel # 1132060140260
Plumbing Permit
Contractor's Address: 12135 NE 11 PL
Page 1 of 1
Legal Description: 6 53 41 MIAMI SHORES SEC 2 PB 10 -37 E1/2 LOT 18 ALL LOTS 19 & 20
Fees: Description Amount
FEE2005 -6994 Building Fee $190.00
FEE2005 -6996 CCF $1.20
FEE2005 -6999 Technology Fee $4.75
FEE2005 -7000 Training and Education Fee $0.40
FEE2005 -7004 Notary Fee $5.00
FEE2005 -7005 Scanning Fee $3.00
Total Fees: $204.35
Total Fees: $204.35
Total Receipts: $0.00
55
Permit Status: APPROVED Permit Expiration: 11/21/2005 Construction Value: $2,000.00
Work: INSTALL NEW MASTER BATH, ONE SHOWER, TUB, TWO LAVATORIES AND ONE TOILET
Signed: (INSPECTOR)
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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
Inspection Number: INSP4
Inspection Date: 02/07/2006
Inspector: Levrack, James
Owner: ROLPH, RODNEY & FRANCES
Job Address: 453 92 Street NE
Miami Shores Village, FL
Project: <NONE>
Contractor: PRONTO PLUMBING INC
Building Department Comments
Monday, February 6, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Ph • " e. (305)795 -2204 Fax: (305)756 -8972
Vtobiii4D
Permit Type: Imported Permit
Inspection Type: Rough
Work Classification: Addition /Alteration
Block:
Phone Number (305)762 -6756
Parcel Number 1132060140260
Lot:
Phone: 305 - 892 -2255
Page 1 of 2
Passed
/ (pep
" ;�
r
omments
)=,...._
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Number: INSP4
Inspection Date: 02/07/2006
Inspector: Levrack, James
Owner: ROLPH, RODNEY & FRANCES
Job Address: 453 92 Street NE
Miami Shores Village, FL
Project: <NONE>
Contractor: PRONTO PLUMBING INC
Building Department Comments
Monday, February 6, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Ph • " e. (305)795 -2204 Fax: (305)756 -8972
Vtobiii4D
Permit Type: Imported Permit
Inspection Type: Rough
Work Classification: Addition /Alteration
Block:
Phone Number (305)762 -6756
Parcel Number 1132060140260
Lot:
Phone: 305 - 892 -2255
Page 1 of 2